Current UK guidelines do not recommend routine prostate cancer screening for asymptomatic men NICE CG97,NICE CKS. Instead, prostate-specific antigen (PSA) testing and digital rectal examination (DRE) are considered in specific circumstances NICE CG97,NICE CKS.
For men presenting with lower urinary tract symptoms (LUTS) suggestive of bladder outlet obstruction secondary to benign prostate enlargement (BPE), or if their prostate feels abnormal on DRE, or if they are concerned about prostate cancer, they should be offered information, advice, and time to decide if they wish to have PSA testing NICE CG97. A physical examination, including an abdominal, external genitalia, and DRE, is also offered at initial assessment for men with LUTS NICE CG97. If a DRE indicates a malignant prostate or if PSA levels are above the age-specific reference range, a suspected cancer pathway referral (for an appointment within 2 weeks) for prostate cancer should be made NICE CKS.
In contrast to the UK approach, recent international literature indicates that some countries have developed or are proposing organized prostate cancer screening programs Ficarra et al. 2024John et al. 2024. For example, the Italian Society of Urology has put forward a proposal for an organized screening program Ficarra et al. 2024, and South Africa has published specific guidelines for prostate cancer screening John et al. 2024.
Key References
- NG131 - Prostate cancer: diagnosis and management
- CG97 - Lower urinary tract symptoms in men: management
- CKS - Urological cancers - recognition and referral
- CKS - Prostate cancer
- (Aus et al., 2001): EAU guidelines on prostate cancer.
- (John et al., 2024): The South African Prostate Cancer Screening Guidelines.
- (Ficarra et al., 2024): Organized prostate cancer screening program: a proposal from the Italian Society of Urology (SIU).