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Insight

PSA testing for prostate cancer only works if cases are correctly referred

Emma Kendall
01/12/2021
In the UK, prostate cancer is the most commonly diagnosed cancer in men over the age of 65, with one in eight men likely to be diagnosed with this cancer during their lifetime.

While survival has increased substantially over the past 40 years, prostate cancer remains the second highest cause of male cancer deaths in both the UK and USA.

A key barrier to early detection is that many men with early stage disease do not experience any symptoms, which is where PSA testing can be crucial.

Men are more likely to develop prostate cancer if:

  • They have a family history of a first degree relative developing prostate cancer at a young age;
  • They are of Afro-Caribbean descent;
  • They have a BRCA gene mutation.

Typically, prostate cancer is slow growing and early detection can result in an excellent prognosis. Many men with low risk and early stage prostate cancer can be managed by careful observation and repeat biopsy ('active surveillance') rather than urgent radical treatment.  Conversely, men with more aggressive or advanced disease usually require radical treatment because the disease is a significant threat to their life.

What is the PSA test?

The PSA (Prostate Specific Antigen) test is a simple blood test routinely performed in the primary care setting. An elevated PSA level can be indicative of prostate cancer and may prompt a referral to a specialist. Once referred, the patient will usually be biopsied and this will lead to a diagnosis.

Why is the PSA test controversial?

The test is said to have both pros and cons, particularly when used as a screening tool in asymptomatic men. The main concern is that patients can have a slightly elevated PSA for other reasons, such as recent ejaculation, heavy exercise or urinary tract infection. There is a risk that patients with borderline PSA might be referred and then 'over treated' when not strictly necessary.

It is therefore important that asymptomatic men are counselled about the risks and benefits of screening so that they can make an informed choice. Men exhibiting symptoms or with a specific risk factor are encouraged to take up screening.

Unfortunately, some men who do take up screening are not correctly referred. This could be for a number of reasons, such as their GP negligently failing to monitor or act on a rising PSA.

I represent clients who have sadly found themselves in this position, and whose cancer could have been detected much earlier. In one case, my client had a significantly raised (and steadily rising) PSA on three successive occasions over an eight-month period. He should have been referred, diagnosed and undergone curative treatment. Instead, his results 'slipped through the net' and his PSA monitoring was discontinued. It was not until a significant time later (when symptoms began to emerge) that he was diagnosed with advanced prostate cancer. By then it was too late, and his GP's errors tragically cost my client his life.

Find out more about prostate cancer misdiagnosis claims.

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