Recent news about Sir Chris Hoy’s prostate cancer diagnosis has understandably prompted many men to think about their own prostate health. His openness has helped raise awareness of a disease that affects thousands of men every year. Alongside Sir Chris, broadcaster and presenter Stephen Fry has also spoken publicly about his experience with prostate cancer, helping to encourage conversations about early detection and treatment.
As a doctor with a particular interest in men’s health, I would like to share some information about the prostate, the symptoms of prostate cancer, and the options available at Courtfield Private Practice.
What is the Prostate?
The prostate is a small gland, roughly the size of a walnut, found only in men. It sits below the bladder and surrounds the urethra – the tube that carries urine from the bladder through the penis.
Its main role is to produce some of the fluid that mixes with sperm to form semen, helping to nourish and transport sperm during ejaculation.
Prostate cancer is now the most common cancer in men in the UK. Around 1 in 8 men will be diagnosed with prostate cancer during their lifetime, with more than 50,000 new cases diagnosed each year.
Is There a Screening Programme for Prostate Cancer?
Unlike breast, bowel and cervical cancer, there is currently no national screening programme for prostate cancer in the UK.
The main test available is the PSA (Prostate Specific Antigen) blood test. Men aged 50 and over can request a PSA test from their GP, even if they have no symptoms. Men who are considered at higher risk may wish to discuss testing at an earlier age.
The PSA test measures the level of a protein produced by the prostate gland. Elevated levels can sometimes indicate prostate cancer, although there are several other causes of a raised PSA, including benign prostate enlargement, infection and inflammation.
While not a perfect test, PSA remains the best initial screening tool currently available.
Who Is at Increased Risk of Prostate Cancer?
Your risk of developing prostate cancer is higher if:
- You are aged 50 or over.
- You have a father, brother or son who has had prostate cancer.
- There is a strong family history of prostate, breast or ovarian cancer.
- You are of Black African or Black Caribbean heritage.
Men of Black African and Black Caribbean backgrounds have approximately double the risk of developing prostate cancer compared with White men and are more likely to develop it at a younger age. For this reason, many experts recommend discussing PSA testing from the age of 45 rather than waiting until 50.
What Are the Symptoms of Prostate Cancer?
In its early stages, prostate cancer often causes no symptoms at all. This is one of the reasons why discussions around PSA testing are so important.
When symptoms do occur, they may include:
- Needing to pass urine more frequently, particularly at night.
- A weaker urine flow than previously.
- Difficulty starting urination.
- A feeling of not completely emptying the bladder.
- Sudden urgency to pass urine.
- Erectile difficulties.
- Blood in the urine or semen.
Importantly, these symptoms do not necessarily mean you have prostate cancer. In fact, they are often caused by benign enlargement of the prostate, which becomes increasingly common with age.
The prostate naturally enlarges over time and, because the urethra passes directly through the centre of the gland, this enlargement can partially obstruct urine flow and produce many of the symptoms listed above.
What Are the Benefits and Risks of PSA Testing?
Like any screening test, PSA testing has both advantages and limitations.
Benefits
- It may detect prostate cancer before symptoms develop.
- Early diagnosis often means more treatment options are available.
- Prostate cancer identified at an early stage is generally easier to treat successfully.
- Regular testing can help identify concerning changes in PSA levels over time.
Limitations and Risks
- PSA is not specific to prostate cancer and may be raised for several non-cancerous reasons.
- Some men with prostate cancer may have a normal PSA result.
- A raised PSA can lead to additional investigations, such as MRI scans or biopsies, which may ultimately show no cancer.
- Screening may detect very slow-growing cancers that would never have caused symptoms or shortened life expectancy, potentially leading to unnecessary treatment.
For these reasons, PSA testing should ideally be considered as part of an informed discussion with your doctor, taking into account your age, family history, ethnicity and individual concerns.
How Do We Test for Prostate Cancer?
The initial test is a simple PSA blood test. Results are usually available within 24 hours.
If the result is elevated, this does not automatically mean cancer is present. Further assessment is often required to determine the cause.
Should I Have a PSA Test?
The decision is a personal one.
However, we would particularly encourage discussion about PSA testing if:
- You are aged 50 or over.
- You are aged 45 or over and of Black African or Black Caribbean heritage.
- You have a family history of prostate cancer.
- You have urinary symptoms or other concerns.
Do I Need a Rectal Examination?
The short answer is no.
Historically, a digital rectal examination (DRE) was routinely recommended alongside PSA testing. This involves a doctor gently examining the prostate through the rectum using a gloved finger.
More recent guidance suggests that PSA testing alone is usually sufficient as an initial assessment, as it is uncommon to detect a significant prostate abnormality on examination when the PSA is completely normal.
That said, at Courtfield Private Practice, we still believe there can be value in a rectal examination for selected patients, as it provides additional information and allows assessment for other rectal conditions. The decision is entirely optional and can be discussed during your consultation.
Preparing for a PSA Test
To help ensure the most accurate result:
- Avoid ejaculation for 48 hours before the test.
- Avoid long-distance cycling for a couple of days beforehand.
- Ensure any urinary symptoms or infections are discussed with your doctor.
You do not need to fast before the blood test.
How Often Should PSA Testing Be Performed?
If your PSA level is normal and there are no concerning symptoms, annual testing is often a sensible approach.
The trend in PSA levels can be just as important as the absolute number. A significant rise compared with previous years may warrant further investigation, even if the result remains within the normal range.
What Happens if My PSA Is Raised?
The first step is often to repeat the blood test and exclude common causes of a temporary PSA rise, such as infection or inflammation.
If PSA levels remain elevated, the next stage is usually a prostate MRI scan. This is a painless imaging test that provides detailed pictures of the prostate without using radiation.
You may also be referred to a urologist, a specialist in conditions affecting the urinary tract and prostate, to discuss whether any further investigations are required.
Prostate Cancer Testing at Courtfield Private Practice
We offer two main options:
- Book a consultation to discuss your individual risk factors, symptoms and concerns. If appropriate, a PSA blood test can be performed during the appointment, with results typically available the following day.
- Our full male health check includes an in-depth consultation, extensive blood testing and additional cancer screening, including PSA testing where appropriate.
For further information, please visit our website or contact the practice directly.
