Prostate Cancer Screening Process Demystified: A Step-by-Step Guide
While mammograms and cervical screenings receive widespread attention, prostate cancer checks remain significantly under-discussed in public health conversations. With Prostate Cancer Awareness Month approaching in March, understanding the screening process becomes crucial for men's health awareness.
Current Screening Landscape in the UK
Mr Wissam Abou-Chedid, consultant urological and robotic surgeon at Nuffield Health in Woking, Guildford, and Parkside in London, clarifies the current situation: "As it stands in the UK, there's no national screening programme for prostate cancer, but any male patient above the age of 50 can go to their GP and ask to have a PSA check, as well as any man above the age of 45 who has a family history of prostate cancer."
This means proactive individuals must initiate the conversation with their healthcare providers rather than waiting for automatic invitations that exist for other cancer screenings.
Understanding Prostate Cancer Risk Factors
Several factors significantly influence prostate cancer risk, making certain populations more vulnerable:
- Race and Ethnicity: "Race is an important risk factor, as we know that Afro Caribbean men are at an increased risk. Prostate cancer affects one in four Afro Caribbean men in their lifespan, one in eight Caucasian men, and one in 13 Asian men," explains Abou-Chedid.
- Family History: Individuals with fathers, brothers, cousins, or uncles who have had prostate cancer face elevated risk.
- Genetic Factors: Patients with BRCA1 or BRCA2 gene mutations have increased susceptibility.
- Age: Prostate cancer predominantly affects men over 50, with diagnosis peaking between ages 70 and 74 according to Prostate Cancer UK.
The Initial GP Consultation: What to Expect
When approaching your GP with prostate cancer concerns, Abou-Chedid outlines the typical process: "When you see a GP and tell them that you're worried about prostate cancer, they're going to ask you a few questions. Firstly, they will ask about your risk factors – so will look at your age, race and will ask you about your family history – and then they will talk to you about the PSA test."
Healthcare providers must explain both benefits and limitations: "They should explain the pros and cons of it to help you decide whether it's something you want to have or not. For example, a pro of the PSA test is that it can lead to early detection of prostate cancer and a con is that it can sometimes lead to anxiety or over-diagnosis – which means detecting a prostate cancer that is insignificant and that wouldn't have required any treatment."
The PSA Test: Procedure and Preparation
The prostate-specific antigen (PSA) test measures protein levels in blood that may indicate prostate abnormalities. Conducted at hospitals or GP practices by medical professionals, this simple blood test requires specific preparation to ensure accuracy.
Abou-Chedid emphasizes: "PSA is not a tumour marker, so it can be elevated due to a number of things such as ejaculation. So, if you ejaculate within 48 hours of the test, it can artificially bring the PSA up by up to 20 per cent so it's important to abstain from ejaculating within 48 hours."
Additional factors affecting PSA levels include:
- Horse riding or prolonged cycling before testing
- Any activity causing pelvic area stress
- Urinary tract infections causing temporary PSA elevation
Screening Without Symptoms: A Preventive Approach
Contrary to common belief, symptoms aren't necessary for requesting screening. Abou-Chedid clarifies: "Prostate cancer at the very early stages up to the late stages is completely asymptomatic, so you don't need to have symptoms to request for a PSA test. Generally, when you do get symptoms such as bone pain, that usually means the prostate cancer has already spread into your bones."
Post-Test Procedures and Next Steps
Following an elevated PSA result, a structured diagnostic pathway unfolds:
- Repeat Testing: Initial elevated PSA requires confirmation through a second test weeks later.
- MRI Referral: Consistently high PSA levels prompt referral to NHS Trust for MRI scanning to identify suspicious prostate areas.
- Biopsy Consideration: "If such areas are detected, that's when we offer patients biopsies," explains Abou-Chedid.
- Results and Treatment Planning: Biopsy results within 7-10 days determine whether cancer requires immediate treatment or active surveillance through regular PSA checks and MRIs.
Digital Rectal Examination: Changing Protocols
The British Association of Urological Surgeons (BAUS) now advises against routine digital rectal exams (DREs) during initial screening. Abou-Chedid explains this shift: "There is a subset of prostate cancer where patients have a normal PSA, but there is prostate cancer that is detected during DRE. One of the reasons why we're trying to move away from this is because a lot of patients have said that they don't go to see their GPs about prostate cancer because they've been told about this harrowing experience of having a finger inserted up the bum, so don't ask for a PSA because they don't want to go through that experience."
Current recommendations prioritize PSA testing first, with DRE reserved for cases showing strong clinical suspicion after initial assessment.
