Smart screening for prostate cancer

One of the most common cancers in men is prostate cancer. Early detection offers the best chance of successful treatment, but widespread screening remains a complex issue due to the risks of overdiagnosis and unnecessary treatment. Smart screening refers to a more targeted, informed approach - using available tools like the PSA test alongside patient-specific risk factors to decide who should be tested and when.

Understanding PSA

The prostate-specific antigen (PSA) test is a blood test that measures the level of PSA, a protein produced by the prostate gland. Elevated PSA levels can suggest the presence of prostate cancer, but they can also be raised in other conditions such as benign prostatic hyperplasia (BPH) or prostatitis.

Although the PSA test can detect cancer early, it is not a definitive diagnostic tool. Some slow-growing prostate cancers detected through PSA testing may never cause symptoms or harm, leading to overdiagnosis. On the other hand, not all prostate cancers raise PSA levels, meaning some cases may be missed. For this reason, PSA testing must be interpreted in context, ideally as part of a smart screening strategy.

Who should be screened

Men can request a PSA test from their GP after discussing the potential benefits and risks. Smart screening involves assessing individual risk rather than applying the test broadly to all men.

Men considering a PSA test should have a clear discussion with their healthcare provider about:

• Their age and general health
• Any urinary symptoms they may be experiencing
• Family history of prostate or other cancers
• The possible outcomes of testing and treatment

In many cases, smart screening begins with a baseline PSA test in the early 50s to help guide future monitoring.

Which groups are at high risk from prostate cancer?

Certain groups of men are at higher risk of developing prostate cancer. These individuals may benefit from earlier and more frequent screening.

High-risk groups include:

• Older men: Risk increases significantly with age. Most prostate cancers are diagnosed in men over 65. However, screening discussions may start from age 50, or earlier in those at higher risk.
• Men with a family history: Having a father or brother with prostate cancer doubles a man's risk. The risk is even higher if multiple relatives are affected or if they were diagnosed at a younger age.
• Black men: Men of African or Caribbean descent are more likely to develop prostate cancer and at a younger age.
• Men with certain genetic conditions: Inherited mutations such as BRCA1 or BRCA2, which are better known for their role in breast cancer, can also increase prostate cancer risk.

What does smart screening look like in practice?

Smart screening combines PSA testing with individual risk assessment and, when needed, further diagnostic tools such as:

• Digital rectal examination (DRE)
• Multiparametric MRI (mpMRI)
• Targeted prostate biopsies when appropriate

This personalised approach aims to detect significant cancers early while reducing unnecessary procedures for those unlikely to benefit.