Prostate Cancer and PSA Testing- October 2025

[BELL RINGING] Welcome back to Coffee Break, the audio equivalent of a straight answer to an all-good question. This week we're talking about prostate cancer. It's the most common cancer in men, but many don't know when or if they should get checked. There's no national screening programme, which makes it even more confusing. So, who's at risk? What is a PSA test? And is it worth having? We will cut through the confusion. There's no scared tactics here, just what you need to know. Or in this week's Coffee Break. I'm Dr. Jeff Ham. And I'm Dr. Sam McGinley. And this is season one of Coffee Break. We are two general practitioners from beautiful dogs that are in the United Kingdom, and we are happy to have you here with us for another Coffee Break. In our show, we give you helpful and useful health and wellness information in short and easily digestible episodes. And that's right and hopefully in a fun and enjoyable way as well. In today's VARSEE of Health Information, we hope to be your trusty island of reliable and impartial independent, unbiased information. And we may even have some guests with us to help. So sit back and enjoy. Hey Coffee Break! Hello, you might have been pointed to this podcast, or you may be a regular listener. But either way, we wanted to take a short number of minutes to inform you about prostate cancer. And why it is really important to consider getting yourself checked. Yes, prostate cancer is the most common cancer in men. One in eight men will get it. And if you are black, your risk is double that, so one in four. Now, the NHS, alongside various charities, including prostate cancer UK, are working hard to raise awareness of prostate cancer. And why is that? Well, unfortunately, prostate cancer is often silent, so it has no symptoms until it is really advanced. And what's really important to know is that men with urine symptoms, which we are going to outline shortly for you, are actually less likely to have cancer, and more likely to have a benign enlargement of the prostate. Yeah, that's right, isn't it? And we see a lot of men who have urinary symptoms. They have no other symptoms, and they're very worried. I understandably about prostate cancer. So some of those urine symptoms are things like difficulty starting to urinate, or difficulty emptying your bladder, a weak flow when you're trying to pass urine, sometimes a feeling that your bladder has an empty tropling. At the end of urination, you may have excessive dribbling of urine, or you might find, for example, you're needing to get up at night, particularly often. Others include suddenly needing to urinate, so what we call an urgency, and sometimes even leaking before you can get to toilet. And finally, also erection changes that have come on quite quickly. Okay, so that is some of the symptoms that are less likely to be linked to prostate cancer, some of the symptoms that might be more putting us towards a diagnosis of prostate cancer. Yeah, I think that's the thing, isn't it? So men will have prostate, and most men, our prostate will enlarge as we get older. And so we are as men likely to get symptoms related to that. And as we say, the list we just gave you our far more likely to link to just a benign enlargement rather than the cancer itself. And because prostate cancer can present silently, it might mean that there are some symptoms that present later, because the cancer has already advanced. And so these are some that are really important that you tell someone straight away if you're experiencing. And that list is sudden rapid change in your urine flow, particularly if you have also blood in your urine or new pain in your bones that you find hard to explain. There might be, for example, back pain or large bone pain, particularly if it's bothering you at night and you haven't had an injury or trauma, that should prompt you to get yourself checked with a healthcare professional. And finally, if you've got something that's maybe affecting your whole body, such as weight loss or unexplained sweating at night. So as we say, about one in eight men are at risk of developing prostate cancer. There are some groups of men who are more likely to develop it. Do you want to tell us about those, Geoff? Yeah, so if you're black, if there's a family history of prostate cancer, and also if there's a history of melanoma. But importantly, any man over the age of 50 does have an increasing risk. We know that prostate cancer develops more as we get older. Therefore, normally, in most cases, it's rare to. it's rare at sea prostate cancer under the age of 50, isn't it? Yeah, it's absolutely. So unless you're in one of the high risk groups before the age of 50, we would want to reassure your risk is extremely low. That's right. So if you are in one of the high risk groups, we would really encourage you to approach your primary care team for a blood test. There are actually also, locally, if you research, you may find there are some charities running spot PSA tests, and you could approach them as well. Yeah. You're entitled to a test if you're in this group. And also if you just approach your GP in any circumstances, it's worth having the conversation. There are some important things that we would want to tell you about the test there. Definitely, and this is where the PSA test is good, but it's not perfect. So first of all, a low PSA or your GP-MACA negative PSA doesn't mean that you haven't got cancer. And also doesn't mean that you're not going to develop prostate cancer. So it's really good for one moment in time, but equally, can sometimes be seen in patients who do have early prostate cancers. Conversely, high prostate test, high PSA does not mean that you have prostate cancer. That's really important, especially with some of the screening tests you can go for, because your result could come back high, and that's understandably really what reading, isn't it? Absolutely. But it doesn't mean you've got prostate cancer. And there are lots of different things that can make that PSA test raised artificially. And so your GP will probably say we want you to do a urine sample. If you've got a raised PSA test, because a urine infection can cause a raised PSA test, can't it? So if you've got an infection, that PSA test isn't very helpful. And we want to do that when you've not got an infection. Are there any other things that could raise your PSA? Absolutely, Jeff. And some things that are really important are recent exercise, particularly cycling. Yes, definitely. Recent sexual intercourse, so in the last 48 hours. And actually, I believe any form of exercise will be to influence it, so certainly be it where are those? Yeah, definitely. Definitely. Okay, so if there's enough evidence to suggest further investigations are needed, then you will probably be referred to a urology's pill, an examinute, and check further blood test. And then we'll consider a scan, possibly an MRI, and then proceed to test that we'll confirm if you have or have not got it. Yes, absolutely. And this point, I think we want to bring up the area of examination, because we do wonder if the thought of having an examination for a man is off-putting. Eem. GPs have recently received new guidelines, haven't they, Jeff, that the benefit of a prostate examination is questioned. And if having an examinations, put a uof coming in, then please let us reassure you that you may not be examined, or you can always define that part of the test anyway. Yeah, I think there's a lot of panic dotes in there. There's a lot of bravado about prostate testing and going to a doctor and standard comics do quite a lot. They talk about having a prostate test, and then the doctor comes along and does a finger examination at the back passage to feel the prostate. And while certainly we do do, or we would call a digital rectal exam to feel your prostate, it isn't always necessary to do that if we were at a prostate cancer. And certainly as you say, with PSA screening and testing, there's increased evidence that there's not something that's needed if we need to refer you, if we've got concerns. So, yeah, don't put it off definitely. Absolutely. So, as soon as you were tested, the sooner you would get appropriate treatment recommendations. Yeah. And, yeah, for some men, you might not need any treatment. So, if your PSA is elevated and then you have a MRI scan, the result will then guide the, you're just as to what they want to do next. And for some men that might just be what we call active surveillance, other men may be offered a wide variation of treatment options. Yeah. And in the show notes, we put a link to the prostate cancer UK charity that's got lots of information. So, definitely do have a look. Yeah. So, Jeff, do you have any take-home points from this? Of course. So, Sam, I think I would probably say my take-home point is that the PSA test is a very good test, but it's a test that you have to have done understanding what the results do and don't mean. And the day a home PSA test doesn't necessarily mean you will prostate cancer. I say to people, PSA testing can be really, really helpful if you have a diagnosis prostate cancer because we know that if your PSA goes down, you're responding to treatment. If your PSA doesn't change as you're having prostate cancer treatment, whatever that may be, then actually it's not responding equally if you've been very well treated and your prostate cancer's queuescent and then it starts to go up again. We know that things are flaring up again. So that's where it's really, really helpful. But it is a test that's good, but you have to understand what it means. Well, let your take them, can you say them? - And my take home point, I think, firstly, just a reminder that if you have symptoms relating to your urine, we'd want to reassure you that it is unlikely to be prostate cancer, but of course we're always happy to discuss that and look at the tests that might be appropriate. And also to, yeah, want to reassure you that an examination of the prostate is not strictly necessary as part of your assessment or federal process from primary care. This has been an episode of Coffee Break. We hope you have enjoyed it. And if you have, then we hope you will join us again for another Coffee Break soon. - Remember, if you do want to get in touch with us, or if you have any ideas or suggestions, then please feel free to email us at the show at [email protected]. You can listen to us and subscribe to the show on any of the podcast platforms and via your computer, smartphone and home smart devices. - We have used a variety of resources for the information in the show to try and ensure that it is up to date and the most applicable. We've also put any important links we've discussed in the show notes. - Coffee Break is a coffee break production and is created, written and hosted by me, Dr. Sam McGinley, and me, Dr. Jeff Ham. The editor and producer is Dr. Jeff Ham. All the content we provide in the show is for general informational purposes only. The content does not constitute medical or healthcare advice. The content is valid in England at the time of recording. - The content should not be relied upon as a substitute for professional medical or healthcare advice applicable to your specific circumstances. We advise that you always consult a qualified medical professional for any medical matters. [Music]