New guidance raises concerns on access to PSA testing

The Department of Health and Social Care (DHSC) has confirmed that the Prostate Cancer Risk Management Programme (PCRMP) has been withdrawn, following the UK Government’s recent acceptance of the UK National Screening Committee’s recommendations on prostate cancer screening.

In a letter sent to stakeholders, DHSC said that information for patients will now be provided through NHS channels, while guidance for GPs will be provided through NICE Clinical Knowledge Summaries.

The Department also confirmed there is no change to the symptomatic pathway and that men who are concerned about prostate cancer can continue to discuss PSA testing with their GP.

While the Government has sought to reassure patients that PSA testing remains available through discussions with a GP, the withdrawal of PCRMP in its entirety raises important questions about how men at increased risk of prostate cancer will be supported to make informed decisions about testing.

Since its introduction in 2002, PCRMP has provided a dedicated framework for the informed choice model regarding PSA testing among asymptomatic men, with men over 50 that had discussed the pros and cons with their GP able to have a PSA test. Its removal comes at a time when charities and patient groups have been calling for more proactive and consistent approaches to contacting men at higher risk about PSA testing, including Black men and those with a family history of the disease.

The new guidance also removes previous references to men over 50 being considered at increased risk, with DHSC stating that age should be considered alongside other risk factors rather than in isolation. DHSC has said that there has been no change in policy. However, with the framework underpinning the informed choice model now withdrawn, and the replacement materials no longer explicitly stating that informed, higher-risk men can access a PSA test on request, uncertainty remains about how requests for testing will be handled in practice.

DHSC has said it is working with Cancer Research UK, the Royal College of General Practitioners and the UK Cancer Genetics Group to develop further advice for GPs supporting asymptomatic men who are concerned about their family history of cancer.

The Department says any future advice will be made available through public-facing NHS information and GP guidance. PCR has asked officials at the Department to provide reassurance that men at higher risk of prostate cancer that have been informed of the pros and cons of PSA testing will continue to be entitled to a PSA test from their GP, and is awaiting their response.

“While the Prostate Cancer Risk Management Programme and the informed choice model it facilitated has long been in need of improvement, its withdrawal in its entirety risks creating uncertainty and inconsistency in access to testing.

“Following the recent screening decision, the public were reassured by officials that men over 50 who wanted a PSA test would continue to be able to have one following an informed discussion of the benefits and harms. The withdrawal of PCRMP undermines that commitment by removing the dedicated guidance that supported informed choice.

“Men at increased risk can still raise PSA testing with their GP, but whether their request for a test will be granted is less clear. Even with PCRMP in place, we saw all too frequently men at higher risk of prostate cancer, including Black men and those with a family history of the disease, being refused requests for a PSA test.

“At a time when we should be making progress towards fairer and earlier diagnosis, ministers must explain how the new arrangements will work in practice and provide clear guidance for both patients and clinicians. In the meantime, we advise anyone at higher risk of prostate cancer that wants to explore having a PSA test to continue to contact their GP.”