Why it is wrong to ignore prostate cancer screening
Prostate cancer sits behind lung cancer as the second leading cause of cancer death for men, affects one in seven men, and kills as many men as breast cancer kills women. Like bowel and breast cancer, its progression is linear. Catch it early, and your chance of surviving is greater than 95%.
Why are more men presenting with stage 4, the very worst form of prostate cancer? Because the disease is not found early enough.
PSA, or prostate-specific antigen, is a protein produced in the prostate gland that helps liquefy semen. A certain amount leaks into the circulation and can be detected with a blood test. That amount can increase if the gland enlarges, as it does when we age, or if the architecture of the gland is disrupted, as in cancer.
What does your PSA reading mean?
A PSA reading on its own is of limited value, but sequential readings every year can be used to calculate the velocity of change, a useful warning sign. Moreover, if we know the size of the prostate, measured with an ultrasound or MRI scan, we can calculate the PSA density, which can again enable us to calculate risk. For example, a PSA of 8 in an 80 ml prostate gland is normal, and a PSA of 3 in a 30 ml prostate gland is normal. However, a PSA of 8 in a 30 ml prostate is definitely abnormal.
A high PSA, high PSA density, or PSA velocity may raise concern. If PSA is a concern then an MRI scan, costing about £650, can identify abnormal areas of the prostate or provide reassurance. In addition, a blood test called a Stockholm 3 test, costing £350, is a polygenic risk marker that can again predict your risk.
A biopsy may then be advised. We have moved on from the prostate biopsy done through the rectum, which was associated with a high risk of complications, especially infection, to a transperineal biopsy through the skin between the anus and the scrotum, which is safer, less unpleasant, and targeted at any abnormal areas noticed on the MRI scan.
What if the biopsy confirms prostate cancer?
Cancers are graded according to their severity and their stage of spread. Not all cancers need treating, and for those that do, the modern treatments are much more effective at minimising side effects.
The decision not to instigate a national screening program for prostate cancer, in my opinion, is a travesty and is based on outdated assumptions and without consideration of the advances, effectiveness, and risk reductions with screening and treatments. I don’t know a male doctor who doesn’t have his PSA done regularly. I recommend starting by age 50 at the latest.
A PSA checkup with Wessex Private GP costs £185 and can be booked with the following link. I truly think it’s worth having the discussion. Why wouldn’t you?
WPGP – we’re here for you.
About the author
Dr Charles Middle
Dr Charles Middle is a highly experienced GP and founder of Wessex Private GP. His special interests include orthopaedic medicine, minor surgery, mental health and adolescent medicine, and he holds a Diploma in Sports Medicine.
This post has been written or personally reviewed by Dr Middle.
