The Importance of PSA Testing: Why We Must Do Better for Men's Health
Another Missed Opportunity: The UK Says No to National Screening for Prostate Cancer.
November 2025 brought disappointing news for prostate cancer awareness campaigners across the UK. Once again, the UK National Screening Committee (UK NSC) declined to recommend a national prostate cancer screening programme. Despite mounting evidence showing that modern diagnostic pathways have transformed prostate cancer detection, and despite the stark health inequalities affecting Black men, the committee cited concerns about overdiagnosis and the accuracy of PSA testing as reasons to maintain the status quo.
This decision is particularly frustrating because it fails to recognise how dramatically the landscape has changed. The diagnostic pathway of today bears little resemblance to the one that existed when previous decisions were made.
The Harsh Reality: Numbers That Demand Action
Prostate cancer remains a devastating disease affecting men across the UK, but the burden is not shared equally. According to Prostate Cancer UK, the statistics paint a sobering picture:
More than 56,000 men are diagnosed with prostate cancer every year in England alone
One man dies from prostate cancer every hour in England
Prostate cancer is now the most common cancer in men, and in England, it's the most common cancer overall
Around 510,000 men are living with or after prostate cancer in the UK
But these numbers mask a deeper injustice.
Black Men: A Community at Crisis Point
The data on Black men and prostate cancer reveals a health inequality that should shame our healthcare system. Research highlighted by Prostate Cancer UK shows that:
1 in 4 Black men will be diagnosed with prostate cancer in their lifetime, compared to 1 in 8 men overall
Black men are 2-3 times more likely to develop prostate cancer than white men
Black men face a 30% higher mortality rate from the disease
Black men are more likely to be diagnosed with advanced stage disease
Recent analysis from the National Prostate Cancer Audit revealed that Black men have higher rates of stage 3 and 4 prostate cancer diagnosis. This means they're being diagnosed too late, when treatment options are more limited and outcomes are worse.
As Keith Morgan, Associate Director of Black Health Equity at Prostate Cancer UK, powerfully stated: "We know that Black men are at a higher risk of getting prostate cancer but this new data shows that, if you're Black, the odds are currently stacked even higher against you."
Almost 1,600 Black men are diagnosed with prostate cancer each year in England, and current NHS guidelines are failing them. Guidelines treat all men the same, despite the overwhelming evidence that Black men have a dramatically higher risk. They can't discuss PSA testing proactively with Black men from age 45, leaving many unaware of their elevated risk until symptoms appear—often too late for the best treatment outcomes.
What's Changed? Modern Diagnostics Transform the Pathway
One of the key arguments against screening has always been the risk of overdiagnosis and unnecessary treatment.
The MRI Revolution
The introduction of multiparametric MRI (mpMRI) into the diagnostic pathway has fundamentally changed how we detect and manage prostate cancer. Research shows that:
MRI can reduce unnecessary biopsies by up to 27%
It detects 93% of clinically significant cancers, compared to just 48% with traditional methods alone
Pre-biopsy MRI helps distinguish aggressive cancers that need treatment from indolent ones that may be safely monitored
Men with negative MRI results can safely avoid immediate biopsy, with robust follow-up protocols in place
Studies like PROMIS and PRECISION have demonstrated that using MRI to triage men with elevated PSA significantly reduces both unnecessary biopsies and the detection of clinically insignificant cancers. The National Institute for Health and Care Excellence (NICE) recognised this in 2019 by recommending MRI before biopsy for suspected prostate cancer.
Better Risk Stratification
Modern diagnostic approaches don't rely on PSA alone. Clinicians now use:
PSA density calculations (PSA level relative to prostate size) to improve accuracy
Risk assessment tools that combine PSA with age, ethnicity, and family history
Targeted MRI-guided biopsies that sample suspicious areas precisely
Active surveillance protocols for low-risk cancers, avoiding overtreatment
This sophisticated, multi-layered approach means we can find dangerous cancers early while avoiding unnecessary treatment for harmless ones. The diagnostic pathway of 2025 is light years ahead of what existed even a decade ago.
PSA Testing: Your Right, Not a Privilege
Despite the lack of a national screening programme, it's crucial to understand your rights. Under current NHS guidance:
All men aged 50 and over can request a PSA test from their GP
Black men and men with a family history should be able to request testing from age 45
You should receive balanced information about the pros and cons before testing
No man should be denied a PSA test because they lack symptoms
According to the Prostate Cancer Risk Management Programme, GPs should offer PSA tests to men who request them after an informed discussion.
Contact Prostate Cancer UK's Risk Information Service (0800 074 8383)
Complete the Risk Checker on Prostate Cancer UK's website and use the results to support your request
Preparing for Your PSA Test: Essential Do's and Don'ts
To ensure accurate results from your PSA blood test, proper preparation is essential. Certain activities can temporarily elevate PSA levels, leading to false positives and unnecessary anxiety.
DO:
Eat and drink normally before your test—no fasting required
Stay well hydrated in the days leading up to the test
Schedule your test for the morning when PSA levels tend to be more consistent
Wear clothing with sleeves that roll up easily for blood draw
Inform your GP about all medications you're taking
Communicate any concerns or recent medical procedures
DON'T:
Avoid sexual activity (including masturbation) for at least 48 hours before the test—ejaculation can temporarily raise PSA levels
Skip vigorous exercise for 48 hours before testing—especially weightlifting, contact sports, cycling, or horse riding
Don't have a PSA test after a digital rectal examination—if both are needed, ensure the blood test is done first
Avoid testing within 6 weeks of a urinary tract infection or while taking antibiotics for one
Don't test soon after prostate procedures like biopsy or catheterisation—wait at least 6 weeks
Avoid excessive alcohol consumption before the test
Medications to Discuss:
Certain medications can affect PSA levels:
5-alpha reductase inhibitors (finasteride, dutasteride) for enlarged prostate can lower PSA levels
Discuss with your GP whether you should temporarily discontinue any medications before testing
The Way Forward: What Needs to Happen
The evidence for change is overwhelming. Prostate Cancer UK has outlined what must happen:
Update NHS guidelines immediately to allow GPs to proactively discuss prostate cancer risk with Black men from age 45
Implement targeted screening for high-risk groups, including Black men, men with family history, and those with BRCA gene variations
Invest in the TRANSFORM trial—the £42 million, multi-year study that could provide definitive evidence on the best screening approaches
Mandate data collection on ethnicity in all cancer statistics to properly track and address inequalities
Launch awareness campaigns specifically targeting Black communities, using culturally appropriate messaging and materials
Train healthcare professionals on prostate cancer risk factors, particularly the elevated risk for Black men
What You Can Do Today
Don't wait for policy to change. If you're at risk, take action now:
If You're Over 50 (or Over 45 and Black or Have Family History):
Complete the Risk Checker at Prostate Cancer UK's website
Book an appointment with your GP to discuss PSA testing,we offer this at House of Health UK too for £99.
Don't be put off if you have no symptoms—early prostate cancer rarely causes symptoms
Contact Prostate Cancer UK's Risk Information Service for support and guidance
Help Raise Awareness:
Share information about prostate cancer risk with the men in your life
Encourage Black men you know to learn about their elevated risk
Support organisations like Prostate Cancer UK in their advocacy work
Challenge the misconceptions that surround prostate cancer screening
Until that changes, every man must become his own advocate. Know your risk. Request your test. Don't wait until symptoms appear—by then, it may be too late.
Prostate cancer caught early has excellent survival rates. The five-year survival rate for localised prostate cancer is nearly 100%. But that only applies if we find it early.
For more information, support, or to check your risk, visit Prostate Cancer UK at prostatecanceruk.org or call their specialist nurses on 0800 074 8383.
If you're concerned about your prostate health, don't wait—speak to your GP today. You have the right to a PSA test, and catching cancer early could save your life.
We offer PSA testing for £99 @ HOUSE OF HEALTH UK.
