Something changed last week, and most men haven't heard about it
For more than twenty years there was a simple backstop for men in the UK. If you were 50 or over and you asked your doctor for a PSA test — the blood test used to check for signs of prostate cancer — you were entitled to one. You didn't need symptoms. You didn't need a family history. You just had to ask.
That backstop came from the prostate cancer risk management programme, guidance first published in 2002. It stated plainly that the test was <cite index="16-1">"available free to any man aged 50 or over who requests it"</cite>. Last week, a letter from the Department of Health and Social Care confirmed that guidance has been withdrawn.
The reaction was immediate. Lord Cameron, who was treated for prostate cancer after a PSA test picked it up, called the move a backwards step and repeated his call for proper targeted screening for men at higher risk. Jeremy Clarkson, who has spoken publicly about his own prostate cancer diagnosis, told his followers he couldn't work out what the reasoning behind the decision could possibly be. His post has been seen millions of times. Charities working in prostate cancer have used words like betrayal.
So what has actually changed, and what should you do about it?
What's changed — and what hasn't
Here's the honest version, because the headlines have been louder than the detail.
What's gone: the specific written entitlement. The line that said any man over 50 who asks gets the test has been removed. The department's letter also states that men over 50 are no longer treated as high risk by default, on the basis that age is only one factor in someone's overall risk.
What's still true: you can still ask your GP for a PSA test. The Department of Health and Social Care has said the policy itself hasn't changed, that the old guidance was retired because it was ambiguous, and that the final judgement was always meant to rest with the GP. Men with possible symptoms should still be referred for testing exactly as before.
Where the disagreement sits: critics argue that in practice the written entitlement was the thing men could point to. It gave a man who'd been turned away something to reference. Take the wording out and the outcome starts to depend on which surgery you walk into and which doctor you happen to see. Supporters of the change argue the PSA test has real limitations and that a conversation with a clinician about your individual risk is a better route than a blanket age rule.
Both of those things can be true at once. But the practical effect for men is a system that now relies even more heavily on you knowing what to ask for and being willing to push.
Why this matters
Prostate cancer is the most common cancer in men in the UK, with roughly 63,000 diagnoses and around 12,000 deaths a year. Unlike bowel, breast and cervical cancer, there is no national screening programme for it.
The hardest part is that early prostate cancer usually has no symptoms at all. Sir Chris Hoy was 47 and felt fine. By the time symptoms appear — trouble urinating, going more often, especially at night, blood in urine, pain in the hips or back — the disease may already be advanced. That's why the conversation about testing matters so much, and why men who don't know to have it are the ones most likely to be missed.
Risk isn't evenly spread either. Your risk goes up with age. It roughly doubles if your father or brother has had prostate cancer. And black men in the UK are around twice as likely to be diagnosed as white men. If any of those apply to you, it's worth being the one who raises it.
Being honest about the PSA test
We sell a prostate PSA test, so we'll be straight with you about what it does.
A PSA test measures prostate-specific antigen in your blood. It's a signal, not a verdict. A raised level can point to cancer, but it can also be caused by an enlarged prostate, an infection, recent exercise or recent sex. And a normal level doesn't rule cancer out completely. Nobody, including us, should be selling a PSA test as a diagnosis. Diagnosis involves further investigation, usually an MRI scan and sometimes a biopsy, and that's a job for a doctor.
What a PSA result gives you is information — and a reason to have a conversation you might otherwise have put off for another year.
What you can actually do
Ask your GP — and don't be fobbed off. This is still your first and best route, and you're still entitled to ask. Say clearly that you'd like to discuss a PSA test, and mention your age, family history and ethnicity if they're relevant.
This part matters more than it should. Even under the old guidance, men reported being told the test wasn't accurate enough and not to bother — and some of those men are alive today because they insisted anyway. Around one in eight prostate cancer cases in the UK is caught at stage 4, when it can no longer be cured. If you feel you're being brushed off, it's reasonable to ask for the reasoning to be recorded in your notes, or to ask to see a different GP.
Know your own risk. Age, family history and ethnicity are the three big ones. Learn them, and tell whoever you speak to.
Learn the symptoms — and don't wait for them, because early prostate cancer usually doesn't cause any.
Consider a rapid PSA test as a starting point. The U-Test Prostate PSA Self-Test is a rapid test kit that gives you a result in around ten minutes using a small finger-prick sample. It won't diagnose anything and it isn't a replacement for your GP. What it can do is give you a first indication, and if the result is raised, take that to your doctor. A man walking into a surgery with a raised result and a specific question is in a very different position to a man asking a vague one.
Talk to the men in your life. The dad who says he's fine. The mate who hasn't been to a doctor in a decade. That conversation costs nothing.
The bottom line
The withdrawal of this guidance doesn't stop you getting tested. What it does is shift more of the responsibility onto you to ask, and to keep asking. Whatever your view of the decision, the practical response is the same one it's always been: know your risk, know your options, and don't wait until something feels wrong.
Shop the U-Test Prostate PSA Self-Test →
This article is for information only and is not medical advice. If you have symptoms or concerns about your prostate health, speak to your GP. A raised PSA result should always be followed up with a doctor.
