Should I, as a man, get tested for prostate cancer with the PSA test?
Whether the PSA test is worthwhile depends on your personal risk. Men aged 55 to 69 with an elevated risk, such as a family history or Black ethnicity, have the greatest reason to discuss this with their GP.
The PSA test reduces the chance of dying from prostate cancer, but the effect is modest. In the large European ERSPC study, with 23 years of follow-up, the screening group died from prostate cancer 13% less often than the unscreened group1. In absolute numbers, that means: for every 456 men invited to screening, one death was prevented. Even a single PSA invitation led to a small reduction in prostate cancer mortality after 15 years, as shown by the British CAP study2. On overall mortality, that is, from all causes combined, screening has no demonstrable effect.
There is a serious drawback on the other side: overdiagnosis. Screening produces 30% more prostate cancer diagnoses. A substantial proportion of these are slow-growing, low-grade tumours that would probably never have caused the man any trouble without screening. Yet those diagnoses lead to treatments, and treatments have side effects. Per 1,000 screened men, modelling estimates: 1 extra hospital admission due to blood poisoning after biopsy, 3 extra men with urinary incontinence, and 25 extra men with erectile dysfunction3. These are estimates, not directly measured figures, but they show that the path from a positive PSA to biopsy to treatment can cause real harm.
Whether screening is worthwhile for you depends heavily on your risk profile. Black men develop prostate cancer almost twice as often as white men (173 versus 97 cases per 100,000 in the US). Because of this, the balance works out differently for them. Hereditary factors account for more than half of prostate cancer risk. A father or brother with prostate cancer considerably increases your own risk. For men with such an elevated risk, the scales may tip more readily toward screening.
International guidelines and the American USPSTF therefore advise men aged 55 to 69 not to simply get a PSA test, but to make this decision together with their GP4,5. That conversation covers your age, family history, and ethnicity. But also: how much weight do you place on the chance of overdiagnosis and side effects, versus the chance of a death from prostate cancer being prevented? There is no universally correct answer.
For men aged 55 to 69 with an elevated risk, there is the strongest evidence that a conversation about PSA screening is worthwhile. For men with an average risk, the benefit-harm balance is less favourable. Men over 70 are generally no longer routinely invited for screening in guidelines, because the benefit diminishes further and the risk of overtreatment increases.
Based on two large randomised studies: the ERSPC with 23 years of follow-up (PMID 41160819) and the British CAP study with 15 years of follow-up (PMID 38581198). Also based on a broad meta-analysis (PMID 30185521) and guideline sources (PMID 40063046, 29406053). The side effect estimates are model-based (PMID 30185521). The ERSPC and CAP together encompass hundreds of thousands of men.
Can I inherit breast cancer in the family, and should I get tested?
Breast cancer can be hereditary, and if you recognise multiple cases in your family, it is sensible to discuss this with your GP or a genetic counsellor so you can determine whether testing is worthwhile.
Is breast cancer population screening worth it?
For most women, participating in the population screening programme yields more benefit than cost, though this varies by age and risk profile. If you have dense breast tissue or a family history of breast cancer, discuss with your doctor whether supplemental testing makes sense for you.
Is it true that circumcision protects against penile cancer and HPV?
Circumcision before adulthood reduces the risk of invasive penile cancer and high-risk HPV, but penile cancer is rare in Western countries and HPV vaccination, condom use and not smoking offer comparable or complementary protection.
Do lycopene and tomatoes protect against prostate cancer?
The association between tomatoes, lycopene, and lower prostate cancer risk is plausible, but not yet proven firmly enough to justify specific supplement recommendations. Tomatoes as part of a varied diet is a sensible choice; taking lycopene in isolation has no proven added value at this time.
Does being overweight increase my risk of cancer, and if so, which types?
Excess weight increases your risk of at least 13 types of cancer, including uterine, colorectal, breast and liver cancer. Losing weight reduces that risk, although it remains unclear whether all methods of weight loss are equally effective for immune defence against cancer.
Does using the contraceptive pill increase my risk of cancer?
The pill demonstrably lowers the risk of ovarian and uterine cancer, but slightly raises the risk of breast cancer with long-term use or use before a first pregnancy. Discuss your personal situation with your GP or gynaecologist if you have any doubts.