PSA Testing: Making an Informed Decision About Prostate Cancer Screening

Prostate cancer is now the most commonly diagnosed cancer in England, with over 58,000 men diagnosed in 2024 alone [NPCA State of the Nation Report, 2025]. Across the UK, the figure is higher still. And yet there is no national screening programme for prostate cancer, because the main screening tool, the PSA blood test, has significant limitations that every man considering it should understand.

This article explains what PSA measures, what it can and can't tell you, what the latest long-term evidence says about screening, and how to make a genuinely informed decision about whether to get tested.

What Is PSA?

PSA (prostate-specific antigen) is a protein produced by the prostate gland. It's present in the bloodstream of virtually all men, and its level is measured with a simple blood test. A higher PSA level can be a sign of prostate cancer, but it can also be raised by several non-cancerous conditions:

• Benign prostatic hyperplasia (BPH): an enlarged prostate, extremely common in men over 50

• Prostatitis: inflammation or infection of the prostate

• Recent ejaculation or vigorous exercise: both can temporarily raise PSA

• Urinary tract infections: can cause transient elevation

• Age: PSA naturally rises as the prostate grows with age

This is the core challenge with PSA testing. A raised result doesn't necessarily mean cancer, and a normal result doesn't guarantee you're cancer-free.

What PSA Level Triggers Further Investigation?

There is no single "normal" PSA level. NICE guideline NG131 uses age-adjusted thresholds for referring men for further assessment:

• Age 40 to 49: PSA above 2.5 ng/mL

• Age 50 to 59: PSA above 3.5 ng/mL

• Age 60 to 69: PSA above 4.5 ng/mL

• Age 70 to 79: PSA above 6.5 ng/mL

These thresholds exist because the prostate naturally enlarges with age, producing more PSA. A PSA of 4.0 ng/mL in a 45-year-old is more significant than the same level in a 75-year-old. If your PSA is above the threshold for your age, your GP will typically discuss referral for further investigation, which now usually begins with an MRI scan (multiparametric MRI, or mpMRI) rather than an immediate biopsy [NICE NG131].

What Does the Evidence Say About PSA Screening?

The UK doesn't have a national prostate cancer screening programme. Instead, the NHS operates an informed choice model: any man aged 50 or over can request a PSA test from their GP after discussing the benefits and limitations. The reason for this cautious approach is that the evidence on screening has, until recently, been finely balanced.

The European Randomised Study of Screening for Prostate Cancer (ERSPC) is the largest and longest-running trial of PSA screening. Its 23-year follow-up, published in the New England Journal of Medicine in October 2025, provides the most definitive data we have [Roobol et al., NEJM, 2025]:

• PSA screening reduced prostate cancer deaths by 13% over 23 years

• For every 456 men invited for screening, one prostate cancer death was prevented

• For every 12 men diagnosed with prostate cancer through screening, one death was prevented

• The harm-to-benefit ratio improved over time compared with earlier analyses

These numbers represent a meaningful improvement over the 16-year data, where 570 men needed to be invited and 18 needed to be diagnosed to prevent one death. The trend is clear: the longer the follow-up, the better the balance tips in favour of screening. But the trade-off remains real. Screening detects cancers that may never have caused harm (overdiagnosis), and some men who are diagnosed will undergo treatment they didn't need, with side effects including urinary incontinence and erectile dysfunction.

This is why the decision to test isn't straightforward, and why informed choice matters so much. In my practice, I find that patients who understand both sides of the equation are better placed to make a decision they're comfortable with.

Who Should Consider PSA Testing?

Not every man needs a PSA test, but some men are at higher risk and may benefit more from screening. Consider discussing PSA testing with your GP if:

• You're aged 50 or over

• You're Black. Black men have roughly double the risk of prostate cancer compared with White men, and are more likely to be diagnosed with aggressive disease

• You have a family history of prostate cancer, especially a father or brother diagnosed before age 65

• You carry a known BRCA2 genetic variation (which increases prostate cancer risk)

• You have lower urinary tract symptoms (waking frequently at night to urinate, weak stream, hesitancy, or incomplete emptying)

A PSA test is not a diagnosis. It's a starting point. If the result is raised, modern diagnostic pathways use MRI scanning to assess the prostate before deciding whether a biopsy is needed, which reduces unnecessary biopsies significantly compared with older approaches.

When to See Your GP

See your GP promptly if you notice any of the following symptoms:

• Blood in your urine or semen

• Difficulty starting or stopping urination

• A weak or interrupted urinary stream

• Unexplained pain in the lower back, hips, or pelvis

• Waking frequently at night to urinate (nocturia)

These symptoms don't necessarily mean cancer. Most are caused by benign prostate enlargement, which is very common. But they do warrant assessment by your GP, who can arrange a PSA test alongside a clinical examination.

How Brooksby Medical Can Help

Brooksby Medical offers PSA testing as part of the Men's Health Blood Test, which also includes testosterone, full blood count, liver function, kidney function, cholesterol, and thyroid markers. A venous blood sample provides the accuracy needed for reliable PSA measurement.

Every result comes with a GP-written report that interprets your PSA level alongside your age, symptoms, and other results. If your PSA is raised, the report will explain what the next steps should be, including when to see your GP for referral. A PSA test on its own isn't a diagnosis. The value is in understanding what your result means in context, and that's what the report provides.

References

1. Roobol MJ, de Vos II, Mansson M, et al. European Study of Prostate Cancer Screening, 23-year follow-up. New England Journal of Medicine. 2025;393(17):1669-1680

2. National Prostate Cancer Audit. State of the Nation Report 2025. NPCA/NATCAN

3. NICE. Prostate cancer: diagnosis and management. Guideline NG131 (2019, updated 2021). NICE NG131

4. NHS. PSA testing and prostate cancer. NHS

5. Prostate Cancer UK. Data and evidence. Updated January 2026. Prostate Cancer UK

6. Cancer Research UK. Prostate cancer incidence statistics. Cancer Research UK

Written by Dr James Coleman, GP and founder of Brooksby Medical. Dr Coleman is a practising General Practitioner who founded Brooksby Medical to give patients direct access to the blood tests and clinical interpretation they need, without waiting lists.

Medically reviewed: March 2026 | Next review due: March 2027

Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Blood test results should always be interpreted by a qualified healthcare professional in the context of your individual symptoms, medical history, and clinical picture. If you have concerns about your health, please consult your GP.