Statement re NHS Scotland prostate cancer referral guidelines

Prostate Scotland welcomes updated NHS Scotland prostate cancer referral guidelines but calls for greater support for at-risk asymptomatic men

NHS Scotland has published updated Referral Guidelines for all major cancers, including prostate cancer, an important step towards earlier diagnosis and improved outcomes.

Prostate cancer is the most diagnosed cancer among Scottish men. While earlier detection improves treatment success, many men are still diagnosed at a late, less treatable stage, often without symptoms.

Prostate Scotland welcomes the strengthened guidance for men presenting with symptoms of prostate disease. However, the updated guidelines still do not provide clear, actionable referral guidance for asymptomatic men at increased risk – including those with a family history, men of Black African or Caribbean heritage, or inherited genetic mutations. Asymptomatic men are referenced, yet those most at risk without symptoms remain underserved, leaving a critical gap in early detection pathways.

Professor Alan McNeill, Consultant Urological Surgeon and Founding Trustee of Prostate Scotland, said:

“We continue to see far too many men in their 50s and 60s presenting with advanced prostate cancer – often because testing was only prompted by symptoms, which men with a family history, men of Black African or Caribbean heritage, or inherited genetic mutations may never develop.

“While we welcome the updated referral guidelines for men with symptoms, they miss an important opportunity to support GPs in initiating PSA testing conversations with asymptomatic men at increased risk. What’s missing is a clear prompt for GPs to consider PSA testing based on risk factors alone – not just symptoms. Embedding this in referral tools would give GPs more confidence to act early, when treatment is most effective. These are exactly the men who stand to benefit most from early testing and curative treatment.”

Existing guidance from the Prostate Cancer Risk Management Programme (PCRMP) offers more detailed recommendations for asymptomatic men at increased risk. Consolidating this information with the updated guidelines would better support busy primary care teams in confidently identifying and referring these men for early assessment.

Recognising this, Prostate Scotland has developed PSA in Practice, a quick-reference guide to help primary care clinicians identify and advise both symptomatic and asymptomatic men with elevated risk factors, ensuring timely, informed discussions about PSA testing.

“Helping asymptomatic men with a genetic risk of prostate cancer access early testing will save lives by detecting cancer when it is most treatable,” added Professor McNeill. “We hope PSA in Practice offers valuable guidance to GPs and primary care teams in improving early detection and reducing late-stage diagnoses.”

Prostate Scotland continues to hear from men who have been denied PSA testing based on a low International Prostate Symptom Score (IPSS) – despite having other risk factors such as a family history of prostate cancer. This raises concern that some men who could benefit from early testing may be slipping through the net.

As a next step, the charity is exploring how best to capture and share patient experiences of accessing PSA testing. The aim is to use these insights to inform policy, support clinical practice, and ultimately save lives.

Prostate Scotland remains committed to working with healthcare professionals, policymakers, and communities to close gaps in early detection and improve outcomes for all men affected by prostate disease.

PSA in Practice will be available on Prostate Scotland’s website soon and will be rolled out directly to GP practices across Scotland.

For more information, visit prostatescotland.org.uk

For more information, please contact:

Julie Fraser, Holler PR on 07834 708611 / julie@hollerpr.co.uk

About Prostate Scotland

• Prostate Scotland is a Scottish charity set up to provide information, advice and support on prostate health and diseases test and treatments
• Prostate cancer is the most common cancer affecting 1 in 10 men in Scotland. Nearly 1 in 2 men in Scotland will be affected by prostate disease at some stage of their lives
• The charity’s mission is to inform, educate, support, campaign and advance on prostate disease in Scotland
• It currently receives no government or local authority assistance and generates its own income, receives donations from fundraising and support from voluntary sources
• When reporting on prostate cancer, Prostate Scotland encourages the use of sensitive language that avoids terms like “battle,” “fight,” or “survivor,” which can unintentionally imply blame or failure. Instead, phrases such as “lived with,” “was treated for,” “recovered from,” or “died from prostate cancer” are more accurate and compassionate