New guidance for PSA testing and cancer detection
Recent guidance published in the British Journal of Hospital Medicine (June 2025) emphasises that PSA testing remains a valuable tool in prostate cancer detection, but also brings challenges around overdiagnosis and overtreatment. The authors conclude that clinicians across all disciplines should deepen their understanding of PSA use to balance the test’s advantages (early detection of aggressive cancers) against potential harms like false positives and unnecessary treatment.
Prostate cancer in the UK
Prostate cancer is the most common cancer in men in the UK, affecting approximately 1 in 8 men during their lifetime. However, most early-stage cancers are slow-growing and may not require immediate treatment. That’s why the current pathway prioritises mpMRI before biopsy, effectively identifying clinically significant cancers while avoiding unnecessary intervention.
Prostate Cancer UK and a UK clinical consensus peer-review found that while routine screening of asymptomatic men isn’t recommended, primary-care professionals should proactively discuss PSA testing with higher‑risk men – including those of Black ethnicity, with a strong family history, or known genetic risks – and ensure informed decision-making.
Elevated PSA investigations
Consultant Urological Surgeon Mr Rahim Kaba follows a patient-centred approach when managing those with elevated PSA levels. His protocol encompasses:
- A detailed discussion of PSA velocity and density to interpret individual risk
- Routine use of multi-parametric MRI (mpMRI) of the prostate before any biopsy is considered – a method shown to improve diagnostic accuracy and reduce unnecessary biopsies
- When imaging suggests concern, performing targeted and systematic transperineal biopsy
Mr Kaba explains: “Before deciding whether to have a PSA test, you should discuss it taking into account your personal preferences and risk factors,” stressing that the decision is never taken lightly.
Key recommendations
The updated guidance reinforces that PSA testing should be offered on an individual basis, especially in men at higher risk. Therefore, men over 50, or over 45 who are of African descent, have a family history of prostate cancer, or carry genetic risk factors, should discuss PSA testing with their Consultant.
Mr Rahim Kaba’s practice, with its emphasis on mpMRI and precision transperineal biopsy, exemplifies a modern, evidence-based approach that aligns with current UK recommendations. This pathway helps ensure that prostate cancer is detected accurately, interventions are appropriate, and men can make well-informed decisions about their health.
Contact Mr Kaba’s secretary to book a consultation: call us on +441926 436316 or email us at laura.quince@nuffieldhealth.com.
