Together we are beating cancer

Donate now
  • Health & Medicine

Why a one-off PSA test for prostate cancer is doing men more harm than good

by Katie Edmunds | Analysis

6 March 2018

74 comments 74 comments

The potential for blood tests that detect cancer is huge.

But what if a test is, in some ways, too good? What if it finds cancers that if left undetected wouldn’t cause a person any harm? And what if it’s not possible to know for certain which cancers need to be treated, or who could avoid a life-altering diagnosis and potential long-term treatment side effects?

This is the situation right now with prostate cancer.

There’s no UK screening programme for prostate cancer. That’s because the blood test that would be used – called the PSA (or prostate specific antigen) test – isn’t reliable enough.

Men over the age of 50 with no symptoms of prostate cancer can still ask for the test in the UK. But its use is hotly debated around the world.

Now, a new Cancer Research UK-funded study, from scientists at the Universities of Bristol and Oxford, sheds more light on how unreliable the test is. And it confirms that for men without symptoms, the PSA test doesn’t save lives.

What is the PSA test?

Prostate cancer is the most common cancer in men, with 46,690 cases diagnosed each year in the UK.

The PSA blood test is one of the main ways, along with a rectal exam, that doctors can look for signs of prostate cancer.

The test measures the level of PSA in a blood sample. And while it’s normal for men to have some PSA in their blood, a raised level can be a sign of prostate cancer.

But PSA can be raised for lots of other reasons too, meaning a man might get an abnormal result when he doesn’t have cancer.

PSA test prostate cancer screening

Copy this link and share our graphic. Credit: Cancer Research UK

It’s this, combined with the test missing some cancers and finding others that would never cause a man any harm, that makes it unreliable for screening.

What does the new study show?

The CAP trial is the largest to date looking at whether the PSA test can reduce the number of men dying from prostate cancer. It includes over 400,000 men from almost 600 GP practices in the UK. Some practices invited men aged 50 to 69 for a one-off appointment with a nurse where they were offered information about PSA testing and, if they wanted it, the test. The rest operated as normal, and didn’t invite men for the test.

After an average of 10 years, the researchers found that the one-off PSA test led to many more prostate cancers being found. But crucially, the men who had the test were no less likely to die of prostate cancer than the men that hadn’t had it.

This suggests that giving a one-off PSA test to men without symptoms doesn’t save lives from prostate cancer, because it:

  • Picks up cancers that are unlikely to cause a person any harm
  • Misses cancers that are aggressive and probably would benefit from treatment

Professor Richard Martin, who led the study from the University of Bristol, says the results show that giving a one-off PSA test to men without symptoms “risks diagnosing more men with a cancer that would never have caused them any harm”.

“In some cases, this might mean men unnecessarily living with the stigma of having a cancer and the side effects of treatment that was not needed, such as incontinence and erectile dysfunction, for many years, maybe even decades,” he adds.

This backs up a study from 2013 that pooled data from 5 of the largest and most rigorous trials on prostate cancer screening. It too found that the test leads to many men being diagnosed with a cancer that did not need to be found. And that screening for prostate cancer using the PSA test doesn’t reduce the number of men dying from the disease.

PSA prostate cancer screening data

Copy this link and share our graphic. Credit: Cancer Research UK

What’s the problem with finding more prostate cancers?

It seems counter-intuitive to suggest that some cancers would be better off left alone. Especially when early diagnosis can boost treatment success for some cancers. But these overdiagnosed cancers pose a serious problem.

What is overdiagnosis?

Some cancers grow fast and spread quickly, but some grow so slowly that if they went undetected they wouldn’t cause a person any problems. People with these harmless cancers won’t have any symptoms, and they won’t die from the disease.

In other words, it doesn’t matter if the cancer is never found.

When these slow-growing cancers are found they’re said to be overdiagnosed.

Read more: Overdiagnosis – when finding cancer can do more harm than good

Unfortunately, there’s no way of telling apart the cancers that need to be found and treated and the ones that could have been left alone. This means that some patients will receive an unnecessary diagnosis, unnecessary treatment, and the emotional and physical side effects they come with.

Richard Roope, a GP and one of Cancer Research UK’s senior clinical advisors, says this highlights the challenge of diagnosing prostate cancer early.

“Some areas of medicine are very clear cut, others less so,” he says. “PSA testing falls very much into the latter. Prostate cancer comes in many shapes and sizes, ranging from the aggressive to the very slow growing. Unfortunately, no available test will discriminate between these.

“What we know is that giving men without symptoms a PSA test does not change the ultimate outcome if cancer is present, meanwhile any treatment used may produce unpleasant side effects.”

What should you do if you’re worried about prostate cancer?

This study shows that having a PSA test when you don’t have any prostate cancer symptoms comes with some serious risks. If you’re still thinking about having the test, it’s important to get the full picture to help you decide. Our website and your doctor can help.

For those with symptoms, or if you notice anything that’s not normal for you, visit your doctor. In most cases it won’t be cancer, but it’s still best to get it checked.

What next for prostate cancer research?

Over 11,000 men die from prostate cancer in the UK every year. And Professor Martin says it’s here that research must be focussed.

We’re not saying that screening for prostate cancer should be discounted. What we’re saying is PSA testing for prostate cancer is not the answer

– Professor Richard Martin

“Finding a way to detect and successfully treat these cancers, ones that are aggressive and harmful, is what we must continue to strive for.

“We’re not saying that screening for prostate cancer should be discounted. What we’re saying is PSA testing for prostate cancer is not the answer.”

One of the most pressing challenges for researchers is finding a way to distinguish the potentially lethal cancers that need treating from the harmless ones that don’t. This would be an important first step in addressing the problem of overdiagnosis of prostate cancer.

One area that’s showing promise is the use of specialised scans. A type of MRI has shown potential in clinical trials as a way of reducing the number of men who need to go through uncomfortable prostate biopsies. The scans could also help accurately map the size and location of prostate tumours and to identify those cancers that are more likely to be aggressive and need treatment.

Our goal is to save men from harm. This means finding a way to stop men with aggressive prostate cancer dying from their disease by developing better tests and more effective treatments. But as the latest research shows, this also means sparing men with harmless cancers an unnecessary but life-altering diagnosis.

Katie Edmunds is a health information officer at Cancer Research UK


    Comments

  • James Booth
    11 July 2018

    Helpful response-a friend who has had prostate cancer keeps pushing me to take a PSA test.

  • Reg
    14 May 2018

    What about the benefit to all screened who have NO CANCER at all? This is a positive result and removes any worry from that section of the populace. For those unfortunate to have a cancer diagnosed, at least they then have a choice of having treatment if they wish.
    It is plain from this article that CRUK desperately wants to dissuade us from having any PSA test at all. How is this a good thing? I would like to know that I am totally clear, or that I need to have further tests.

  • Kevan Wildy
    6 May 2018

    I had no symptoms but had a PSA test because my brother was diagnosed with PCa.
    As a result of my PSA test I was sent for further tests and diagnosed with Gleason 9 T3b locally advanced PCa. How can CRUK possibly say that for men with no symptoms a PSA test doesn’t save any lives? It saved mine or don’t I count?

  • Barry G
    6 May 2018

    This article largely misses the point! It is true that a more accurate initial indicator of PCa is needed to replace the PSA test which currently leads to some men who have cancer but with a low expression of PSA being overlooked as requiring further investigation. For those that do have a raised PSA it is only an indicator that gives rise to further tests/scans that determine that radical treatment is advisable. Now let us suppose that the PSA test was replaced with a more accurate test that would show whether a man had PCa. This would certainly mean that more of the men who in fact had cancer but with a low PSA were not overlooked and would save other men from having unnecessary tests. However, it is the actual treatment, whether really necessary or not which often causes damage and severe side effects. A better test than the PSA one would not of itself change the situation of having treatment. More importantly, what is needed is a test that identifies those men who need treatment because they have cancers that are highly likely to become a problem whilst those determined to be at very low risk could just be actively monitored. This would reduce the incidence of ‘over-treatment’ and research is being undertaken in this regard. Meanwhile, we are where we are and although the PSA test (and even the PCA3) test producers anomalies ,it is a cheap test most men must have heard about and enables them to decide how far they wish to go. Relying on symptoms is insufficient because many men with PCa have none. DRE’s can also miss affected men.

    I was lucky my GP ticked the PSA test box when I had no symptoms but was having a blood test for something unrelated. Had this been done earlier, the cancer may have still been contained within the capsule. As it is, I have had two major treatments and expect to have more. It is likely that PCa will get me in the end (assuming there is no other serious illness or mishap), but treatment has undoubtedly pushed back my demise.

    My experience and those of other men I am familiar with, shows in many cases that treatment at an appropriate time can be beneficial although for some would be more than necessary. It must be down to the individual to decide having considered the pros and cons not just of the PSA test but the possibility of what this could lead, whether to proceed. A man is free at any stage to decline test/treatment and some do.

  • Jeff Haddock
    9 April 2018

    I may have missed it but why no mention of the STHLM3 testing?

  • Ken Green
    9 April 2018

    For the last three years I have been giving regular prostate cancer awareness talks on behalf of PCUK to companies, clubs, etc, using the Prostate Cancer Awareness slideshow. Some of the slides describe the PSA test as a way of diagnosing possible cancer, and informing attendees that they are entitled to a test if they are over 50, even if they have no symptoms. After reading the above this seriously concerns me, as I feel the slides need to be amended. Can someone in PCUK take this forward?

  • reply
    Nick Peel
    10 April 2018

    Hi Ken,
    Thanks for your comment.
    If what you’ve read concerns you, we’d recommend chatting about the latest evidence and the content of your slides with your contact at Prostate Cancer UK.
    As Cancer Research UK, we’re unable to help on this one.
    Best wishes,
    Nick, Cancer Research UK

  • Martin B
    4 April 2018

    Test

  • Tony T
    3 April 2018

    Having read all of the posts I am fast coming to the conclusion that this article (whilst being interesting) has no real value to anybody looking for a steer on the best way to discover whether they have prostate cancer or not.
    My advice to any man who finds it difficult to Pee, gets up regularly to pee at night or has other symptoms is to forget what they have read in the article and speak with their GP who has a duty to refer to a consultant (if they think you are at risk) within 2 weeks. Only an expert such as a Urologist is in a position to test and make a proper judgement and although a DRE or a PSA test is an indicator the science is often unreliable and should be treated as such.

  • Karen Mackulin
    3 April 2018

    Thank you for a very informative article about the pitfalls of using PSA as a test for prostate cancer. My father had prostate cancer for about 20 years that had no adverse effects on his life; ironically he died of throat cancer! My brother on the other hand was diagnosed with prostate cancer about 7 years ago. He has a more aggressive kind and regularly has hormone injections which, to date, have kept the disease in check. Thank you for all the great research you continue to do!

  • Nick Peel
    3 April 2018

    Thanks for all your comments.

    We’ve noticed that several responses touch on the same points, and wanted to address them here.

    First, when we talk about a one-off PSA test not saving lives from prostate cancer, we’re talking specifically about it being used for screening in men without prostate cancer symptoms.

    For anyone experiencing symptoms, or anything that isn’t normal for you, tell your doctor. The chances are it’s not cancer, but it’s better to check with a doctor. The PSA test is one of the things your doctor might suggest to help work out what is at the root of your symptoms, but they’ll be able to talk to you about what tests they think you should have and why. In this instance, the PSA test is being used as part of several routes of investigation.

    While the study covered in this blog post specifically looked at a one-off PSA test in men without symptoms, previous studies have looked at whether or not multiple tests could be of benefit. The results of this research have been mixed, but when the results of these trials were combined in a large review in 2013 it also showed that no lives were saved from prostate cancer, and some men were diagnosed with cancers that if left undetected wouldn’t have harmed them.

    Unfortunately, it’s not yet possible to tell the difference between prostate cancers that need treating and those that can be left alone. While Gleason scores and MRI scans can give us a good indication of how aggressive or advanced someone’s cancer may be, they aren’t perfect. It’s not possible to know if a person’s life has been saved, or when their prostate cancer would have been diagnosed, had they not had a PSA test.

    This is why it’s crucial that research continues to try and find ways to detect and successfully treat aggressive prostate cancers.

    Cancer Research UK will be funding the CAP trial for a further five years, and will continue to monitor research into PSA testing closely. We’re also funding other research into prostate cancer, including a recently announced study looking at MRI scans.

    Best wishes,
    Katie, Cancer Research UK

  • Terence carrigan
    3 April 2018

    I can not believe what I have just read, your headline
    “Why a one-off PSA test for prostate cancer is doing men more harm than good”
    This looks like it come from one of the daily tabliods rather than the CRUK. Who bases their prognosis on just one PSA test? Surely a DRE would be carried out and then a MRI scan so a full transperineum biopsy could be carried out. Then and only then would a prognosis be made. It has taken men years and years to start talking openly about Prostate Cancer (because men unlike women do not talk about such things) and this article has just put that back by about fifteen years, men will think its not worth having the PSA test as if its high the doctors will go in there with all guns blazing, thanks CRUK.
    In late 2013 I had blood in my urine for about 30 hours, GP sent me for blood tests etc. My PSA was 7.19 but a DRE showed up the left lobe of the prostate to be enlarged and had hard knobbly bits on it (my words). I had a MRI scan, bone scan and then a full transperineum biopsy and from that I was diagnosed in early April 2014 it was a Gleason score 7. So I opted for hormone injections, HDR Brachytherapy and external beam Radiotherapy in case it had spread out of the prostate.
    Yes there is collateral damage but without the treatment I don’t think I would still be here. More men are killed by Prostate Cancer than women are killed by breast cancer. The article also seems to imply that some men with cancer feel ashamed? What century was this written in.

  • Charles Carr
    2 April 2018

    This s completely counter intuitive. I was diagnosed with an aggressive Prostate Cancer only because I went for a routine annual company medical. It saved my life and I would have otherwise have gone undiagnosed as I had no symptoms. I have encouraged all my male friends to go get a PSA test and I stand by that advice. To not get checked for the single largest killer in the UK makes no sense!

  • Pauline Atkinson
    30 March 2018

    Until there is a better way of checking for prostate cancer the PSA test can help as it might lead to scans and biopsies. I object to the idea that men might be stigmatised if they have cancer.

  • Mike Lingwood
    30 March 2018

    I am quite sure that dissuading men from having PSA tests is a very bad a idea. Regular PSA testing and then reacting if and when there is an unusual increase is, in my opinion, the way to go. Next step a multiparametric mri scan and if this reveals cancer then a targeted biopsy using the scan data should enable an accurate diagnosis. After a few years of seeing my PSA gradually rise a significant increase prompted me to follow this route and I had a prostatectomy 2 years ago and now have undetectable PSA. As I had no symptoms, without the PSA testing and subsequent investigations, I would not have been aware that a significant cancer was developing close to the perimeter of my prostate!

  • Kerry Hodgson
    30 March 2018

    I had an annual PSA and DRE for years. However a change in velocity of the PSA test plus a weakening urine flow called for further examination. The result was gland confined prostate cancer Gleason score 7. I opted for a prostatectomy and the PSA reading has been negligible for almost 4 years.. I am a firm believer in the PSA test, bearing in mind, it’s the change in velocity which is the key.

  • Prof Brian Austen
    29 March 2018

    My PSA was measured at 25 three years ago. Biopsy showed Gleason T3 I think it was, cancer outside the prostate but not in the bones. I had the op. PSA undetecatable since. Without the PSA test I would never have known. I had colleagues that were diagnosed too late, and are dead now. I dont know why my GP ticked the PSA to be tested, but Im glad he did!!.

  • Patrick McGroggan
    28 March 2018

    I’ve had over the past years colonoscopy procedure, if your in that age group, why can’t they carry out the procedure to check the prostate, your in there, as I remember around 30 minutes, maybe in which time it could be done.
    There may be some reason why this can’t be carried out, just an an observation on my part….

  • Andy Golding
    28 March 2018

    I am even more confused especially as I always thought early diagnosis was always best. I have several of the associated symptoms and will be seeing my G.P. soon. What do I do if he doesn’t advise a P.S.A? Really wished I hadn’t read this.

  • Sandy Tyndale-Biscoe
    28 March 2018

    Very depressing indeed to see that CRUK (generally regarded as the UK’s foremost cancer related charity, and one to which the largely ill-informed public is most likely to donate) have failed to notice most of the research that has gone on in this area since the turn of the century, and are still pedalling advice based on evidence that is hugely out of date. The introduction of two key changes in PCa management over the past 10 years (MRI pre-biopsy, and Active Surveillance for low risk disease) have resulted in vastly reduced incidence of over-treatment and over-diagnosis, the only “harm” that can arise from PSA testing.
    The disastrous and wrong 2012 recommendation from the US Preventive Services Task Force (USPSTF) not to routinely screen asymptomatic patients to detect early disease has, as predicted by those who understand the issues, now resulted in a significant increase (by about 75%) of men first presenting with higher-risk (Gleason 8 or more) disease. Treatment of these patients will be more problematic and more of them will die. The ill-informed attitudes displayed in this article are contributing to this rise in likley mortality.

  • Keith Cregan
    28 March 2018

    My father died of prostate cancer when he was 67. I have been having the PSA test once a year for approximately 35 years.my brother who lives in Australia has been having the PSA test twice a year. He developed prostate cancer 5 years which was aggressive and if he was only having the PSA test once a year he might not have survived.

  • Anthony Trigwell
    28 March 2018

    I cannot believe this article is being published by CRUK after all their comments over the years about early diagnosis.
    Having just lost a brother with this cancer ( he was late diagnosed and it was in the bones before they found it) he lived in pain for 15 years. I can assure you if you asked any of my family about UNNECESSARY DIAGNOSIS their answer would be do not be so B****Y DAFT.
    I am also certain that any GP with symptoms (however mild) would be seeing one of their mates in Urology ASAP…
    Regards

  • Roger Bacon
    28 March 2018

    What I don’t understand about this study is that men were only given 1 PSA test, which produces a ‘baseline’ result. For screening to be effective then it should be repeated every few years, like breast cancer is 3 yearly screened. So why did this trial not repeat the PSA tests every 3 years or so? Almost certainly if a trial for women had been conducted where they were screened for breast cancer just once and then left with no further checks, the outcome would have been the same – breast cancer screening does not save lives! What an outcry that would have caused. Talking of over treatment due to PSA testing, there are 18,000 breast cancers found each year and a review in 2012 found around 4,000 are over diagnosed, information found on CRUK website! I truly believe, along with a lot of other men who have posted comments, that this research was ill conceived and has resulted in GPs now giving out distorted information to men about the PSA test. As chairman of PCaSO, a prostate cancer support charity with over 1100 members, we will be making our membership aware of what CRUK have done, as well as notifying the National Federation of support groups who will alert their member organisations to the fact that GPs have yet again been given negative information about the PSA test. PCaSO will continue to offer free PSA tests to any man.

  • Richard Perkins
    28 March 2018

    I am surprised by the level of the strong opinion which, in the main, appears to be antagonistic
    towards the results of the research. An important point to bear in mind, in my view, is that the sample used was for men “WITHOUT ANY SYMPTOMS”. I would imagine that any sample of men WITH symptoms would have produced a different result showing that the PSA test was useful as a first step in diagnosing cancer? I would welcome, from the results of more research, much better guidance on the SYMPTOMS which would lead me to be concerned enough to obtain medical advice. More research, please! I hope that a more reliable screening test can be found, soon!

  • Alex Mcintyre
    28 March 2018

    I was thinking of a test I have a brother with it I am 64 years old I always hear get checked from TV stars etc I have a few symptoms but confused should I shouldn’t I my doctor just said just because your brother got it doesn’t mean you will get it and ended the conversation thanks

  • Jeanne Hewton
    28 March 2018

    I so agree with this and am grateful to still have my husband, Eric.
    The first test provides a baseline. Then subsequent PSA tests can indicate progress of the disease. Surely this makes sense.
    I am surprised that an established organisation like Cancer Research should be following what is now considered as outdated thinking.
    Surely, until better tests are found, regular PSA tests are better than nothing.

  • david mitchell
    28 March 2018

    I thought this information very useful and confirms my current understanding about the test.

  • Doug Larsen
    28 March 2018

    I guess I fall into the group that has been diagnosed with advanced prostate cancer following a PSA test, rectal examination and biopsy. The description is T4 NO M1, Gleeson8, PSA with some metastases. This was in 2015. My treatment has been hormone therapy and radio therapy. I am continuing with hormone therapy and the PSA levels have dropped to zero. I now have yearly checkups where PSA levels are examined after a blood test. My understanding is that eventually hormone therapy no longer becomes effective and the cancer revives. I would like to know how likely this is and whether more effective tests than PSA levels can tell me if the cancer has revived.

  • I.J.Hofer-Villiers
    28 March 2018

    I already have prostate cancer, when the Doctor sent me for test the Hospital Doctor said what have you come here for. only to find out that I had a PSA of 7. It was treated with Radio treatment. After MRI scans .

  • Terry Hopkinson
    27 March 2018

    I would not be around to write this today if I’d not had a one-off PSA test nearly five years ago. My understanding is that the whole point of the test is to indicate that things could be going downhill so that at least you know it’s worthwhile getting investigated. Consequently my view is that this particular bit of research does nobody any favours and I’m gobsmacked that CRUK have published it.

  • John Fallows
    27 March 2018

    This article is misleading as clearly explained in previous posts. Thanks to my visionary GP I had been having annual PSA tests for 20 years with intermittent referrals to the (fantastic) Urology unit at Stepping Hill. Last year my PSA had risen to over 15 which had been set as the trigger point for further investigation. I had an MRI scan & bone scan – which revealed I had cancer to the edge of the prostate but fortunately it hadn’t spread outside or to the bones. A biopsy showed Gleason 7 – which led to a radical prostatectomy.

    The point is that the PSA test is an indicator and an MRI and targeted biopsy (if required) are what dictates required treatment (or not). This is only mentioned as an afterthought in the article – my understanding is that it is now best practice in the best centres. I don’t believe there are any serious risks in an MRI scan,

    My friend’s GP suggested a precautionary PSA test although no symptoms … PSA 20 … MRI … Biopsy … Op … life saved?

    Clearly a better blood test will be a major step forward but let’s not dismiss what we have that works – even if it’s imprecise.

  • Liz
    27 March 2018

    test

  • M J HARNETT
    27 March 2018

    I agree with disadvantages of a one off PSA,but surely a regular check say 1/2 annually would be better.This would show up a change in level which could be significant.

  • Julia Berg
    25 March 2018

    This article doesn’t make it clear if the rectal examination is worthwhile or not.
    Can a rectile examination reveal if cancer is present (with or without a PSA test)?
    if not, is it only a scan that can diagnose prostate cancer?
    In other words, what tests should men ask their doctor for (if over the age of 60) to check?
    Many thanks

  • Chris Falla
    25 March 2018

    Let no one forget that the first symptoms of prostate cancer are no symptoms.

    Katie Edmunds, I believe your article is misleading, very damaging – and bordering on moronic.
    You are in a position to reach and influence very many people, but very unfortunately you’ve done it with selective data and opinions, rather than ‘fact on the ground’. Who on earth approved this article for release?
    Firstly, you state that no available test will determine between aggressive and slow growth cancers.
    For me the test (after PSA and DRE) was a biopsy that led to a Gleason rating which in conjunction with a MRI scan informed my urologist and oncologist on the aggression level and led to my treatment options being explained and actioned.
    Secondly, you chose to quote Professor Richard Martin: “We’re not saying that screening for prostate cancer should be discounted. What we’re saying is PSA testing for prostate cancer is not the answer.” So PSA testing is not the answer? If you’ve got a better answer, Professor, we’re all ears.
    Let’s bring this back to earth with a post recopied from PCaSO Dorset (below). This is how it actually is ‘on the ground’ all over the country, men being properly informed and tested. What would you say to those 200 men mentioned below?
    You should withdraw your article and advise all who’ve read it that unfortunately it has not been considered or researched properly. Don’t forget decisions about lives are at stake here. Accuracy of information is totally key.

    ‘This report is not only inaccurate but misleading. As chairman of Prostate Cancer Support Organisation (PCaSO) in Dorset which has now offered free PSA testing for men. We have now tested 5,000 men. Of these, 600+ have been referred to their GPs and of those, 200 have either been treated (some with advanced prostate cancer) or have been “put on the radar” through active surveillance. Every man is made aware of the advantages and disadvantages of the test before they make their choice. Those with a low score are also advised that the result is a yardstick to compare with any further PSA tests which we recommend they have. We do not rely on anecdotal stories to support our success as we have received scores of letters from grateful men whose cancers have been identified early enough for a complete cure. The article, through its credulous and selective sorting of the “evidence”, is not only misleading but actually undermines the outcomes that we are trying to achieve. It also makes us question the future credibility of CRUK. Early detection of all forms of cancer is key to successful treatment. Symptoms often appear after cancer has already established itself – a contributing factor, I believe to the 12,000 men who die of it annually’

  • DONALD LEGGET
    25 March 2018

    Better to have a REGULAR PSA test every year. I agree a one-off test is not the answer. Just do it regularly.

  • Peter PHILLIPS
    25 March 2018

    This is a most helpful article, however it does create concern regarding diagnosis and in particular the identification of a cancer that is non aggressive but is treated aggressively. The MRI non invasive checking is the area that needs concentration of effort to determine accuracy.

  • Olaniyi Oladapo Timothy Onibiyo
    25 March 2018

    There should be a men screening ln the UK urgently please.

  • Bill Burrows
    25 March 2018

    I am 72 and for some years have had the PSA test once a year . More recently after a rectal exam. my GP prescribed Tamsulosin MR 400mcq which has not prevented dribbling sometime after having a pee. Should I seek to have an MRI scan?

  • Alan John Williams
    25 March 2018

    I asked for a voluntary PSA test as I’d read somewhere that if you’re over 50, it was a good idea to have one. If I hadn’t had one, I probably wouldn’t be here today, that was back in 2009, I was told I had cancer, and it was caught early. I had a laparoscopic prostatectomy in 2010, then I was told that it was worse than first thought, following the opp, it was found to have spread into my bladder. Then I was asked if I would like to try a clinical trial to help with research, so I agreed, I had harmone injections for 6 months, followed by radiotherapy for 4 weeks half way through the injections. The good news is that it appears to have worked. I now have a PSA test every 12 months to keep an eye on things, my main point being that if I hadn’t had a PSA test I would probably be dead now, I would rather suffer a biopsy of the prostate after a PSA test to be on the safe side, than not have a PSA test at all. I was 55 when I had my prostatectomy.

  • Amelie
    25 March 2018

    Unfortunately, I will not be donating to Cancer Research UK again because of this article. How disappointing. I agree with Chris.

  • Chris
    25 March 2018

    You’ve framed your email intro with a reference to Stephen Fry. The PSA test alerted him. It also alerted me (I’m in treatment) as well as thousands of men.
    To suggest that men without symptoms should not have the test is irresponsible. 40% of cases are not diagnosed until late stage. Why? The timeline between symptoms and late stage can be negligible.
    The issue lies with properly trained GPs and there are some horrendous ones out there. My brother (2.5 times likely to get it because I have) was fobbed of by his GP after I was diagnosed. That GP should be urgently re-trained.
    I agree that national screening is not possible, but every man over 50 should offered a baseline PSA test with proper education about the test from GP.
    No wonder survival rate in Britain is below the European average, with articles like this one.

  • Millie
    25 March 2018

    Whilst I agree more research should be conducted, I strongly disagree that you are implying that the PSA test is unhelpful. Many people close to me have only discovered that they have prostate cancer because of the PSA test and if it wasn’t available then it would be a completely different situation now. What are you suggesting? I disapprove of this article and I am very disappointed with the lack of alternatives. You are indicating that men should not get checked… But tell me, would Bill Turnbull and Stephen Fry agree with that?

  • Robert bullock
    25 March 2018

    Thankyou for the infirmation.

  • Gerald Cornick
    25 March 2018

    Whilst I agree that a better way of diagnosing prostate cancer should be a priority the most should be made of what we have. Me generally are reticent when it comes to speaking about health matters and the high profile publicity which we are seeing can only help.
    I was diagnosed with prostate cancer in September 2007 through a chance comment I made to my GP when visiting him for an entirely separate problem. Whilst my GP thought I was ok through an initial internal (anal) examination a blood test followed by an anal biopsy confirmed prostate cancer. By the time of my diagnosis it was too late for me to have my prostate removed so I went down the road of radiotherapy and hormone treatment.
    Thanks to a brilliant team of consultants I have had at the Royal Hampshire County Hospital Winchester and the NHS the cancer is very much being kept under control. When diagnosed my PSA was 18 & the last reading recently was 1.2.

  • Phil Shergold
    25 March 2018

    I have a family history of prostrate cancer. My father died of it at the age of 61, my two elder brothers have both have had their prostrates removed. I have a PSA test each year which I have to ask my GP for as it’s not an automatic recall. Each reading has come back lower than the 2 mark since I began having the test. I’m 60 next year & always aware that this strain of cancer may be hereditary. Screening sounds far more productive than the current method of testing which in turn will obviously save time & money.

  • Michael McClure
    25 March 2018

    I arrived back in the U.K. aged 68, in September 2014 after working in a highly stressful position. My PSA reading at that time was 37! Way above the advised 4. After a biopsy to check for cancer it returned a negative result. Over the past 3.5 years the PSA readings have slowly reduced – 27 – 19 – 22 – now 12 .5.
    Obviously very worrying.
    However as a very active cyclist my readings will always be high! Although I have friends, also cyclists with readings below 4.
    I will continue to be concerned I have been told that the reduction and ups/downs are a clear indication of no cancer.
    Then why is my readings so high?

  • Rogercharles
    25 March 2018

    It is a sad sad story.

  • Steve Mayers
    25 March 2018

    Very useful analysis, far better quality information than the media present

  • Helen Rowe
    25 March 2018

    Thank you for this very informative artical, I was under the impression that a PSA test was the answer for early detection in the battle against prostrate cancer and will pass on what I have learnt to family and friends that this isn’t the whole answer at all. Good luck with your continued work in the battle against this killer.

  • Yvonne
    24 March 2018

    Thank you for keeping me up-to-date on the progress of prostate cancer, which seems to be rather a difficult cancer to diagnose, but I have great faith in our laboratory personel to eventually be able to recognise this particular killer and then the battle begins. Continue your very special work, and keep all our men safe.

  • Eric Hewton
    24 March 2018

    I had the PSA test 12years ago. It was 5. Before we did any more I waited a month and had another test. It had risen to 6.5. A further test a month or so later and I was up to 7.5. This triggered a biopsy which found cancer and a high gleeson score. So I had radiotherapy. I believe I am still here because of the test. The simple conclusion is surely to rely, not one test, but on a follow up.

  • IAN MCDONALD
    24 March 2018

    I AM A PROSTRATE CANCER SUFFERER,MYSELF I DO NOT TRUST THE BLOOD TESTS,I HAVE BEEN TOLD MINE IS A LOT BETTER,BUT THEY WAY I FEEL I AM DOUGHTFULL,BUT WHAT CAN WE DO WE HAVE TO TRY AND TRUST,MYSELF MEN SHOULD BE MORE AWARE.

  • Lorraine Hopkinson
    24 March 2018

    The PSA test saved my husband’s life. His reading was high and subsequently he had a biopsy and MRI. He had advanced prostate cancer and had this not been detected when it was he may well not be alive now. In our view the comments from CRUK are not totally helpful.

  • Euan Holt
    24 March 2018

    Accepting there are no syptoms and you feel well aged approx. 70yrs ; having an unreliable PSA test may just cause unnecessary anxiety and possible treatment that isn’t necessary.

  • David Collins [email protected]
    24 March 2018

    It worked for me. I was diagnosed in 2008 and had the treatment later in 2008 This was Brachytherapy which consists of filling the prostate with small radioactive Seed like things.
    I worked for me My PSA levels are very low and so far the cancer didnt return However I have since has my right kidney removed as it was cancerous and Have had two small tumors removed from my Bladder. So I guess I am one very lucky guy. Best wishes to all

  • David wright
    24 March 2018

    Great keep it coming

  • Ian Davies
    24 March 2018

    Starting in my 70’s had an annual PSA test for several years with very slight but low annual increments. There was no real trend to observe, or so I thought. At the age of 80 the PSA result doubled and set off alarm bells with me and my GP, especially when he pointed out that a relatively low reading of 11 was in fact to be regarded as 22 because my Finasteride medication (to reduce an enlarged prostate) masked the true reading. No one had warned me of this before. He asked me to undergo a manual check of the prostate and found a lump. Within a few weeks I had gone through a thorough screening at the hospital and ended up with RT to eliminate the cancer in the prostate which had fortunately not actually broken out: I was right on the cusp of much worse. I think it is irresponsible of the media and some medical people to give the impression that PSA testing is useless/irresponsible/indesirable etc because of inadequacies in some instances. I note that your article carefully criticises one-off tests rather than PSA testing in general but the headlines resulting from this may be doing a great disservice to those at risk of prostate cancer. Yes, there must be better ways of screening comprehensively for cancer risk but please don’t allow the anti-PSA test headliners win the day. PSA testing is saving many lives by indicating a potential problem, mine for one!

  • Adrian Stone
    24 March 2018

    Research is extremely important………but until such time that an extra test/tests are discovered/ proved……the PSA Blood check should be used when requested as an indication

  • Derek
    24 March 2018

    Just been forwaded this article. I support totally the 2 points made by Paul Ledbury. I have had regular annual tests for many years, steady but minimal raise in levels. Regular monitoring for trends is better than “one-off then forget it”. But, why is it suggested that research and tests should be applied only to 50-69 year olds. Is my life not worth saving now I am in my 70s?

  • Kenneth
    15 March 2018

    I was diagnosed with prostate cancer a couple of years ago at age 48. My PSA test came back suggesting I was okay and could probably leave it for a while. However I went for keyhole surgery to remove prostate and I was later told my situation was much worse than what the PSA test had came back with. Basically if I had listened to the results and left it .. I would now be dead. Also the Gleason scale I was told before operation was also wrong. Again if I had went with this information I would now be dead. Very haunted to this day with the voice of doctor telling me it came down to a matter of a week or mabey two for me to be alive or not. I was so angry and still psychologically troubled. Since the operation I am happy to say my blood test “suggest” I am ok.

  • FP Graziano
    13 March 2018

    Never good looking for trouble? But what if. Medical research is the answer that hopefully will solve it.

  • Mike cole
    13 March 2018

    Yes there should be a test found to be useful for all men to have this decteced early for longevity of life

  • Ian
    13 March 2018

    Very useful, my father died from prostrate cancer at 67, now i’m 64 I am getting concerned, but do not want the rectal examination blood test could be useful in my case ?

  • Angus mcCuaig
    13 March 2018

    I would like to get a test done

  • Graham Turner
    13 March 2018

    The sooner you start the better I have prostate cancer and the biopsy and the examination I found degrading then you are left to make your decision from three options I am lucky in a way it’s watch and wait every three months for blood test

  • Brian Merritt
    13 March 2018

    As a result of receiving this text I am seriously considering cancelling my monthly donation to CRUK. I have prostate cancer which at the moment is held back by hormone therapy injections, I was diagnosed after a PSA test which pointed me to further tests which confirmed the diagnosis. If I had not had the PSA test I would not have been diagnosed in time and would not be alive now. If CRUK are using funds to make this crass research possible then I don’t think I want to be part of it.

  • David Allanson
    13 March 2018

    Helpful, glad I was sent the text/link to website.

  • Nick Goddard
    8 March 2018

    Since the age of 50 I had regular PSA screening as part of a private healthcare package. In 2010, at the age of 57, my PSA had rocketed, although I had no physical symptoms that worried me. The subsequent biopsy produced a Gleason score of 7, and scans indicated that there were nodes extending beyond the prostate wall. In other words I had a fairly aggressive cancer that was in danger of becoming advanced. My treatment of a robotic radical prostatectomy and radio therapy on the prostate bed a year later has been entirely successful and currently my PSA is undetectable.
    The message here is that, having no symptoms, without PSA screening the probability is that my cancer would not have been detected before it was too advanced for the chance of a cure!
    You cannot tell me that PSA screening does not have the potential to save lives, or at the very least enable treatments to be started earlier therefore extending their lives.

  • Paul Ledbury
    8 March 2018

    1. It would seem that the “other” reasons (on the infographic) for having raised PSA levels can be easily mitigated. Why not give better instructions to men having the test? Some NHS pages do have instructions on what not to do before the test (https://www.nhs.uk/livewell/prostatehealth/pages/psa-test.aspx) but none of these were mentioned to me by my GP, and none of them are included in the NHS/Public Health England leaflet I was given (https://www.gov.uk/government/publications/prostate-specific-antigen-testing-description-in-brief).

    2. Why the fixation on a one-off test? If it’s that unreliable as a one-off then wouldn’t it be better to use multiple tests over a period, to determine a trend? Like in Ben Stiller’s case: https://www.statnews.com/2016/10/04/ben-stiller-prostate-cancer-psa/

  • Jim Davis
    8 March 2018

    This report is not only inaccurate but misleading. As chairman of Prostate Cancer Support Organisation (PCaSO) in Dorset which has now offered free PSA testing for men. We have now tested 5,000 men. Of these, 600+ have been referred to their GPs and of those, 200 have either been treated (some with advanced prostate cancer) or have been “put on the radar” through active surveillance. Every man is made aware of the advantages and disadvantages of the test before they make their choice. Those with a low score are also advised that the result is a yardstick to compare with any further PSA tests which we recommend they have. We do not rely on anecdotal stories to support our success as we have received scores of letters from grateful men whose cancers have been identified early enough for a complete cure. The article, through its credulous and selective sorting of the “evidence”, is not only misleading but actually undermines the outcomes that we are trying to achieve. It also makes us question the future credibility of CRUK. Early detection of all forms of cancer is key to successful treatment. Symptoms often appear after cancer has already established itself – a contributing factor, I believe to the 12,000 men who die of it annually.

  • Katie Edmunds
    7 March 2018

    Hi David,

    Thanks for your comment.
    The infographic you mention is based on the data from the 2013 Cochrane Review. This review combined results from five of the biggest and most rigorous studies testing if prostate cancer screening would work. The overall conclusion was that PSA screening for prostate cancer doesn’t save lives. The CAP trial, published yesterday, adds further evidence that PSA screening doesn’t save lives.

    You can read more about why there aren’t screening programmes for all cancer types on our website.

    Best wishes,
    Katie, Cancer Research UK

  • roger bacon
    7 March 2018

    This research is not taking into perspective the recent PROMIS and ProtecT trial results where men are now having, in most hospitals, an mpMRI scan BEFORE a biopsy, the scan can show accurately if there is any cancer within the gland, if not the man walks away, if there is it can be targeted at the biopsy stage and given a gleason score. Many men now are put on active surveillance if the cancer is insignificant. The recent National Cancer Audit has shown that over treatment has reduced to 8%. The statement about PSA testing does not save lives is rubbish! The large European trial on PSA testing proved that our cancer death rate would reduce by 25%. Why is it in the USA, where PSA screening used to be happen, they decided to stop screening and now the death rate in the USA has increased year on year after screening stopped.

  • Alan Davies
    7 March 2018

    The graphic assumes that ALL of those men diagnosed with prostate cancer will be treated. That is clearly not the case unless watchful waiting is considered to be treatment. Even then, I assume that a few of those diagnosed would prefer not to be involved in a watchful waiting programme even. Watchful waiting certainly doesn’t classify as an invasive treatment. As a prostate cancer survivor I am certainly thankful to know that I no longer carry the uncertainty of not knowing whether I will die with prostate cancer or of it.

  • David Hutchinson
    6 March 2018

    Where is the real data on PSA testing? The graphic in the article said ‘If there was a PSA Prostate Cancer Screening Programme…’ It then presented data stating that NO lives would be saved as a result of such a programme. Where’s the data behind that statement? Has such a programme ever been conducted and if so, where is the data? I know several asymptomatic men who have been diagnosed with aggressive malignant prostate cancer following a PSA test result with a high number. I know that is anecdotal, but they are real people. How would they register on the graphic, which without real data behind it, is rather an insult to our intelligence. Prove it to me, and I will accept the argument.

    Comments

  • James Booth
    11 July 2018

    Helpful response-a friend who has had prostate cancer keeps pushing me to take a PSA test.

  • Reg
    14 May 2018

    What about the benefit to all screened who have NO CANCER at all? This is a positive result and removes any worry from that section of the populace. For those unfortunate to have a cancer diagnosed, at least they then have a choice of having treatment if they wish.
    It is plain from this article that CRUK desperately wants to dissuade us from having any PSA test at all. How is this a good thing? I would like to know that I am totally clear, or that I need to have further tests.

  • Kevan Wildy
    6 May 2018

    I had no symptoms but had a PSA test because my brother was diagnosed with PCa.
    As a result of my PSA test I was sent for further tests and diagnosed with Gleason 9 T3b locally advanced PCa. How can CRUK possibly say that for men with no symptoms a PSA test doesn’t save any lives? It saved mine or don’t I count?

  • Barry G
    6 May 2018

    This article largely misses the point! It is true that a more accurate initial indicator of PCa is needed to replace the PSA test which currently leads to some men who have cancer but with a low expression of PSA being overlooked as requiring further investigation. For those that do have a raised PSA it is only an indicator that gives rise to further tests/scans that determine that radical treatment is advisable. Now let us suppose that the PSA test was replaced with a more accurate test that would show whether a man had PCa. This would certainly mean that more of the men who in fact had cancer but with a low PSA were not overlooked and would save other men from having unnecessary tests. However, it is the actual treatment, whether really necessary or not which often causes damage and severe side effects. A better test than the PSA one would not of itself change the situation of having treatment. More importantly, what is needed is a test that identifies those men who need treatment because they have cancers that are highly likely to become a problem whilst those determined to be at very low risk could just be actively monitored. This would reduce the incidence of ‘over-treatment’ and research is being undertaken in this regard. Meanwhile, we are where we are and although the PSA test (and even the PCA3) test producers anomalies ,it is a cheap test most men must have heard about and enables them to decide how far they wish to go. Relying on symptoms is insufficient because many men with PCa have none. DRE’s can also miss affected men.

    I was lucky my GP ticked the PSA test box when I had no symptoms but was having a blood test for something unrelated. Had this been done earlier, the cancer may have still been contained within the capsule. As it is, I have had two major treatments and expect to have more. It is likely that PCa will get me in the end (assuming there is no other serious illness or mishap), but treatment has undoubtedly pushed back my demise.

    My experience and those of other men I am familiar with, shows in many cases that treatment at an appropriate time can be beneficial although for some would be more than necessary. It must be down to the individual to decide having considered the pros and cons not just of the PSA test but the possibility of what this could lead, whether to proceed. A man is free at any stage to decline test/treatment and some do.

  • Jeff Haddock
    9 April 2018

    I may have missed it but why no mention of the STHLM3 testing?

  • Ken Green
    9 April 2018

    For the last three years I have been giving regular prostate cancer awareness talks on behalf of PCUK to companies, clubs, etc, using the Prostate Cancer Awareness slideshow. Some of the slides describe the PSA test as a way of diagnosing possible cancer, and informing attendees that they are entitled to a test if they are over 50, even if they have no symptoms. After reading the above this seriously concerns me, as I feel the slides need to be amended. Can someone in PCUK take this forward?

  • reply
    Nick Peel
    10 April 2018

    Hi Ken,
    Thanks for your comment.
    If what you’ve read concerns you, we’d recommend chatting about the latest evidence and the content of your slides with your contact at Prostate Cancer UK.
    As Cancer Research UK, we’re unable to help on this one.
    Best wishes,
    Nick, Cancer Research UK

  • Martin B
    4 April 2018

    Test

  • Tony T
    3 April 2018

    Having read all of the posts I am fast coming to the conclusion that this article (whilst being interesting) has no real value to anybody looking for a steer on the best way to discover whether they have prostate cancer or not.
    My advice to any man who finds it difficult to Pee, gets up regularly to pee at night or has other symptoms is to forget what they have read in the article and speak with their GP who has a duty to refer to a consultant (if they think you are at risk) within 2 weeks. Only an expert such as a Urologist is in a position to test and make a proper judgement and although a DRE or a PSA test is an indicator the science is often unreliable and should be treated as such.

  • Karen Mackulin
    3 April 2018

    Thank you for a very informative article about the pitfalls of using PSA as a test for prostate cancer. My father had prostate cancer for about 20 years that had no adverse effects on his life; ironically he died of throat cancer! My brother on the other hand was diagnosed with prostate cancer about 7 years ago. He has a more aggressive kind and regularly has hormone injections which, to date, have kept the disease in check. Thank you for all the great research you continue to do!

  • Nick Peel
    3 April 2018

    Thanks for all your comments.

    We’ve noticed that several responses touch on the same points, and wanted to address them here.

    First, when we talk about a one-off PSA test not saving lives from prostate cancer, we’re talking specifically about it being used for screening in men without prostate cancer symptoms.

    For anyone experiencing symptoms, or anything that isn’t normal for you, tell your doctor. The chances are it’s not cancer, but it’s better to check with a doctor. The PSA test is one of the things your doctor might suggest to help work out what is at the root of your symptoms, but they’ll be able to talk to you about what tests they think you should have and why. In this instance, the PSA test is being used as part of several routes of investigation.

    While the study covered in this blog post specifically looked at a one-off PSA test in men without symptoms, previous studies have looked at whether or not multiple tests could be of benefit. The results of this research have been mixed, but when the results of these trials were combined in a large review in 2013 it also showed that no lives were saved from prostate cancer, and some men were diagnosed with cancers that if left undetected wouldn’t have harmed them.

    Unfortunately, it’s not yet possible to tell the difference between prostate cancers that need treating and those that can be left alone. While Gleason scores and MRI scans can give us a good indication of how aggressive or advanced someone’s cancer may be, they aren’t perfect. It’s not possible to know if a person’s life has been saved, or when their prostate cancer would have been diagnosed, had they not had a PSA test.

    This is why it’s crucial that research continues to try and find ways to detect and successfully treat aggressive prostate cancers.

    Cancer Research UK will be funding the CAP trial for a further five years, and will continue to monitor research into PSA testing closely. We’re also funding other research into prostate cancer, including a recently announced study looking at MRI scans.

    Best wishes,
    Katie, Cancer Research UK

  • Terence carrigan
    3 April 2018

    I can not believe what I have just read, your headline
    “Why a one-off PSA test for prostate cancer is doing men more harm than good”
    This looks like it come from one of the daily tabliods rather than the CRUK. Who bases their prognosis on just one PSA test? Surely a DRE would be carried out and then a MRI scan so a full transperineum biopsy could be carried out. Then and only then would a prognosis be made. It has taken men years and years to start talking openly about Prostate Cancer (because men unlike women do not talk about such things) and this article has just put that back by about fifteen years, men will think its not worth having the PSA test as if its high the doctors will go in there with all guns blazing, thanks CRUK.
    In late 2013 I had blood in my urine for about 30 hours, GP sent me for blood tests etc. My PSA was 7.19 but a DRE showed up the left lobe of the prostate to be enlarged and had hard knobbly bits on it (my words). I had a MRI scan, bone scan and then a full transperineum biopsy and from that I was diagnosed in early April 2014 it was a Gleason score 7. So I opted for hormone injections, HDR Brachytherapy and external beam Radiotherapy in case it had spread out of the prostate.
    Yes there is collateral damage but without the treatment I don’t think I would still be here. More men are killed by Prostate Cancer than women are killed by breast cancer. The article also seems to imply that some men with cancer feel ashamed? What century was this written in.

  • Charles Carr
    2 April 2018

    This s completely counter intuitive. I was diagnosed with an aggressive Prostate Cancer only because I went for a routine annual company medical. It saved my life and I would have otherwise have gone undiagnosed as I had no symptoms. I have encouraged all my male friends to go get a PSA test and I stand by that advice. To not get checked for the single largest killer in the UK makes no sense!

  • Pauline Atkinson
    30 March 2018

    Until there is a better way of checking for prostate cancer the PSA test can help as it might lead to scans and biopsies. I object to the idea that men might be stigmatised if they have cancer.

  • Mike Lingwood
    30 March 2018

    I am quite sure that dissuading men from having PSA tests is a very bad a idea. Regular PSA testing and then reacting if and when there is an unusual increase is, in my opinion, the way to go. Next step a multiparametric mri scan and if this reveals cancer then a targeted biopsy using the scan data should enable an accurate diagnosis. After a few years of seeing my PSA gradually rise a significant increase prompted me to follow this route and I had a prostatectomy 2 years ago and now have undetectable PSA. As I had no symptoms, without the PSA testing and subsequent investigations, I would not have been aware that a significant cancer was developing close to the perimeter of my prostate!

  • Kerry Hodgson
    30 March 2018

    I had an annual PSA and DRE for years. However a change in velocity of the PSA test plus a weakening urine flow called for further examination. The result was gland confined prostate cancer Gleason score 7. I opted for a prostatectomy and the PSA reading has been negligible for almost 4 years.. I am a firm believer in the PSA test, bearing in mind, it’s the change in velocity which is the key.

  • Prof Brian Austen
    29 March 2018

    My PSA was measured at 25 three years ago. Biopsy showed Gleason T3 I think it was, cancer outside the prostate but not in the bones. I had the op. PSA undetecatable since. Without the PSA test I would never have known. I had colleagues that were diagnosed too late, and are dead now. I dont know why my GP ticked the PSA to be tested, but Im glad he did!!.

  • Patrick McGroggan
    28 March 2018

    I’ve had over the past years colonoscopy procedure, if your in that age group, why can’t they carry out the procedure to check the prostate, your in there, as I remember around 30 minutes, maybe in which time it could be done.
    There may be some reason why this can’t be carried out, just an an observation on my part….

  • Andy Golding
    28 March 2018

    I am even more confused especially as I always thought early diagnosis was always best. I have several of the associated symptoms and will be seeing my G.P. soon. What do I do if he doesn’t advise a P.S.A? Really wished I hadn’t read this.

  • Sandy Tyndale-Biscoe
    28 March 2018

    Very depressing indeed to see that CRUK (generally regarded as the UK’s foremost cancer related charity, and one to which the largely ill-informed public is most likely to donate) have failed to notice most of the research that has gone on in this area since the turn of the century, and are still pedalling advice based on evidence that is hugely out of date. The introduction of two key changes in PCa management over the past 10 years (MRI pre-biopsy, and Active Surveillance for low risk disease) have resulted in vastly reduced incidence of over-treatment and over-diagnosis, the only “harm” that can arise from PSA testing.
    The disastrous and wrong 2012 recommendation from the US Preventive Services Task Force (USPSTF) not to routinely screen asymptomatic patients to detect early disease has, as predicted by those who understand the issues, now resulted in a significant increase (by about 75%) of men first presenting with higher-risk (Gleason 8 or more) disease. Treatment of these patients will be more problematic and more of them will die. The ill-informed attitudes displayed in this article are contributing to this rise in likley mortality.

  • Keith Cregan
    28 March 2018

    My father died of prostate cancer when he was 67. I have been having the PSA test once a year for approximately 35 years.my brother who lives in Australia has been having the PSA test twice a year. He developed prostate cancer 5 years which was aggressive and if he was only having the PSA test once a year he might not have survived.

  • Anthony Trigwell
    28 March 2018

    I cannot believe this article is being published by CRUK after all their comments over the years about early diagnosis.
    Having just lost a brother with this cancer ( he was late diagnosed and it was in the bones before they found it) he lived in pain for 15 years. I can assure you if you asked any of my family about UNNECESSARY DIAGNOSIS their answer would be do not be so B****Y DAFT.
    I am also certain that any GP with symptoms (however mild) would be seeing one of their mates in Urology ASAP…
    Regards

  • Roger Bacon
    28 March 2018

    What I don’t understand about this study is that men were only given 1 PSA test, which produces a ‘baseline’ result. For screening to be effective then it should be repeated every few years, like breast cancer is 3 yearly screened. So why did this trial not repeat the PSA tests every 3 years or so? Almost certainly if a trial for women had been conducted where they were screened for breast cancer just once and then left with no further checks, the outcome would have been the same – breast cancer screening does not save lives! What an outcry that would have caused. Talking of over treatment due to PSA testing, there are 18,000 breast cancers found each year and a review in 2012 found around 4,000 are over diagnosed, information found on CRUK website! I truly believe, along with a lot of other men who have posted comments, that this research was ill conceived and has resulted in GPs now giving out distorted information to men about the PSA test. As chairman of PCaSO, a prostate cancer support charity with over 1100 members, we will be making our membership aware of what CRUK have done, as well as notifying the National Federation of support groups who will alert their member organisations to the fact that GPs have yet again been given negative information about the PSA test. PCaSO will continue to offer free PSA tests to any man.

  • Richard Perkins
    28 March 2018

    I am surprised by the level of the strong opinion which, in the main, appears to be antagonistic
    towards the results of the research. An important point to bear in mind, in my view, is that the sample used was for men “WITHOUT ANY SYMPTOMS”. I would imagine that any sample of men WITH symptoms would have produced a different result showing that the PSA test was useful as a first step in diagnosing cancer? I would welcome, from the results of more research, much better guidance on the SYMPTOMS which would lead me to be concerned enough to obtain medical advice. More research, please! I hope that a more reliable screening test can be found, soon!

  • Alex Mcintyre
    28 March 2018

    I was thinking of a test I have a brother with it I am 64 years old I always hear get checked from TV stars etc I have a few symptoms but confused should I shouldn’t I my doctor just said just because your brother got it doesn’t mean you will get it and ended the conversation thanks

  • Jeanne Hewton
    28 March 2018

    I so agree with this and am grateful to still have my husband, Eric.
    The first test provides a baseline. Then subsequent PSA tests can indicate progress of the disease. Surely this makes sense.
    I am surprised that an established organisation like Cancer Research should be following what is now considered as outdated thinking.
    Surely, until better tests are found, regular PSA tests are better than nothing.

  • david mitchell
    28 March 2018

    I thought this information very useful and confirms my current understanding about the test.

  • Doug Larsen
    28 March 2018

    I guess I fall into the group that has been diagnosed with advanced prostate cancer following a PSA test, rectal examination and biopsy. The description is T4 NO M1, Gleeson8, PSA with some metastases. This was in 2015. My treatment has been hormone therapy and radio therapy. I am continuing with hormone therapy and the PSA levels have dropped to zero. I now have yearly checkups where PSA levels are examined after a blood test. My understanding is that eventually hormone therapy no longer becomes effective and the cancer revives. I would like to know how likely this is and whether more effective tests than PSA levels can tell me if the cancer has revived.

  • I.J.Hofer-Villiers
    28 March 2018

    I already have prostate cancer, when the Doctor sent me for test the Hospital Doctor said what have you come here for. only to find out that I had a PSA of 7. It was treated with Radio treatment. After MRI scans .

  • Terry Hopkinson
    27 March 2018

    I would not be around to write this today if I’d not had a one-off PSA test nearly five years ago. My understanding is that the whole point of the test is to indicate that things could be going downhill so that at least you know it’s worthwhile getting investigated. Consequently my view is that this particular bit of research does nobody any favours and I’m gobsmacked that CRUK have published it.

  • John Fallows
    27 March 2018

    This article is misleading as clearly explained in previous posts. Thanks to my visionary GP I had been having annual PSA tests for 20 years with intermittent referrals to the (fantastic) Urology unit at Stepping Hill. Last year my PSA had risen to over 15 which had been set as the trigger point for further investigation. I had an MRI scan & bone scan – which revealed I had cancer to the edge of the prostate but fortunately it hadn’t spread outside or to the bones. A biopsy showed Gleason 7 – which led to a radical prostatectomy.

    The point is that the PSA test is an indicator and an MRI and targeted biopsy (if required) are what dictates required treatment (or not). This is only mentioned as an afterthought in the article – my understanding is that it is now best practice in the best centres. I don’t believe there are any serious risks in an MRI scan,

    My friend’s GP suggested a precautionary PSA test although no symptoms … PSA 20 … MRI … Biopsy … Op … life saved?

    Clearly a better blood test will be a major step forward but let’s not dismiss what we have that works – even if it’s imprecise.

  • Liz
    27 March 2018

    test

  • M J HARNETT
    27 March 2018

    I agree with disadvantages of a one off PSA,but surely a regular check say 1/2 annually would be better.This would show up a change in level which could be significant.

  • Julia Berg
    25 March 2018

    This article doesn’t make it clear if the rectal examination is worthwhile or not.
    Can a rectile examination reveal if cancer is present (with or without a PSA test)?
    if not, is it only a scan that can diagnose prostate cancer?
    In other words, what tests should men ask their doctor for (if over the age of 60) to check?
    Many thanks

  • Chris Falla
    25 March 2018

    Let no one forget that the first symptoms of prostate cancer are no symptoms.

    Katie Edmunds, I believe your article is misleading, very damaging – and bordering on moronic.
    You are in a position to reach and influence very many people, but very unfortunately you’ve done it with selective data and opinions, rather than ‘fact on the ground’. Who on earth approved this article for release?
    Firstly, you state that no available test will determine between aggressive and slow growth cancers.
    For me the test (after PSA and DRE) was a biopsy that led to a Gleason rating which in conjunction with a MRI scan informed my urologist and oncologist on the aggression level and led to my treatment options being explained and actioned.
    Secondly, you chose to quote Professor Richard Martin: “We’re not saying that screening for prostate cancer should be discounted. What we’re saying is PSA testing for prostate cancer is not the answer.” So PSA testing is not the answer? If you’ve got a better answer, Professor, we’re all ears.
    Let’s bring this back to earth with a post recopied from PCaSO Dorset (below). This is how it actually is ‘on the ground’ all over the country, men being properly informed and tested. What would you say to those 200 men mentioned below?
    You should withdraw your article and advise all who’ve read it that unfortunately it has not been considered or researched properly. Don’t forget decisions about lives are at stake here. Accuracy of information is totally key.

    ‘This report is not only inaccurate but misleading. As chairman of Prostate Cancer Support Organisation (PCaSO) in Dorset which has now offered free PSA testing for men. We have now tested 5,000 men. Of these, 600+ have been referred to their GPs and of those, 200 have either been treated (some with advanced prostate cancer) or have been “put on the radar” through active surveillance. Every man is made aware of the advantages and disadvantages of the test before they make their choice. Those with a low score are also advised that the result is a yardstick to compare with any further PSA tests which we recommend they have. We do not rely on anecdotal stories to support our success as we have received scores of letters from grateful men whose cancers have been identified early enough for a complete cure. The article, through its credulous and selective sorting of the “evidence”, is not only misleading but actually undermines the outcomes that we are trying to achieve. It also makes us question the future credibility of CRUK. Early detection of all forms of cancer is key to successful treatment. Symptoms often appear after cancer has already established itself – a contributing factor, I believe to the 12,000 men who die of it annually’

  • DONALD LEGGET
    25 March 2018

    Better to have a REGULAR PSA test every year. I agree a one-off test is not the answer. Just do it regularly.

  • Peter PHILLIPS
    25 March 2018

    This is a most helpful article, however it does create concern regarding diagnosis and in particular the identification of a cancer that is non aggressive but is treated aggressively. The MRI non invasive checking is the area that needs concentration of effort to determine accuracy.

  • Olaniyi Oladapo Timothy Onibiyo
    25 March 2018

    There should be a men screening ln the UK urgently please.

  • Bill Burrows
    25 March 2018

    I am 72 and for some years have had the PSA test once a year . More recently after a rectal exam. my GP prescribed Tamsulosin MR 400mcq which has not prevented dribbling sometime after having a pee. Should I seek to have an MRI scan?

  • Alan John Williams
    25 March 2018

    I asked for a voluntary PSA test as I’d read somewhere that if you’re over 50, it was a good idea to have one. If I hadn’t had one, I probably wouldn’t be here today, that was back in 2009, I was told I had cancer, and it was caught early. I had a laparoscopic prostatectomy in 2010, then I was told that it was worse than first thought, following the opp, it was found to have spread into my bladder. Then I was asked if I would like to try a clinical trial to help with research, so I agreed, I had harmone injections for 6 months, followed by radiotherapy for 4 weeks half way through the injections. The good news is that it appears to have worked. I now have a PSA test every 12 months to keep an eye on things, my main point being that if I hadn’t had a PSA test I would probably be dead now, I would rather suffer a biopsy of the prostate after a PSA test to be on the safe side, than not have a PSA test at all. I was 55 when I had my prostatectomy.

  • Amelie
    25 March 2018

    Unfortunately, I will not be donating to Cancer Research UK again because of this article. How disappointing. I agree with Chris.

  • Chris
    25 March 2018

    You’ve framed your email intro with a reference to Stephen Fry. The PSA test alerted him. It also alerted me (I’m in treatment) as well as thousands of men.
    To suggest that men without symptoms should not have the test is irresponsible. 40% of cases are not diagnosed until late stage. Why? The timeline between symptoms and late stage can be negligible.
    The issue lies with properly trained GPs and there are some horrendous ones out there. My brother (2.5 times likely to get it because I have) was fobbed of by his GP after I was diagnosed. That GP should be urgently re-trained.
    I agree that national screening is not possible, but every man over 50 should offered a baseline PSA test with proper education about the test from GP.
    No wonder survival rate in Britain is below the European average, with articles like this one.

  • Millie
    25 March 2018

    Whilst I agree more research should be conducted, I strongly disagree that you are implying that the PSA test is unhelpful. Many people close to me have only discovered that they have prostate cancer because of the PSA test and if it wasn’t available then it would be a completely different situation now. What are you suggesting? I disapprove of this article and I am very disappointed with the lack of alternatives. You are indicating that men should not get checked… But tell me, would Bill Turnbull and Stephen Fry agree with that?

  • Robert bullock
    25 March 2018

    Thankyou for the infirmation.

  • Gerald Cornick
    25 March 2018

    Whilst I agree that a better way of diagnosing prostate cancer should be a priority the most should be made of what we have. Me generally are reticent when it comes to speaking about health matters and the high profile publicity which we are seeing can only help.
    I was diagnosed with prostate cancer in September 2007 through a chance comment I made to my GP when visiting him for an entirely separate problem. Whilst my GP thought I was ok through an initial internal (anal) examination a blood test followed by an anal biopsy confirmed prostate cancer. By the time of my diagnosis it was too late for me to have my prostate removed so I went down the road of radiotherapy and hormone treatment.
    Thanks to a brilliant team of consultants I have had at the Royal Hampshire County Hospital Winchester and the NHS the cancer is very much being kept under control. When diagnosed my PSA was 18 & the last reading recently was 1.2.

  • Phil Shergold
    25 March 2018

    I have a family history of prostrate cancer. My father died of it at the age of 61, my two elder brothers have both have had their prostrates removed. I have a PSA test each year which I have to ask my GP for as it’s not an automatic recall. Each reading has come back lower than the 2 mark since I began having the test. I’m 60 next year & always aware that this strain of cancer may be hereditary. Screening sounds far more productive than the current method of testing which in turn will obviously save time & money.

  • Michael McClure
    25 March 2018

    I arrived back in the U.K. aged 68, in September 2014 after working in a highly stressful position. My PSA reading at that time was 37! Way above the advised 4. After a biopsy to check for cancer it returned a negative result. Over the past 3.5 years the PSA readings have slowly reduced – 27 – 19 – 22 – now 12 .5.
    Obviously very worrying.
    However as a very active cyclist my readings will always be high! Although I have friends, also cyclists with readings below 4.
    I will continue to be concerned I have been told that the reduction and ups/downs are a clear indication of no cancer.
    Then why is my readings so high?

  • Rogercharles
    25 March 2018

    It is a sad sad story.

  • Steve Mayers
    25 March 2018

    Very useful analysis, far better quality information than the media present

  • Helen Rowe
    25 March 2018

    Thank you for this very informative artical, I was under the impression that a PSA test was the answer for early detection in the battle against prostrate cancer and will pass on what I have learnt to family and friends that this isn’t the whole answer at all. Good luck with your continued work in the battle against this killer.

  • Yvonne
    24 March 2018

    Thank you for keeping me up-to-date on the progress of prostate cancer, which seems to be rather a difficult cancer to diagnose, but I have great faith in our laboratory personel to eventually be able to recognise this particular killer and then the battle begins. Continue your very special work, and keep all our men safe.

  • Eric Hewton
    24 March 2018

    I had the PSA test 12years ago. It was 5. Before we did any more I waited a month and had another test. It had risen to 6.5. A further test a month or so later and I was up to 7.5. This triggered a biopsy which found cancer and a high gleeson score. So I had radiotherapy. I believe I am still here because of the test. The simple conclusion is surely to rely, not one test, but on a follow up.

  • IAN MCDONALD
    24 March 2018

    I AM A PROSTRATE CANCER SUFFERER,MYSELF I DO NOT TRUST THE BLOOD TESTS,I HAVE BEEN TOLD MINE IS A LOT BETTER,BUT THEY WAY I FEEL I AM DOUGHTFULL,BUT WHAT CAN WE DO WE HAVE TO TRY AND TRUST,MYSELF MEN SHOULD BE MORE AWARE.

  • Lorraine Hopkinson
    24 March 2018

    The PSA test saved my husband’s life. His reading was high and subsequently he had a biopsy and MRI. He had advanced prostate cancer and had this not been detected when it was he may well not be alive now. In our view the comments from CRUK are not totally helpful.

  • Euan Holt
    24 March 2018

    Accepting there are no syptoms and you feel well aged approx. 70yrs ; having an unreliable PSA test may just cause unnecessary anxiety and possible treatment that isn’t necessary.

  • David Collins [email protected]
    24 March 2018

    It worked for me. I was diagnosed in 2008 and had the treatment later in 2008 This was Brachytherapy which consists of filling the prostate with small radioactive Seed like things.
    I worked for me My PSA levels are very low and so far the cancer didnt return However I have since has my right kidney removed as it was cancerous and Have had two small tumors removed from my Bladder. So I guess I am one very lucky guy. Best wishes to all

  • David wright
    24 March 2018

    Great keep it coming

  • Ian Davies
    24 March 2018

    Starting in my 70’s had an annual PSA test for several years with very slight but low annual increments. There was no real trend to observe, or so I thought. At the age of 80 the PSA result doubled and set off alarm bells with me and my GP, especially when he pointed out that a relatively low reading of 11 was in fact to be regarded as 22 because my Finasteride medication (to reduce an enlarged prostate) masked the true reading. No one had warned me of this before. He asked me to undergo a manual check of the prostate and found a lump. Within a few weeks I had gone through a thorough screening at the hospital and ended up with RT to eliminate the cancer in the prostate which had fortunately not actually broken out: I was right on the cusp of much worse. I think it is irresponsible of the media and some medical people to give the impression that PSA testing is useless/irresponsible/indesirable etc because of inadequacies in some instances. I note that your article carefully criticises one-off tests rather than PSA testing in general but the headlines resulting from this may be doing a great disservice to those at risk of prostate cancer. Yes, there must be better ways of screening comprehensively for cancer risk but please don’t allow the anti-PSA test headliners win the day. PSA testing is saving many lives by indicating a potential problem, mine for one!

  • Adrian Stone
    24 March 2018

    Research is extremely important………but until such time that an extra test/tests are discovered/ proved……the PSA Blood check should be used when requested as an indication

  • Derek
    24 March 2018

    Just been forwaded this article. I support totally the 2 points made by Paul Ledbury. I have had regular annual tests for many years, steady but minimal raise in levels. Regular monitoring for trends is better than “one-off then forget it”. But, why is it suggested that research and tests should be applied only to 50-69 year olds. Is my life not worth saving now I am in my 70s?

  • Kenneth
    15 March 2018

    I was diagnosed with prostate cancer a couple of years ago at age 48. My PSA test came back suggesting I was okay and could probably leave it for a while. However I went for keyhole surgery to remove prostate and I was later told my situation was much worse than what the PSA test had came back with. Basically if I had listened to the results and left it .. I would now be dead. Also the Gleason scale I was told before operation was also wrong. Again if I had went with this information I would now be dead. Very haunted to this day with the voice of doctor telling me it came down to a matter of a week or mabey two for me to be alive or not. I was so angry and still psychologically troubled. Since the operation I am happy to say my blood test “suggest” I am ok.

  • FP Graziano
    13 March 2018

    Never good looking for trouble? But what if. Medical research is the answer that hopefully will solve it.

  • Mike cole
    13 March 2018

    Yes there should be a test found to be useful for all men to have this decteced early for longevity of life

  • Ian
    13 March 2018

    Very useful, my father died from prostrate cancer at 67, now i’m 64 I am getting concerned, but do not want the rectal examination blood test could be useful in my case ?

  • Angus mcCuaig
    13 March 2018

    I would like to get a test done

  • Graham Turner
    13 March 2018

    The sooner you start the better I have prostate cancer and the biopsy and the examination I found degrading then you are left to make your decision from three options I am lucky in a way it’s watch and wait every three months for blood test

  • Brian Merritt
    13 March 2018

    As a result of receiving this text I am seriously considering cancelling my monthly donation to CRUK. I have prostate cancer which at the moment is held back by hormone therapy injections, I was diagnosed after a PSA test which pointed me to further tests which confirmed the diagnosis. If I had not had the PSA test I would not have been diagnosed in time and would not be alive now. If CRUK are using funds to make this crass research possible then I don’t think I want to be part of it.

  • David Allanson
    13 March 2018

    Helpful, glad I was sent the text/link to website.

  • Nick Goddard
    8 March 2018

    Since the age of 50 I had regular PSA screening as part of a private healthcare package. In 2010, at the age of 57, my PSA had rocketed, although I had no physical symptoms that worried me. The subsequent biopsy produced a Gleason score of 7, and scans indicated that there were nodes extending beyond the prostate wall. In other words I had a fairly aggressive cancer that was in danger of becoming advanced. My treatment of a robotic radical prostatectomy and radio therapy on the prostate bed a year later has been entirely successful and currently my PSA is undetectable.
    The message here is that, having no symptoms, without PSA screening the probability is that my cancer would not have been detected before it was too advanced for the chance of a cure!
    You cannot tell me that PSA screening does not have the potential to save lives, or at the very least enable treatments to be started earlier therefore extending their lives.

  • Paul Ledbury
    8 March 2018

    1. It would seem that the “other” reasons (on the infographic) for having raised PSA levels can be easily mitigated. Why not give better instructions to men having the test? Some NHS pages do have instructions on what not to do before the test (https://www.nhs.uk/livewell/prostatehealth/pages/psa-test.aspx) but none of these were mentioned to me by my GP, and none of them are included in the NHS/Public Health England leaflet I was given (https://www.gov.uk/government/publications/prostate-specific-antigen-testing-description-in-brief).

    2. Why the fixation on a one-off test? If it’s that unreliable as a one-off then wouldn’t it be better to use multiple tests over a period, to determine a trend? Like in Ben Stiller’s case: https://www.statnews.com/2016/10/04/ben-stiller-prostate-cancer-psa/

  • Jim Davis
    8 March 2018

    This report is not only inaccurate but misleading. As chairman of Prostate Cancer Support Organisation (PCaSO) in Dorset which has now offered free PSA testing for men. We have now tested 5,000 men. Of these, 600+ have been referred to their GPs and of those, 200 have either been treated (some with advanced prostate cancer) or have been “put on the radar” through active surveillance. Every man is made aware of the advantages and disadvantages of the test before they make their choice. Those with a low score are also advised that the result is a yardstick to compare with any further PSA tests which we recommend they have. We do not rely on anecdotal stories to support our success as we have received scores of letters from grateful men whose cancers have been identified early enough for a complete cure. The article, through its credulous and selective sorting of the “evidence”, is not only misleading but actually undermines the outcomes that we are trying to achieve. It also makes us question the future credibility of CRUK. Early detection of all forms of cancer is key to successful treatment. Symptoms often appear after cancer has already established itself – a contributing factor, I believe to the 12,000 men who die of it annually.

  • Katie Edmunds
    7 March 2018

    Hi David,

    Thanks for your comment.
    The infographic you mention is based on the data from the 2013 Cochrane Review. This review combined results from five of the biggest and most rigorous studies testing if prostate cancer screening would work. The overall conclusion was that PSA screening for prostate cancer doesn’t save lives. The CAP trial, published yesterday, adds further evidence that PSA screening doesn’t save lives.

    You can read more about why there aren’t screening programmes for all cancer types on our website.

    Best wishes,
    Katie, Cancer Research UK

  • roger bacon
    7 March 2018

    This research is not taking into perspective the recent PROMIS and ProtecT trial results where men are now having, in most hospitals, an mpMRI scan BEFORE a biopsy, the scan can show accurately if there is any cancer within the gland, if not the man walks away, if there is it can be targeted at the biopsy stage and given a gleason score. Many men now are put on active surveillance if the cancer is insignificant. The recent National Cancer Audit has shown that over treatment has reduced to 8%. The statement about PSA testing does not save lives is rubbish! The large European trial on PSA testing proved that our cancer death rate would reduce by 25%. Why is it in the USA, where PSA screening used to be happen, they decided to stop screening and now the death rate in the USA has increased year on year after screening stopped.

  • Alan Davies
    7 March 2018

    The graphic assumes that ALL of those men diagnosed with prostate cancer will be treated. That is clearly not the case unless watchful waiting is considered to be treatment. Even then, I assume that a few of those diagnosed would prefer not to be involved in a watchful waiting programme even. Watchful waiting certainly doesn’t classify as an invasive treatment. As a prostate cancer survivor I am certainly thankful to know that I no longer carry the uncertainty of not knowing whether I will die with prostate cancer or of it.

  • David Hutchinson
    6 March 2018

    Where is the real data on PSA testing? The graphic in the article said ‘If there was a PSA Prostate Cancer Screening Programme…’ It then presented data stating that NO lives would be saved as a result of such a programme. Where’s the data behind that statement? Has such a programme ever been conducted and if so, where is the data? I know several asymptomatic men who have been diagnosed with aggressive malignant prostate cancer following a PSA test result with a high number. I know that is anecdotal, but they are real people. How would they register on the graphic, which without real data behind it, is rather an insult to our intelligence. Prove it to me, and I will accept the argument.