Prostate Health: A Comprehensive Guide to Screening and Awareness
While many individuals are proactive about scheduling smear tests or mammograms, discussions surrounding prostate health often remain surprisingly muted. To shift this narrative ahead of Prostate Cancer Awareness Month in March, we have compiled expert insights to help men navigate the screening process with greater confidence and clarity.
Understanding Your Risk Factors
Mr Wissam Abou-Chedid, a prominent consultant urological surgeon at Nuffield Health, emphasizes that recognizing personal risk factors is a crucial first step toward proactive health management. He highlights several key elements that significantly influence prostate cancer risk, as reported by Camilla Foster.
- Ethnicity: Statistics reveal that 1 in 4 Afro-Caribbean men will develop prostate cancer in their lifetime, compared to 1 in 8 Caucasian men and 1 in 13 Asian men.
- Genetics: Individuals carrying BRCA1 or BRCA2 mutations face an elevated risk of prostate cancer.
- Family History: If a father, brother, or uncle has been diagnosed with prostate cancer, your own risk increases substantially.
- Age: Most diagnoses occur between the ages of 70 and 74, as the risk naturally escalates with advancing years.
The Screening Process in the UK
In the United Kingdom, there is no continuous national screening programme for prostate cancer, but men still retain the right to request testing. Any man over the age of 50 can ask for a PSA (Prostate-Specific Antigen) check from their general practitioner, while those over 45 with a family history are also strongly encouraged to come forward.
What to Expect During a GP Consultation
Your doctor will initiate the consultation by discussing your specific risk factors and explaining the intricacies of the PSA test. This dialogue ensures you comprehend the 'pros and cons,' such as the benefit of early detection versus the potential anxiety associated with over-diagnosis for non-aggressive cases.
Mr Abou-Chedid clarifies, "PSA is a protein secreted by the prostate that can be elevated if there is prostate cancer. The result should give us an idea about what to do next."
Preparing for Your PSA Test
The PSA test involves a simple blood draw, but certain activities can 'falsely' inflate your levels. "PSA is not a tumour marker, so it can be elevated due to a number of things," notes Abou-Chedid. Prostate Cancer UK recommends adhering to these guidelines before your appointment to ensure the most accurate reading:
- Ejaculation: This can raise PSA levels by up to 20%, so avoid for 48 hours prior to the test.
- Vigorous Exercise: Activities like long-distance cycling or horse riding cause pelvic stress, which can also elevate PSA levels; avoid for 48 hours before the test.
- Active Infections: A current urinary tract infection can cause a temporary spike in protein levels, so wait until the infection has cleared—ideally around six weeks.
- Medicines: Inform your GP or practice nurse about any prescription or over-the-counter medications, as some might affect your PSA level.
- Prostate Stimulation: Having your prostate stimulated during sex might raise your PSA level temporarily; avoid this for a week before a PSA test.
The Path to Diagnosis: What Comes Next?
Importantly, you do not need to wait for symptoms to request a test, as early-stage prostate cancer is almost always asymptomatic. "If your PSA levels come back elevated, then the first step is to do another PSA test after a few weeks," explains Abou-Chedid. "If the second test is also higher than it should be, then your GP will refer you to your local NHS Trust, where you will be offered an MRI scan."
If the MRI identifies suspicious areas, a biopsy may be recommended, with results typically available within 10 days. From there, specialists assess whether the cancer is 'high-risk' and requires treatment, or 'low-risk,' which can be safely monitored through an active surveillance pathway involving regular checks rather than immediate surgery or radiation.
A Note on the 'Finger Test'
Many men avoid visiting their GP due to fear of a digital rectal examination (DRE). However, current guidance from The British Association of Urological Surgeons suggests that GPs move away from this as a primary screening tool, focusing instead on the PSA blood test to make the process less intimidating for patients.
By understanding these steps and risk factors, men can take empowered actions toward maintaining their prostate health, especially during Prostate Cancer Awareness Month.
