What age?

[janiceS]

Hi - my husband and I are just about reaching our 50th birthdays and we have both been v.lucky with our health etc - we never need to go to our doctors. However it crossed my mind (seeing all the publicity around Movember) that maybe my husband should be thinking about having his prostate checked out or even a general MOT. What age should he be having this checked? Thanks - sorry might seem a very obvious question.

[Dr Jon Rees]

Hi there,

great question, a problem that worries lots of people due to the vast amount of publicity about health checks and screening.

Glad to hear your husband is in good health. Also think of any particular family history, and in this context particularly of prostate cancer (in his father or any brothers). If no history in the family then the decision to have a psa test or not is difficult. There is currently no national screening programme precisely because there is not good enough evidence that it is of benefit - having a test runs the risk of creating problems in terms of overdiagnosing insignficant microscopic prostate cancer and can potentially do more harm than good. There are various information leafelts available on the internet, eg on www.patient.co.uk but also some really good online decision aids - I would recommend this one: http://sdm.rightcare.nhs.uk/pda/psa-testing/ - this can be really good in giving you the important facts to aid a decision.

OTher tests - he should have his BP checked - if normal, repeat it every few years thru his dr surgery. Think about having a cholesterol test, especially if a family history of heart disease. The most important way for him to stay healthy though is nothing to do with drs or tests - simply to keep weight under control and do as much physical exercise as possible (and not smoke) - that will do far more good than anything done by medicine.

Does that help = let me know if you want to ask anything more from this....

[Mr Christopher Eden]

Dr Rees is correct to point out that screening for prostate cancer is not mainstream and remains contentious.

However, balanced against the risk of over-diagnosis and over-treatment is the reality that one man dies of prostate cancer every hour in the UK and that the latest evidence (from the Swedish arm of the European Randomised Study of Screening for Prostate Cancer - ERSPC) shows a 56% reduction in prostate cancer related death in screened individuals versus the unscreened. The reason why other studies have failed to show this is that patients have not been followed for long enough (most screening studies conducted to date) or gave been flawed methodologically by including a number of men whose PSA had already been checked at some earlier stage (like the American PLCO study). The ERSPC study also showed that 42% fewer patients had incurable prostate cancer at the time of diagnosis if they had been detected by PSA screening.

The concern regarding over-diagnosis and over-treatment has been overplayed, in my opinion, as most men diagnosed with a small volume of a slowly-growing tumour will be managed by monitoring alone (active surveillance) and needs to be balanced against under-diagnosis, under-treatment and death. This is a very different perspective to that of Dr Rees but one that is borne out by recently acquired evidence and recent changes in medical practice and is also one that is gaining ground. I think that the main barrier to screening for prostate cancer is, and will remain, its cost.

[Philippa Aslet]

This remains a difficult question and one which doctors don't all agree.

There is evidence for and against screening for prostate cancer and both Dr Rees and Mr Eden have a good argument and give good advice. However your husband is left with a choice. PSA is not a diagnostic test but it is a useful marker. If your husband has the test and it is elevated than that will trigger a referral to a urologist and some further investigations. If he is found to have a significant prostate cancer he will be glad it was done. If the test is normal he will have some reassurance. Though a normal PSA today does not mean he will never go on to develop the disease.

There is no right or wrong here. The patient information links can be very useful. I would also suggest prostate cancer charity website. They have a helpful leaflet on PSA testing. On balance if a man of 50 like your husband asks for a PSA, I will do the test for them.