Routine screening for prostate cancer is not available on the NHS as the Department of Health have decided that it is not justified. This decision causes a lot of concern to many men because prostate cancer is a common condition and it is increasing in frequency.

Two essential requirements for any screening programme are:

• A simple reliable test to detect the condition.
• Treatment that will improve the outcome.

The expert view is that neither of these exists at the present time. This opinion is a source of confusion as many people have heard about PSA testing for prostate cancer as a possible screening test and also have heard about various types of treatment for the disease.

PSA level is useful as a way of testing for abnormalities in the prostate but is not specific for cancer. As it can be raised in other, non cancerous conditions of the prostate. It is also possible for the PSA level to be normal in men with very small cancers. For these reasons the use of PSA measurement as a means of screening for early prostate cancer remains controversial.

Both surgery (radical prostatectomy) and radiotherapy are currently available as treatment for early prostate cancer. At the present time there is no clear evidence that either of these treatments alter the overall survival in prostate cancer. Some men opt to have no treatment at all but to ‘watch and wait’ to see what happens. This is because prostate cancer usually affects more elderly men and often develops very slowly, many men live with the condition for years before any symptoms or problems develop.

Clinical trials assessing the value of screening for prostate cancer are in progress in the USA and Europe (but not in the UK) but it will be some years before any results are available. Until then the subject of screening for prostate cancer will remain controversial.