Frequently asked questions

Personalised Prostate Cancer Prevention is an approach to understanding and reducing your risk of prostate cancer. It takes into account your genetics and comparisons to men of similar age and ethnicity to provide tailored screening recommendations and risk management strategies.

Personalised prostate cancer prevention integrates genetic risk assessment into early detection strategies for asymptomatic men aged 40 and above.

While PSA testing remains a key tool in early detection, it has significant limitations:

• Clinically significant prostate cancer may be missed in men with “normal” PSA values.
• Uniform screening strategies risk both overdiagnosis in low-risk individuals and missed diagnoses in high-risk individuals.
• Prostate cancer is the most heritable common cancer, with ~58% of risk attributable to genetic factors.

Personalised prevention is beneficial for:

• Men aged 40 and over, who want to understand their risk and take preventive steps.
• Men with a family history of prostate cancer, even if they have not been recommended for genetic testing under current guidelines.
• Men concerned about their prostate cancer risk, looking for a personalised screening and prevention plan.

No, this complements national screening programmes by providing personalised risk-based recommendations. Some men may need earlier or more frequent screenings, while others may require less intensive monitoring.

Your prostate cancer risk is influenced by:

• Genetics (polygenic risk scores and family history).
• Age and ethnicity (as prostate cancer risk varies across populations).

Risk assessment includes:

• Personal and family medical history.
• Genetic analysis using polygenic risk scores (PRS).
• Comparison to men of similar age and ethnicity, followed by comparison to those aged 50 to contextualise the risk.

This method provides a more precise estimate of your prostate cancer risk than general population statistics.

If you are identified as higher risk, your prevention plan may recommend:

• Earlier or more frequent screenings (e.g. using MRI for better detection).
• Preventative lifestyle modifications (such as diet, exercise, and weight management).
• Additional medical consultations (such as specialist referrals).

Even with a lower risk, routine screenings remain important. Your prevention plan may suggest:

• PSA follow-up according to EAU risk-adapted strategy.
• Continued lifestyle awareness to maintain a lower risk profile.

A Polygenic Risk Score (PRS) assesses hundreds of common genetic variants to estimate overall genetic risk for developing prostate cancer. Unlike rare genetic mutations, PRS evaluates the combined effect of many genetic factors that influence risk in the general population.

• BRCA2 or HOXB13 tests are not routine genetic tests—they are only performed in specific cases, such as when there is a strong family history of prosate cancer. These tests are not available to all men via public healthcare.
• BRCA1/2 and HOXB13 mutations are rare.
• PRS evaluates common genetic variations that influence prostate cancer risk for all men, not just those with a strong family history.

Yes, a genetic risk assessment can provide valuable insights into whether you have an elevated genetic risk. However, even men without a strong family history may benefit from genetic risk assessments to personalise their screening and prevention strategy.

Your personalised prevention plan may include recommendations such as:

• Regular physical activity to maintain a healthy weight.
• A balanced diet rich in whole foods, fibre, and healthy fats.
• Limiting alcohol consumption and avoiding smoking.

Yes, research shows that 5-10% of prostate cancer cases can be prevented through lifestyle changes, making risk-based prevention strategies highly effective.

In the UK, NHS prostate cancer screening is not part of a national routine programme, but men over the age of 50 can request a PSA blood test after discussing the risks and benefits with their GP. There is ongoing discussion about the effectiveness of population-wide screening and how to better identify men at higher risk.

For men identified as higher risk – due to family history, genetic factors, or ethnic background – earlier and more personalised screening strategies may be recommended, which could include regular PSA testing, MRI scans, or referrals to urology specialists.

Your personalised prevention plan may recommend:

• PSA testing (standard screening method).
• MRI scans (for men at higher genetic risk).
• Consultation with urologists.

Screening frequency depends on your individual risk level:

• Higher-risk individuals (e.g. those with a family history, high polygenic risk score, or certain genetic variants like BRCA2 or HOXB13):
  May benefit from annual PSA tests, starting from age 40–45, and may also be offered MRI scans depending on clinical findings.
• Moderate-risk individuals:
  May be advised to have PSA testing every 1–2 years, starting around age 50.
• Lower-risk individuals:
  May not need regular screening, but can still request a PSA test from age 50 onward after informed discussion with a GP, as per current NHS guidelines.

• Undergo genetic testing.
• Complete a risk assessment questionnaire (online or with a healthcare provider).
• Receive a detailed risk report with personalised screening and prevention recommendations.
• Discuss next steps with a healthcare provider if needed.

Currently, the NHS does not fund genetic-based personalised prostate cancer prevention services. You should consult with your private health insurer to determine if genetic testing and additional screenings are covered under your policy.