PCUK HAVE ANNOUNCED THEIR INTERIM POSITION ON PSA TESTING - NOVEMBER 2022

Interim position

Following a review of new evidence and two co-production workshops including men with lived experience, academics, and clinicians, we have agreed some key changes in what we think and say about the PSA blood test for men without symptoms. This is an interim position because a large-scale epidemiological study of PSA blood test use in the UK and an evidence review are currently underway; our position will continue to evolve in response to our findings.

Statement 1

Since the 2019 NICE guidance updateⁱ, the prostate cancer diagnosis and treatment pathway changed to make it safer and more accurate.

Statement 2

The PSA blood test is the first step in the prostate cancer diagnostic pathway. It is a cheap, safe and effective way of identifying men who would benefit from further testing – in the first instance an MRI scan.

Statement 3

There isn’t a national screening programme for prostate cancer^xii, so men won’t get invited to have a test. Men at risk, have a right to a PSA blood test for free from their GP if they want one^xiv.

Statement 4

The risks from over-diagnosis and over-treatment of prostate cancer have reduced to a point where we believe GPs should proactively engage higher-risk men, about the PSA blood test.

Statement 5

The individual benefits of a PSA blood test will be different for each man. This is because some men will have more risk factors than others or will have pre-existing health conditions. Information or counselling on the PSA blood test should explain this.

Statement 6

Our role, alongside the NHS, is to reach and activate higher-risk men and support them to make an informed choice about whether to have a PSA blood test. We can achieve this through partnership awareness campaigns and our risk checker.

Statement 7

Because Black men have double the risk of prostate cancer and develop it younger, we strongly recommend they talk to their GP about a regular PSA blood test from the age of 45. As a Black man, if you are worried about prostate cancer, you can speak to a GP from any age.

Statement 8

Men with a known family history of prostate, breast, or ovarian cancer – in particular if a first degree relative has died of these cancers – are at higher risk and we strongly recommend they talk to their GP about a regular PSA blood test from the age of 45.

Black Men with a known family history of prostate, breast, or ovarian cancer – in particular if a first degree relative has died of these cancers – are at the highest risk and should seriously consider PSA blood testing at an earlier age.

Statement 9

One normal PSA result can’t rule out a future diagnosis of prostate cancer. Regular PSA tests can spot trends in PSA levels.

Statement 10

The European Commission is calling for prostate cancer screening in men up to 70 on the basis of PSA testing, and magnetic resonance imaging (MRI) scanning as follow-up^xxxiii,xxxiv, The recommendations are backed by a combination of evidence from randomised controlled trials and real-world studies^xxxv. We believe this provides good evidence to change current practice but acknowledge that some evidence gaps remain.

Should this recommendation be ratified in Europe, we would urgently call on the UK National Screening Committee to review this evidence in a UK-specific context and assess whether the proposed framework for screening should also be rolled out in the UK.