Prostate cancer and the right to be tested: why symptom-free men are entitled to PSA screening

Posted: 11/06/2025

Men who are concerned about prostate cancer should see their GP as soon as they notice any unusual urinary symptoms, such as difficulty starting or stopping urination, a weak flow, or increased frequency, especially at night. 

This advice is particularly important for those at higher risk, including men with a family history of prostate cancer or those of Black ethnic origin, who are statistically more likely to develop the disease.

Men should feel empowered to speak to their GP about prostate cancer concerns, especially if they are over 50 or have risk factors. Even in the absence of symptoms, men aged 50 and over are entitled to request a PSA (prostate-specific antigen) blood test on the NHS, to test for prostate cancer. The PSA test, while not perfect, is a valuable tool in early detection.

The diagnosis process for prostate cancer 

When a man presents with concerns about prostate cancer, a GP should begin by taking a detailed medical history and assessing risk factors. While digital rectal examination (DRE) has historically been used to screen for prostate cancer, its role is being reevaluated due to its limited effectiveness compared to other screening methods. Current guidelines, including those from Prostate Cancer UK, recommend that DRE is not a reliable screening test for prostate cancer and that it should not be used as a first-line screening tool.  

The next steps typically include a PSA test. This is a simple blood test that measures the level of prostate-specific antigen in the bloodstream. PSA is a protein produced by both normal and cancerous prostate cells. Elevated levels can indicate prostate cancer, but they can also be caused by benign conditions such as prostatitis or an enlarged prostate. To ensure accuracy, men are advised to avoid ejaculation, vigorous exercise, and certain medical procedures for at least 48 hours before the test. If the PSA result is abnormal, the GP should refer the patient for further investigations, such as an MRI scan or a prostate biopsy. 

It is crucial not to ignore symptoms or delay seeing a GP. Prostate cancer often develops slowly and may not cause symptoms in its early stages, but early detection significantly improves treatment outcomes. Men who wait too long may miss the opportunity for early intervention, which can be lifesaving. Raising awareness about the importance of a timely medical consultation is essential, especially since many men may feel embarrassed or reluctant to discuss urinary or sexual health issues. Some men have previously been unwilling to book a GP appointment due to their aversion to the prospect of DRE, but as this is no longer a routine primary care investigation for potential prostate cancer, it is hoped that more men will now come forward.  

How can negligent care affect this process? 

Importantly, it is incorrect and potentially harmful for GPs to dismiss men aged 50 and over who request a PSA test. According to NHS guidelines and the Prostate Cancer Risk Management Programme (PCRMP), any asymptomatic man aged 50 or over has the right to request a PSA test after discussing the risks and benefits with their GP. 

GPs are expected to provide balanced information and support informed decision-making, not to deny access to testing. To do so may, depending on the circumstances, be considered negligent care. 

GPs play a critical role in ensuring men receive appropriate investigations and referrals. Ignoring symptoms or being turned away from testing can delay diagnosis and treatment, potentially affecting outcomes. Awareness, access, and advocacy are therefore key to improving prostate cancer care and survival rates.

Our clinical negligence team is experienced in investigating oncology and andrology cases and will be happy to discuss how we may be able to assist, should you or a family member feel that a prostate cancer diagnosis has been delayed, potentially due to negligent medical care.

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