Originally published: 2021 | Updated: March 2026
Reading Time: 6 minutes
Medically reviewed on: March 20th 2026. Dr Jeff Foster BSc (Hons), MB ChB, DRCOG, MRCGP GMC 4431235
Authors: Ms Clare Delmar. The Focal Therapy Clinic
At a Glance
PSA testing remains the most widely available screening tool for prostate cancer, but a single result in isolation has limited value. GP and men’s health specialist Dr Jeff Foster explains why cumulative PSA tracking over time — combined with a holistic approach to men’s health — gives a far more reliable picture of prostate cancer risk than any one-off blood test.
Key takeaways:
- PSA alone is limited — a single PSA result without context can be misleading; cumulative tracking over months and years is far more useful
- Pandemic screening backlog — COVID-19 caused a significant drop in all forms of screening, creating a rebound demand that continues to strain NHS capacity
- Variability across the NHS — diagnostic pathways differ between regions, meaning two men with the same PSA may receive different follow-up care
- Whole-body health matters — maintaining a healthy weight, regular exercise, and a balanced diet can meaningfully reduce prostate cancer risk
- Know your options — if screening raises concerns, focal therapy treatments such as HIFU (NICE-approved, IPG424) offer targeted treatment that preserves quality of life, with 90%+ sexual function preservation and 97% urinary continence (FTC audit, n=265)
Should I Ask My GP for a PSA Test? A Doctor Explains
PSA testing is the most widely available screening tool for prostate cancer in the UK, but its value depends entirely on how it is used. A single PSA result in isolation has limited clinical meaning — however, when tracked cumulatively over time alongside a comprehensive health assessment, PSA becomes a far more powerful indicator of prostate cancer risk.
In this episode of OnFocus, GP and men’s health specialist Dr Jeff Foster — author of Man Alive — shares his frontline perspective on PSA screening, the impact of COVID-19 on diagnostic pathways, and what men can do at every age to protect their prostate health. His expertise on testosterone deficiency, erectile dysfunction, and prostate health has been shared widely through national media and applied in his clinical practice.
A written transcript of the full interview follows below. If screening has raised concerns about your prostate health, The Focal Therapy Clinic’s team can help you understand your options — including NICE-approved focal therapy treatments that preserve quality of life. Call 020 7036 8870 to speak with our team.
Why Is PSA Testing Controversial — and Is It Still Worth Having?
The PSA blood test remains the most widely available screening tool for prostate cancer, but it is not a definitive diagnostic test. An elevated PSA can be caused by infection, benign prostate enlargement, or recent exercise — not only cancer. However, when interpreted in context — considering a man’s age, risk factors, and PSA trend over time — it remains a valuable first step. NICE guideline NG131 recommends that men concerned about prostate cancer risk should be offered a PSA test alongside informed discussion about its limitations.
Clare: How does the pandemic impact play out specifically around PSA testing?
Dr Jeff Foster: The big thing for PSA testing, from my perspective, is that it’s how you use the PSA that’s important. Our practice has just short of sixteen thousand patients. We have maybe one or two patients a week who just request a PSA test — they wouldn’t necessarily want to see a doctor, but would send an e-consult saying, can I just book for a PSA test?
These are not the same men who have symptoms or are already under urology. They’ve heard of PSA and just want it tested. The problem is that the PSA is not a widely accepted national screening tool for all forms of prostate cancer. It doesn’t work that well.
But on the other hand, it’s the best we’ve got for now. So you have to have this middle ground — you counsel every patient: what is your risk, your age group, what is your expected level of PSA? Then you can give them informed choice about whether the test will be useful, and what to do with the result in six months, a year, or five years.
If your PSA raises concerns: An elevated PSA should be followed by a multiparametric MRI (mpMRI) scan to identify any areas of concern before any biopsy is considered. At The Focal Therapy Clinic, our consultants use mpMRI-guided diagnostics to ensure accurate assessment. If treatment is needed, NICE-approved options such as HIFU (IPG424) can target the cancer while preserving surrounding healthy tissue.
Why Cumulative PSA Tracking Is More Valuable Than a Single Test
A single PSA result has limited clinical meaning without context. The real value of PSA testing comes from tracking changes over time — a concept known as PSA velocity. A gradually rising PSA may warrant investigation even if each individual reading falls within the “normal” range, while a stable PSA over several years provides meaningful reassurance.
Clare: Do you see a point where every man should have a baseline PSA and then begin to self-track?
Dr Jeff Foster: A single PSA by itself, I would consider to be useless. We spoke to several urologists about this, and there is so much discussion around when we should start looking at people’s PSAs.
I think a PSA is very useful if it’s initially screened properly and then used cumulatively. Medicine is moving away from subjective feelings and symptoms of disease — we’re looking to gain as much objective data as possible. Patients want to see their PSAs. If you can say you’ve got a man’s PSA every six months for five years, that’s useful data you can do something with.
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Why Does Prostate Cancer Screening Vary Across the NHS?
Unlike breast cancer screening, which follows a standardised national pathway from mammogram to specialist review, prostate cancer screening lacks a consistent process across the NHS. The PSA test’s inherent limitations — and disagreement about how to interpret results — mean that two men in different parts of the country with the same PSA level may receive very different follow-up care.
Dr Jeff Foster: The inherent problem with the pathway is the PSA itself. With breast screening, a patient has a mammogram, and based on that result, it goes to a specialist who reviews patients. The follow-up process is very clear and the operating procedures are well established — you can apply them to a nationally accepted screening process.
If you have a test like PSA, which no one really agrees on the use of, then you can’t apply a well-regulated process to go with it. There’s rough processes and NICE guidance, and the two-week referral criteria still apply if you’ve got an enormous PSA. But there are so many variables — not everyone gets referred, and some hospitals will interpret PSA results differently to others.
Could a Prostagram Replace the PSA Test?
The concept of a “prostagram” — a quick, non-invasive imaging test for prostate cancer comparable to the mammogram used in breast screening — has the potential to transform early detection. While still in trial, this MRI-based approach could provide a more reliable screening tool than PSA alone.
Clare: We’ve begun to see a new approach in imaging that could be used for screening. It’s being called the prostagram. Do you see a role for this in primary care?
Dr Jeff Foster: If you could devise a screening test that was cheap, reliable and minimally invasive and you could get men to engage with it, then it would easily surpass the PSA. If you could have a national prostagram service comparable to cervical or breast screening — men walking in for a quick, non-invasive image with a very good pick-up rate — then we could get rid of PSA as a screening tool in primary care completely.
The problems at the minute are that the cost is too prohibitive. In primary care, you are budgeted on everything you do, and if you over-investigate, you are penalised for it.
MRI in prostate cancer today: While a national prostagram programme is not yet available, multiparametric MRI (mpMRI) is already the gold standard for prostate cancer diagnostics under NICE guideline NG131. At The Focal Therapy Clinic, every patient undergoes detailed mpMRI review before any biopsy or treatment decision. This MRI-first approach means cancers are located precisely, enabling targeted focal therapy rather than whole-gland treatments.
How Can NHS Data Improve Prostate Cancer Research?
Better use of NHS patient data could significantly accelerate prostate cancer research, but current systems are fragmented. GP records, hospital notes, and community care data are often held in separate systems that cannot communicate with each other — limiting the ability to conduct large-scale studies that improve diagnosis and treatment.
Dr Jeff Foster: Patients always imagine that the hospital can see what we write in our electronic notes, which they can’t. And the hospital also imagine that district nurses can see what I write, but they can’t. This kind of separated piles of data — the amount of information out there is unbelievable. If it was more readily available, the difficulty behind research would be surmounted much more easily.
People are also very protective of the NHS and their health records. The way data sharing has been handled — almost surreptitiously, with a behind-closed-doors feel — has meant that for many patients it has not been a positive experience.
What Can Men Do to Reduce Their Prostate Cancer Risk?
The most effective approach to prostate health is a holistic one. Rather than focusing solely on PSA testing, men should take a whole-body approach — regular health checks, maintaining a healthy weight, staying physically active, and eating a balanced diet can all meaningfully reduce prostate cancer risk. GP Dr Jeff Foster recommends comprehensive health MOTs at key life stages.
Health Checks at 40, 50, and 60
Dr Jeff Foster: Don’t just focus on your prostate — to focus on any single gland or organ is the route to failure. If you’re truly interested in your own health and better quality of life, you want to focus on your entire self.
At 40, 50, and 60, you want a full-blown health check looking at everything in terms of disease risk profiling. This matters for prostate health because conditions overlap — for example, there’s evidence that vitamin D supplementation could reduce prostate cancer risk. People don’t make that connection if they’re only thinking about PSA tests.
Lifestyle Changes That Lower Prostate Cancer Risk
Dr Jeff Foster: Prostate cancer is incredibly common for men, but it’s just another cancer. The same principles that reduce overall cancer risk apply:
- Maintain a healthy weight — being overweight increases prostate cancer risk
- Exercise regularly — physical inactivity is a known risk factor for cancer
- Eat a balanced diet — it may sound banal, but it really does decrease prostate cancer risk
- Watch calcium intake — excessive calcium (not normal dietary amounts) may be an isolated risk factor for prostate cancer
- Consider vitamin D — emerging evidence suggests supplementation could reduce risk
- Get regular health MOTs — every decade at minimum, or more frequently if able
If prostate cancer is detected early: Early detection through screening gives men the widest possible range of treatment options. At The Focal Therapy Clinic, our consultants have collectively performed over 2,000 focal therapy procedures across seven UK locations. In our audit of 265 patients, 90% remained cancer-free at one year, with 90%+ sexual function preservation and 97% urinary continence. Learn more about focal therapy options.
