Intended for healthcare professionals

Rapid response to:


Diagnosing prostate cancer in asymptomatic patients

BMJ 2022; 377 doi: (Published 31 May 2022) Cite this as: BMJ 2022;377:e071076

Rapid Response:

Asymptomatic patients may have signs that something is awry with their prostate

Dear Editor

The authors appear to focus their attention on symptoms while they seem not to even acknowledge signs. It is well-established that most patients with an early stage prostate cancer have no symptoms. They feel fine and are experiencing nothing which ought to incline them to visit their GP but they may have signs that their prostate health is not as good as it could or should be. The entire point of the PSA test is to look for a sign which is indicative that something might be awry with the patient's prostate. The PSA test certainly has its limitations but so does any test that looks for circumstantial evidence. This is no different from the faecal blood test kits that the NHS sends out every two years to patients who have turned 60. Just as with the PSA test, the aim is not to diagnose a colorectal cancer but to check for signs consistent with it which then warrant further investigation.

So, while a patient is waiting for symptoms of prostate cancer to appear, their disease may be progressing and potentially advancing from where it might be curable to one where it is, at best, chronic and/or where the treatments available potentially come at considerable cost to quality of life.

Currently, among the few tests indicative that something might be awry with a patient's prostate is the PSA test. It is cheap, easy to carry out and certainly much easier to convince men (and trans-women) to undergo than a DRE where the clinician can only feel part of the prostate anyway, is often uncomfortable and embarrassing, and is itself only at best indicative of prostate health.

From my perspective as someone who has lived with prostate cancer for over a decade and whose work, both paid and voluntary, brings him into contact with very many people affected by this disease, it seems naïve that the authors appear to advocate a stance of "don't look in case you find". A better stance from a patient perspective is to encourage looking, educating both patients and clinicians as to the PSA test and what it actually does, what are its limitations and so on. Currently, around 12,000 men die each year in the UK from prostate cancer. Anything that helps reduce this number is to be welcomed, even if it does come with limitations - after all, what doesn't?

Dr David Matheson

Competing interests: Patient representative for Prostate Cancer UK, Prostate Cancer Research and the STAMPEDE trial.

22 June 2022
David Matheson
reader in education for health
University of Wolverhampton
WA103, Walsall Campus, Gorway Road, Walsall WS1 2BD