Why there is no national screening programme, what PSA actually tells you, and who should be testing earlier.
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Prostate cancer is the most common cancer in men in the UK, and one of the most survivable. Many prostate cancers grow so slowly that they never cause symptoms or shorten life at all.
That last fact is what makes this different from most cancers, and it is why there is no national screening programme. The problem is not detecting prostate cancer — it is telling the dangerous ones from the harmless ones, and treating only the first.
Testing is a genuine choice, and reasonable men reach opposite conclusions on the same evidence. Anyone who tells you it is obvious — in either direction — is oversimplifying.
What shifts the balance towards testing: a family history of prostate cancer, and Black African or Caribbean heritage, both of which raise risk substantially.
We do not diagnose or treat prostate cancer. What we can do is give you the twenty minutes the decision actually deserves, and arrange the test if you want it.
Early prostate cancer usually causes no symptoms at all. The urinary symptoms men associate with the prostate — getting up at night, a weaker stream, difficulty starting — are far more often caused by benign prostate enlargement, which is common, harmless and treatable.
So the absence of symptoms tells you very little, and the presence of urinary symptoms usually points away from cancer rather than towards it.
Getting up several times a night is usually benign enlargement — and worth mentioning that sleep apnoea is a frequently missed cause of waking at night that has nothing to do with the prostate at all.
None of that means urinary symptoms should be ignored. It means they should be assessed rather than feared.
Diet, obesity and exercise have been studied extensively and the associations are weaker than for most cancers. Being overweight may be linked to more aggressive disease.
What does not cause it: vasectomy, masturbation frequency, cycling, or having a normal sex life. These come up often and none is a risk factor.
If you are Black, or have a father or brother who was diagnosed, the conversation should start earlier — around 45 rather than 50. Ask for it; you may not be offered it.
PSA is a protein made by the prostate. It rises with cancer, and also with benign enlargement, infection, prostatitis, recent ejaculation and cycling.
Most men with a raised PSA do not have cancer. And a proportion of significant cancers occur with an entirely normal PSA. It is a prompt to look further, not a verdict.
A raised PSA no longer means straight to biopsy. Current UK practice is multiparametric MRI first, which frequently avoids biopsy altogether and, where one is still needed, targets it far better than the old approach.
That is worth knowing before deciding whether to test — the pathway is considerably less unpleasant than its reputation.
Finasteride and dutasteride roughly halve PSA, whether taken for hair loss or prostate enlargement. The result must be doubled to be interpreted, and this is missed regularly.
We cannot examine your prostate, which requires an in-person examination. We do not diagnose or treat prostate cancer — that needs urology, MRI, biopsy and a specialist team.
The decision about whether to test at all. That sounds like a strange thing to charge for, until you consider that this is the decision most likely to be made in ninety seconds at the end of an appointment about something else.
Twenty minutes covers: what a raised result would actually lead to, what overdiagnosis means in practice, and where your own risk genuinely sits given your age, family history and ethnicity.
Any man over 50 can request a free PSA test from his NHS GP after a discussion of the pros and cons. Men at higher risk should be having that conversation from around 45.
That entitlement is widely unknown, and we would rather say it plainly: you do not have to pay for this test.
A private GP generally cannot refer directly into the NHS urgent suspected cancer pathway — that usually comes from your own NHS GP. We write to them the same day with the result and the reasoning.
If you are Black, or have a father or brother who had prostate cancer, raise it from around 45 rather than waiting.
There is no proven way to prevent prostate cancer, and it is better to say that than to imply otherwise.
What is worth doing: stopping smoking, keeping a healthy weight, staying active. These reduce the risk of the things far more likely to kill you — and being overweight may be associated with more aggressive prostate disease.
Ask your father and brothers whether anyone was diagnosed, and at what age. Men frequently do not know their own family history because nobody discussed it.
And if you are of Black African or Caribbean heritage, know that your risk is roughly double. That is information you are entitled to have.
PSA testing is free from your NHS GP for any man over 50 who requests it after a discussion — and over 45 where risk is higher. There is no charge, and there is no need to buy it privately.
There is no national screening programme, and that is a deliberate decision rather than an oversight. The evidence that screening saves enough lives to outweigh the harms of over-diagnosis remains genuinely unsettled — many prostate cancers detected would never have caused symptoms, and treatment carries real risks of incontinence and erectile dysfunction.
What has improved the picture substantially is MRI before biopsy, now standard on the NHS, which has considerably reduced unnecessary biopsies and the detection of insignificant disease.
Where private PSA testing goes wrong is doing it without the conversation. A result arrives by email with no context, and the man is left with a number he cannot interpret. The test is a decision, not a commodity, and that is what a consultation is actually for.
Practical preparation matters and is routinely ignored: no ejaculation or vigorous cycling for 48 hours, and no test within six weeks of a urine infection — all of which raise PSA and generate unnecessary referrals.
Risk is substantially higher and starts younger in Black men, and with a family history — which is a reason to have the conversation earlier rather than to test blindly.
NICE NG12, Suspected cancer: recognition and referral, recommends urgent referral for men with a prostate that feels malignant on examination, or with a PSA above the age-specific threshold.
The UK National Screening Committee does not recommend a population screening programme for prostate cancer, citing the balance of over-diagnosis and over-treatment against mortality benefit — the basis for the position above.
The NHS Prostate Cancer Risk Management Programme provides the framework for informed choice: any man over 50 may request a PSA test after a discussion of benefits and limitations.
NICE NG131, Prostate cancer: diagnosis and management, recommends multiparametric MRI before biopsy, and covers active surveillance for low-risk disease — which avoids treating cancers that would not have caused harm.
NG131 also covers the recognised treatment harms — urinary incontinence and erectile dysfunction — which inform the shared decision.
It is a real decision, not a formality — and reasonable men reach opposite conclusions.
There is no national screening programme precisely because the balance is close. What shifts it towards testing: a family history, and Black African or Caribbean heritage.
No — most men with a raised PSA do not.
Benign enlargement, infection, prostatitis, recent ejaculation and cycling all raise it. A raised result means further assessment, not a diagnosis.
No. A proportion of significant prostate cancers occur with entirely normal PSA levels.
Symptoms still matter — a normal result is not a reason to ignore bone pain, weight loss or blood in the urine.
Finding a cancer that would never have harmed you. Some prostate cancers grow so slowly they would never cause symptoms or shorten life.
The difficulty is that once found, they are hard to leave alone — and treatment carries real risks of incontinence and erectile dysfunction. That is the central argument against routine screening and it deserves stating plainly.
Yes, substantially — and it is not communicated nearly well enough.
Black African and Caribbean men have roughly double the risk and tend to develop it younger. The conversation should start around 45, and you may need to ask for it rather than be offered it.
Yes, considerably — it roughly halves it.
The result must be doubled to be interpreted, so tell any doctor checking it that you take it, whether it is for hair loss or for your prostate. This is missed regularly and produces falsely reassuring results.
Almost certainly not. That is usually benign prostate enlargement, which is common and treatable — and early prostate cancer typically causes no urinary symptoms at all.
It is also worth asking about sleep apnoea, a frequently missed cause of waking at night that has nothing to do with the prostate.
No — that needs an in-person examination. We can arrange the blood test, interpret it properly, and write to your GP.
No. Neither is a risk factor.
Cycling does temporarily raise PSA though, which is why it is worth avoiding for 48 hours before a test.
August 30, 2026
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