Prostates, PSA tests and the conversation men should not avoid

By Dr Mick Watts MBBS MRCGP

(Mick is a GP at Windsor Wellness Clinic with a particular interest in men’s health, healthy ageing and lifestyle medicine.)

Men’s Health Week gives a useful opportunity to talk about one of the subjects many men would rather avoid.

The prostate.

The prostate is in the news again this week as Jeremy Clarkson has revealed that he is sadly suffering from prostate cancer. Lets help use this as an opportunity to raise awareness. I wish him all the best and am pleased to say that the overall 5 year survival for all stages of cancer of the prostate taken together is an excellent 97-98%. So no doubt we will all be able to look forward to season 6!

The prostate is a small gland, but it causes a remarkable amount of anxiety, as well as a surprising amount of mispronunciation and misspelling.

Some of that anxiety is understandable. Prostate cancer is common. Benign prostate enlargement is common. Urinary symptoms are common. Most men know someone who has had a prostate problem, and many quietly wonder whether they should be doing something about their own risk.

The difficulty is that worry does not always lead to action. We addressed some of the reasons for this in my earlier blog Why men put off going to the doctor. (Click for link)

Many men notice urinary symptoms and hope they will settle. Others worry about prostate cancer but avoid the conversation because they fear what might follow. Some are put off by the thought of an examination. Some assume that if they feel well, nothing serious can be going on.

The first thing to say is this. Most prostate symptoms are not caused by cancer.

The prostate commonly enlarges with age. This is called benign prostate enlargement, or benign prostatic hyperplasia. The word benign matters. It means non cancerous.

An enlarged prostate can press on the tube that carries urine out from the bladder. This can cause symptoms such as passing urine more often, getting up at night to pass urine, urgency, difficulty getting started, a weak flow, dribbling, stopping and starting, or feeling that the bladder has not emptied properly.

These symptoms can be frustrating, embarrassing and tiring, especially when sleep is disturbed night after night. But they are also very treatable.

In many cases, simple measures can help. Reducing evening fluids, moderating caffeine and alcohol, treating constipation, reviewing medication and improving general fitness can all make a difference. When symptoms are more troublesome, tablets are often very effective. Some relax the prostate and bladder neck. Others gradually shrink the prostate. There are also good surgical options for men who need them.

The important point is that benign prostate disease is manageable. Men do not need to suffer quietly.

Prostate cancer is not so straightforward but is in general a manageable condition.

Early prostate cancer often causes no symptoms at all. That is why waiting for symptoms is not a safe strategy. When symptoms do occur, they may overlap with benign prostate enlargement, which is why assessment matters.

Men should seek medical advice if they notice urinary symptoms that persist, visible blood in the urine, new erectile dysfunction, unexplained pelvic discomfort, bone pain, weight loss or a general sense that something has changed and is not right.

Most of the time, the explanation will not be cancer. But it is still worth checking.

The PSA blood test is one of the tools we use to assess prostate risk. PSA stands for prostate specific antigen. It is a protein produced by the prostate. A raised PSA can be caused by prostate cancer, but also by benign enlargement, infection, recent ejaculation, vigorous cycling or even recent procedures involving the prostate.

So the PSA test is useful, but it is not perfect.

A normal PSA does not absolutely rule out cancer. A raised PSA does not mean a man has cancer. It means we need to interpret the result sensibly, taking into account age, risk factors, symptoms, examination findings and sometimes repeat testing or further investigation.

This is why the best approach is not panic. It is a proper conversation.

In the UK, there is no routine national prostate screening programme for all men.

But, men aged over 50 can ask their GP about a PSA test and should be given balanced information about the benefits and limitations before deciding. Men at higher risk may need that conversation earlier. For more information

Risk is higher in men of colour, in men with a father or brother who has had prostate cancer, and in men with certain inherited cancer risks such as BRCA2. Current UK screening recommendations support targeted PSA screening for men aged 45 to 61 who have a BRCA2 gene change and a relevant family history of breast, ovarian, pancreatic or prostate cancer.

That sounds complicated, but the practical message is simple:

If you are over 50, consider discussing PSA testing with your GP.

If you are Black, or if prostate cancer runs in your family, consider having that conversation from 45.

If you have a known BRCA2 gene change, or a strong family history of related cancers, make sure your GP knows.

The NHS, Cancer Research UK, and Prostate Cancer UK produce a leaflet with excellent balanced advice around testing for men with no symptoms. (Click here)

If you have urinary symptoms, blood in the urine, new erectile problems or unexplained pain, do not wait for a screening invitation. Make an appointment.

One fear I hear from men is that any discussion about the prostate will automatically involve a rectal examination.

That fear is understandable, but it is often exaggerated.

A rectal examination can still be useful in some circumstances, particularly if a man has symptoms or if the doctor needs more information about the size, tenderness or feel of the prostate. But it is not necessarily a routine part of every primary care conversation about PSA testing. Many assessments begin with a discussion, a urine test and a blood test. If an examination is recommended, it should be explained clearly and done respectfully. You remain in control of what happens.

For some men, removing that fear is enough to make the appointment possible.

The encouraging news is that prostate cancer diagnosed early often has excellent outcomes. Many prostate cancers are slow growing. Some do not need immediate treatment and can be monitored carefully through active surveillance, often requiring regular MRI scans. Others can be treated effectively with surgery, radiotherapy, hormone treatment or combinations of these.

Modern prostate cancer care is far more nuanced than many men imagine. A diagnosis does not automatically mean aggressive treatment. It means understanding the type of cancer, the stage, the risk and the best options.

But early diagnosis gives men more choices.

This is the message I would like men to take from Men’s Health Week:

Do not ignore urinary symptoms. Do not assume prostate problems are just part of getting older. Do not let embarrassment stop you from asking about PSA testing. Do not wait until symptoms become severe.

Most prostate problems are manageable. Many are benign. Prostate cancer, when found early, is often highly treatable.

The first step is not dramatic. It is simply a conversation.

If you are unsure about your risk, speak to your GP or healthcare professional. An appointment, a urine test and a blood test may be all that is needed to begin making sense of things.

Men often worry that they should look after everyone else before they look after themselves.

This is one area where a little earlier attention can make a very large difference.

This blog is written for general information and encouragement. It is not a substitute for personal medical advice. Every man’s health, circumstances and risks are different. If you have concerns about your own health, urinary symptoms, prostate cancer risk, or whether PSA testing is right for you, please speak to your own GP or healthcare professional. I cannot discuss individual cases.

I welcome your feedback and any suggestions for future men's health articles.