Movember Matters: Shedding Light on Prostate Cancer Screening in the UK (and Beyond)

Article by Dr. Donald Greig

November, or Movember, is a time to raise awareness about men’s health, including mental health, testicular cancer, and prostate cancer. Prostate cancer is the most common cancer in men in the UK, with over 52,000 men diagnosed each year. While early detection can save lives, prostate cancer screening comes with both benefits and pitfalls that every man should understand.

In this newsletter, we’ll explore what prostate cancer screening involves, who should consider it, and the pros and cons of screening, all with a focus on the UK perspective—and a brief look at prostate cancer in Hong Kong, where rising cases are also a concern.

What Is Prostate Cancer?

Prostate cancer develops in the prostate gland, a small walnut-shaped gland that produces semen. It is often slow-growing and may not cause symptoms for many years. However, aggressive forms of the disease can spread quickly and become life-threatening if not treated early.

Prostate cancer is most common in men over 50, with risk increasing significantly as men age. Other key risk factors include:

• Family history: Men with a father or brother who had prostate cancer are at higher risk.

• Ethnicity: Black men are more likely to develop prostate cancer and at a younger age than other ethnic groups.

• Lifestyle factors: Diet, obesity, and physical inactivity may contribute to risk.

What Is Prostate Cancer Screening?

In the UK, prostate cancer screening typically involves a PSA (Prostate-Specific Antigen) blood test. PSA is a protein produced by the prostate, and high levels in the blood may indicate prostate cancer. However, elevated PSA can also occur due to non-cancerous conditions, such as an enlarged prostate or prostatitis (inflammation of the prostate).

What Happens During Screening?

1. PSA Test: A simple blood test is taken to measure PSA levels. This increases with age as the prostate gradually enlarges called benign prostatic hyperplasia.  It is important to recognise that a raised PSA may not always signify prostate cancer and conversely, a normal PSA doesn’t always mean that a cancer is not present. Interpretation of this test requires experience and holistic assessment of each individual.

2. Digital Rectal Examination (DRE): In some cases, a doctor may perform a physical examination of the prostate to feel for abnormalities.

3. Further Tests: If PSA levels are high, additional tests such as an MRI scan or a biopsy may be recommended to confirm a diagnosis. MRI scans may also be considered in higher risk men even if the PSA is normal.

Who Should Consider Screening?

In the UK, there is no national prostate cancer screening programme, like those for breast or cervical cancer. This is because the PSA test is not considered reliable enough to justify population-wide screening. Instead, prostate cancer screening is offered on a case-by-case basis through the NHS Prostate Cancer Risk Management Programme. In future newsletters this month, I will explore what is currently available and reported.

Men who should consider a PSA test include:

• Men over 50: If you are over 50, you have the right to request a PSA test from your GP.

• Men with a family history of prostate cancer: Screening may be recommended for men with a father or brother diagnosed with prostate cancer, particularly if they were under 60 at diagnosis.

• Black men over 45: Due to higher risk, Black men should consider discussing screening with their GP from the age of 45.

Prostate Cancer in Hong Kong: A Growing Concern

Prostate cancer is also a significant issue in Hong Kong, where it is the third most common cancer among men, after lung and colorectal cancers. The number of cases has been steadily rising, with over 2,000 new diagnoses each year, likely due to increased awareness, aging populations, and lifestyle changes.

Despite the rising incidence, awareness of prostate cancer in Hong Kong remains relatively low compared to the UK or other Western countries. Screening practices, including PSA tests, are not widely implemented as part of routine health checks, and like in the UK, there is no universal screening programme. The Hong Kong Department of Health recommends men discuss screening with their doctors, particularly if they are over 50 or have a family history of the disease.

A notable challenge in Hong Kong is the stigma surrounding men’s health, which can delay diagnosis and treatment. Increased public education and initiatives, similar to Movember campaigns in the UK, could help encourage men to take proactive steps in managing their prostate health.

Benefits of Prostate Cancer Screening

1. Early Detection Saves Lives

   Prostate cancer caught early is far easier to treat and has significantly better outcomes. Localised prostate cancer (confined to the prostate) has a nearly 100% survival rate at 5 years when treated promptly.

2. Reassurance

   For many men, a normal PSA result can provide peace of mind regarding their prostate health.

   
   

3. Targeted Monitoring

   If cancer is detected early, doctors can monitor it closely with a strategy called active surveillance, delaying or avoiding more invasive treatments until necessary.

Pitfalls of Prostate Cancer Screening

While screening has its benefits, there are also important drawbacks to consider:

1. Overdiagnosis and Overtreatment

   • Many prostate cancers are slow-growing and may never cause symptoms or become life-threatening. However, a diagnosis can lead to unnecessary anxiety and treatments like surgery or radiotherapy, which carry risks of side effects such as incontinence and erectile dysfunction.

   • Studies estimate that up to 50% of prostate cancers detected through PSA screening may not require treatment.

2. False Positives

   • Elevated PSA levels don’t always indicate cancer. Conditions like benign prostatic hyperplasia (enlarged prostate) or prostatitis can also raise PSA levels. False positives can lead to unnecessary tests, including invasive biopsies.

3. False Negatives

   • The PSA test is not perfect—it can miss prostate cancers in their early stages, giving false reassurance. Some men with normal PSA levels may still have cancer.

4. Side Effects of Testing

   • Diagnostic procedures, such as biopsies, can result in infection, bleeding, or pain.

5. Psychological Impact

   • Even when cancer is not found, the stress of waiting for results or undergoing tests can take a toll on mental health.

Should You Get Screened?

The decision to undergo prostate cancer screening is personal and should be made after discussing the risks and benefits with your GP. Key questions to ask yourself include:

• Do I have risk factors, such as age, family history, or ethnicity?

• Am I prepared for the possibility of further tests and potential treatment?

• Would knowing my PSA levels provide reassurance or cause anxiety?
  

Movember: Taking Action for Men’s Health

Movember is more than just an excuse to grow a moustache—it’s a global movement that encourages men to take control of their health. Prostate cancer awareness is a key focus, and screening is an important tool in reducing the burden of the disease.

What Can You Do This Movember?

• Start the Conversation: Talk to your GP about prostate cancer screening if you’re over 50 or have risk factors.

• Encourage Others: Share this information with friends and family to raise awareness.

• Know the Symptoms: Although early prostate cancer often has no symptoms, advanced signs include difficulty urinating, blood in urine or semen, and back or hip pain.
  

Final Thoughts

Prostate cancer screening in the UK and Hong Kong is not one-size-fits-all. While the PSA test has its limitations, it remains a valuable tool for men at higher risk. By understanding the benefits and pitfalls of screening, men can make informed decisions about their health.

This Movember, let’s break the silence on prostate cancer and encourage men to take proactive steps toward early detection and better health outcomes. 💙

Stay informed, stay proactive, and take care of your health. #Movember #ProstateCancerAwareness #MensHealth #PSATest #KnowYourRisk #EarlyDetection #TheNewClinic

Disclaimer: This newsletter is for informational purposes only and does not constitute medical advice. Always consult your healthcare provider for any medical concerns.