Prostate cancer – the importance of screening and early detection

Posted: 14/02/2025

Prostate cancer is the most common cancer in men with more than 52,000 men being diagnosed every year. Indeed, one in eight men will be diagnosed with prostate cancer in their lifetime and around 490,000 men are living with and after prostate cancer. However, there is no national screening programme for the disease in the UK. 

Sir Chris Hoy, Olympic cycling champion, has said that raising awareness of prostate cancer since his own diagnosis has given him a new purpose, after it led to his friend's prostate cancer being caught early. Tragically, the six-time gold-medallist has terminal prostate cancer with a predicted life expectancy of just a few years.

Sir Chris reported that a male friend in his mid-50s, who had no symptoms would not have undergone a prostate-specific antigen (PSA) test to look for signs of prostate cancer had he not made his own diagnosis public. "Off the back of my diagnosis [he] went to his doctor, his doctor said, ‘you don't really need one’ or ‘there's no symptoms, come back when you've got any problems,'" he said. "He pushed the issue, and he had a test, and he has prostate cancer. He's being treated and he caught it early, so he's doing well, but if it had been left for another few years, who knows what might have happened."

So why is there no screening programme for prostate cancer in the UK, when catching cancer early is the best way to treat it successfully? The UK National Screening Committee does not currently recommend screening for prostate cancer because the PSA test, whilst helpful, is not reliable enough to detect prostate cancer that needs treatment. PSA stands for prostate specific antigen, which is a protein made by both normal and cancerous prostate cells. It is normal for all men to have some PSA in their blood. A high level of PSA can be a sign of prostate cancer but can also be raised due to other conditions that are not cancer, including urine infection or a benign enlarged prostate. A PSA test can therefore give a false positive result but can equally also miss some prostate cancers. Medical research has established that one in seven men with a normal PSA level have prostate cancer, and some of those will be fast-growing prostate cancers.

Prostate cancer can develop when cells in the prostate start to grow in an uncontrolled way. Some prostate cancer grows too slowly to cause any problems or affect life expectancy and therefore many men with prostate cancer will never need any treatment. It is said that in many cases, a man will die with prostate cancer, rather than die from it. However, some prostate cancer grows quickly, is more likely to spread and can then be life limiting.  Recognising the signs and symptoms of prostate cancer, to get a diagnosis and start treatment if required, is very important. Symptoms include an increased need to urinate, straining whilst urinating and a feeling that the bladder has not fully emptied. 

Men with these symptoms should consult their GP, who is likely to ask for a urine sample to check for infection, take a blood sample for PSA testing, and examine the prostate by way of a digital rectal examination. The GP should also consider the man’s individual risk factors for prostate cancer. Age, family history and ethnicity are relevant. Most cases develop in men aged 50 and above, prostate cancer is more common in black men and less common in Asian men, and men whose father or brother were affected by prostate cancer are at slightly increased risk themselves. It is also thought that obesity increases the risk of prostate cancer. The GP may then make a referral to hospital for further investigations, likely to include an MRI scan of the prostate, a biopsy and thereafter treatment that may include radiotherapy or cryotherapy to kill the cancer cells or surgery to remove the prostate (a prostatectomy). 

Given the lack of a screening programme for prostate cancer, it is imperative that a thorough assessment is undertaken by a GP when a patient has any symptoms suggestive of poor prostate health. Clinical negligence claims for failure to refer for prostate investigations have led to successful settlements, where avoidable injury has occurred. 

Case study

A man in his mid-60s received £40,000 in damages after GPs failed to refer him for a prostate biopsy, which cost him the opportunity of undergoing nerve-sparing surgery and left him with permanent erectile dysfunction. 

The claimant was seen by three different GPs over a period of three years. He had a relevant family history of his father having died of prostate cancer in his late 60s. The claimant had complained of urinary symptoms and traces of blood had been found in his urine. His PSA level had been tested, was raised and on retesting was noted to be rising. None of the GPs who saw him referred him for a prostate biopsy, as recommended by the guidelines. Finally, an urgent referral was made to the hospital urology team, PSA levels were recorded as raised again, a prostate biopsy was performed and prostate cancer diagnosed. Both sides of the prostate were affected but there was a high volume of the disease on the left side. The malignant tumour had by then grown outside of the prostate but had not spread to the seminal vesicles. The claimant underwent laparoscopic (keyhole) surgery to remove his prostate but due to the passage of time, it needed to be a non-nerve-sparing radical prostatectomy.

The claimant alleged that all three defendant GPs missed the opportunity to refer him, as they should have done, and due to those delays he needed more radical surgery which left him with erectile dysfunction and associated psychiatric harm. He required individual counselling to help him come to terms with his loss of sexual function and he and his wife underwent marital counselling. 

The case study is an example of how even when prostate cancer is diagnosed early enough to be treated, living with prostate cancer or its aftermath can be challenging for all sorts of reasons. There can be side effects of treatment, and the diagnosis itself can cause anxiety and depression. It may be difficult or impossible to work during treatment, due to fatigue and feeling unwell, and this can then cause financial loss. 

If you are concerned that you, or someone close to you, may not have received appropriate medical care when they experienced urinary or oncology symptoms, please do get in touch with our specialist team by email or on 0800 328 9545. Initial advice is offered free of charge and without obligation. 

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