Prostate Cancer Screening: What Jeremy Clarkson and Sir Chris Hoy remind us about early detection

The key message is not that every man should panic. It is that prostate cancer often gives no warning until it is advanced unless picked up through proactive screening.

PSA, the prostate specific antigen blood test, is useful — but it is not a perfect screening test

The PSA blood test remains an important first step. It can detect prostate cancer before symptoms appear and may identify aggressive cancers while they are still curable. But PSA is not cancer-specific. It can rise because of benign prostate enlargement, inflammation, infection, recent ejaculation, cycling or urological procedures.

Just as importantly, a “normal” PSA does not rule out cancer. Emerging evidence from MRI-led screening studies suggests that a substantial proportion of clinically significant prostate cancers occur in men whose PSA remains within the normal range. In the UK ReIMAGINE screening study, MRI identified a number of important cancers that would not have met conventional PSA referral thresholds.

This is why we believe the most useful approach is not a one-off PSA result in isolation, but continuity: knowing the patient, understanding their risk factors, and following PSA trends over time. A PSA that is technically “normal” but rising steadily year on year may be more clinically significant than a single borderline result with no context.

Symptoms: often absent, but never ignored

Most early prostate cancers are asymptomatic. That is why risk-based screening and regular review are so important.

However, prostate cancer should be considered in men with lower urinary tract symptoms (LUTS), haematuria, erectile dysfunction, blood in the semen, unexplained back or bone pain, weight loss or systemic symptoms, and those with a strong family history of prostate, breast, ovarian or pancreatic cancer.

UK best practice is evolving
The UK has historically not offered population-wide prostate cancer screening because PSA alone is not sufficiently sensitive or specific. There is also concern about potential overdiagnosis: identifying slow-growing cancers that may never cause harm, potentially exposing men to unnecessary biopsies.

The traditional diagnostic pathway of random PSA tests with your GP mainly only when you request it, is changing. Multiparametric MRI is now routinely used before biopsy in NHS prostate cancer pathways, and increasing evidence suggests that the “quick” bimodal MRI has an important role in screening selected men with a PSA still in the conventional normal range.

Emerging best practice is increasingly focused on combining PSA testing with MRI-based assessment rather than relying on PSA alone. In particular, biparametric MRI (sometimes referred to as “Quick MRI”) is gaining attention as a faster, lower-cost alternative to full multiparametric MRI while maintaining excellent sensitivity for clinically significant prostate cancer.

This combined approach may be particularly valuable in men with a rising PSA trend over time, additional risk factors such as family history or Black ethnicity, a PSA that is high-normal for age and remains elevated on repeat testing, or persistent clinical concern despite a PSA result within the normal range.

What we offer at Edinburgh GP
At Edinburgh GP, our strength is continuity of care. We do not see PSA as a one-off number. We look at your risk factors and PSA trends.

For many men, we recommend annual PSA testing from age 40, particularly for those who wish to take a proactive approach to their health or who have recognised risk factors. Serial testing allows us to identify important trends that may not be apparent from a single result.

Where appropriate, we can arrange further assessment, including diagnostic multiparametric MRI and the newer validated biparametric (“Quick MRI”) prostate scans. These scans may be particularly useful in men with a rising PSA trend, a high-normal PSA confirmed on repeat testing, or other factors that place them at increased risk.

Screening MRI scans can be arranged through a routine Edinburgh GP consultation or as part of our Advanced Health Screen programme when clinically appropriate.

The goal is not to over-investigate every man. The goal is smarter screening: detecting clinically significant cancers earlier, avoiding unnecessary procedures where possible, and making decisions with the patient rather than for the patient.

Above all we believe in managing our own patients and results with the aim of avoiding further burden to NHS resources.

Jeremy Clarkson and Sir Chris Hoy have done something valuable by making prostate cancer part of normal conversation. The next step is for men to act early, understand their individual risk, and have a proper discussion with a doctor who knows them.

By Dr David Richardson, Director and Lead GP, Edinburgh GP