Prostate cancer remains one of the most significant health challenges facing men today. Early detection is vital, as it can save lives and improve outcomes dramatically. Yet, despite advancements in screening techniques, debates around how best to implement prostate cancer screening continue to persist. While the focus of testing may evolve over time, one thing is clear—PSA (Prostate-Specific Antigen) testing remains an important tool in the fight against prostate cancer.

Why PSA testing still matters

The value of PSA testing has been well-documented. The European Randomised Study of Prostate Cancer (ERSPC) Screening demonstrated that PSA testing leads to a 21% reduction in prostate cancer deaths within 10–12 years after randomisation. These findings highlight the relevance of PSA testing as a tool for early detection and saving lives.

However, the introduction of a national screening program in the UK has faced significant resistance. Concerns have largely revolved around the number of unnecessary biopsies that PSA testing may lead to, as well as the side effects of such procedures, including pain, infection, and even impotence. 

It’s understandable that men may feel apprehensive about these risks. But advancements in diagnostic approaches, such as integration with MRI scans, are helping to address these concerns and minimise potential harm.

Advances in prostate cancer screening

Two landmark trials — PROMIS (2017) and PRECISION (2018) — have shifted the conversation around prostate cancer screening, offering new hope for effective and safer testing methods.

• PROMIS Trial (2017): This study showed that using multi-parametric MRI (MP-MRI) as a triage test before prostate biopsy can reduce the number of unnecessary biopsies by 25% while increasing the diagnosis of clinically significant cancers. This means fewer men undergo invasive procedures while catching more aggressive cancers that require treatment.
  
  
•  PRECISION Trial (2018): Findings from this trial revealed that 28% of men randomised to MRI-targeted biopsy avoided biopsy altogether. Furthermore, 12% more clinically significant cancers were detected compared to standard biopsy methods.

Despite these promising advancements, there has yet to be a national UK screening program for prostate cancer, even five years after these pivotal results were published. Compounding this issue is reduced access to GP testing post-lockdown, making it harder for men over 50 to request PSA tests.

Looking ahead

Prostate cancer remains a major cause of concern, with over 12,000 deaths annually in the UK. Encouragingly, steps are already being taken to innovate and improve screening methods.

In 2025, Prostate Cancer UK will launch the TRANSFORM trial, a groundbreaking study aiming to identify the most accurate and cost-effective way to screen men for prostate cancer.

TRANSFORM trial highlights:

•  Target cohort includes men aged 50–75, or 45–75 for Black men, given their increased risk.
  
  
•  The trial will test four approaches, including fast MRI scans (12 minutes), genetic testing, and PSA testing.
  
  
•  While this is a significant step forward, early results from TRANSFORM are not expected until 2028.

These new techniques hold the potential to revolutionise early detection, offering a future where fewer biopsies are required and more clinically significant cancers are caught early.

What can be done now?

Given the current landscape, there is a need to balance innovation with the tools already at our disposal. PSA testing remains a critical first step in detecting prostate cancer. When combined with MRI scans—specifically for those with elevated PSA levels—it can help triage which patients require targeted biopsies, reducing unnecessary risks.

At Check4Cancer, we are constantly exploring new ways to improve early detection and screening for prostate cancer. One area we’re particularly excited about is the potential of salivary DNA testing. Based on the BARCODE 1 study, this promising approach could help identify men in the top 10% risk category for prostate cancer. This high-risk group has a significant proportion of cancers requiring treatment, making such a tool invaluable for targeted screening.

The path forward

Prostate cancer screening has come a long way, but there is still much work to be done. With continued advancements in diagnostic tools and trials like TRANSFORM on the horizon, we can look forward to a future where prostate cancer deaths are significantly reduced.

For now, though, PSA testing remains a vital tool in the early detection of this disease. Combined with modern MRI technology and innovative research into approaches like salivary DNA testing, we have the opportunity to offer men more accurate, less invasive screening.

If you are over 50—or over 45 and from a higher-risk group such as black men - don’t hesitate to talk to your GP about PSA testing. Early detection could save your life.

Your health matters, and it’s always better to know…