One of Britain's leading prostate cancer surgeons has issued a stark warning about how a single blood test can trigger a chain of events that permanently damages a man's quality of life.
The Snowball Effect of a PSA Test
Professor Freddie Hamdy CBE, a University of Oxford urology expert and member of the UK National Screening Committee, explained the dangers of overdiagnosis during a recent media briefing. He detailed how a simple Prostate Specific Antigen (PSA) test can begin a "snowball" effect that often ends with unnecessary surgery.
"Men need to be really well counselled and informed before the snowball starts," Professor Hamdy stated. "It starts with a blood [PSA] test and then it snowballs. Before you know it you are on an operating table having your prostate removed."
The core issue lies in the difficulty of distinguishing between aggressive tumours that require treatment and slow-growing ones that may never cause harm during a man's lifetime. Yet the psychological impact of a cancer diagnosis often overrides clinical advice.
The Devastating Consequences of Unnecessary Treatment
Professor Hamdy revealed that most men, upon hearing they have prostate cancer, become terrified and demand to "get it out", regardless of whether the tumour is deemed significant. The potential side effects—urinary incontinence and erectile dysfunction—often seem unimportant in the face of a cancer diagnosis.
However, the reality sets in later. "They come back and we see them a year later and they say they're having a problem," Professor Hamdy explained. "It's about loss of sexual function and leakage. They wish their sex life was better. It can lead to difficulties in couples' marriages."
The UK National Screening Committee's report included anonymous testimony from patients living with these consequences. One man shared: "It really changed my life. I couldn't go anywhere. I'm always thinking 'what if I wet myself?'"
Another revealed the emotional toll: "Knowing I might not ever have sex again, I try not to think about it because it does crack me up. I've been married for 36 years and we've just got to the point now where we avoid the situation."
Why Widespread Screening Was Rejected
The committee ultimately decided against offering the PSA test to otherwise healthy men across Britain. The evidence shows the test is not accurate enough for population-wide screening.
PSA levels can rise for numerous reasons, including simple infections, with approximately 75% of people with a raised PSA not having prostate cancer. A false positive can lead to unnecessary biopsies, MRI scans, or treatments for tumours that would never have caused harm.
Even the alternative approach—active surveillance—carries significant mental health burdens. Data presented at the London briefing showed that after three years, about 25% of patients on active surveillance opt for treatment. This increases to 50% after ten years and 60% after fifteen years.
Professor Hamdy described the psychological pressure: "The slightest glitch in any of these [monitoring tests], even if it is a PSA result which goes up only sporadically, the man is so sensitive to the possibility of disease progression that he will ask for treatment. And we find out after surgery from testing that the vast majority of these operations were unnecessary."
The committee's recommendations highlighted the "lifelong harms" from such interventions, including urinary incontinence requiring pads and erectile dysfunction from nerve damage, alongside potential surgical complications like bleeding, infection, and damage to nearby organs.
