Cases/Renal and Urology

Man of 49 Asking About Prostate Cancer After A TV Campaign — Free SCA Practice Case

Man of 49 asking about prostate cancer after a TV campaign

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Data Gathering

History, ICE & Diagnosis

Clinical Management

Diagnosis, Plan & Decisions

Safety Net

Follow-up & Close

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Materials for Candidate

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Patient Profile

Full Name

Everton Beckford

Age

49 years

Consultation Type

Video

Age

Situation

Video Consultation. Routine appointment booked by the patient.

Reason for Encounter

"I saw a campaign about prostate cancer risk and I'd like the test done today."

Medical Records

●PMH: Hypertension, diagnosed 18 months ago. Mild eczema in childhood.
●Medications: Amlodipine 5 mg once daily.
●Allergies: NKDA.
●Social: Service delivery manager for a software company. Married, two children. Non smoker. Drinks within recommended limits.
●Recent notes: Blood pressure 132/80 at annual review three months ago. No PSA result on record.

Patient Script

For the friend playing the patient role

Character Overview: You are Everton Beckford, a 49 year old Black British man whose parents came to England from Jamaica. You work as a service delivery manager for a software company, mostly from home on video calls. You live with your wife Carlene, a ward sister, and your two children, Jerome who is 22 and Alisha who is 18. Your father Roydon is 76 and lives ten minutes away. He was diagnosed with prostate cancer at 64, after two years of being told that getting up at night to pass water was just his age. You have no symptoms yourself and feel well. A few nights ago you saw a television campaign saying that one in four Black men will get prostate cancer, and it hit home. You want a blood test today so you know where you stand. You are articulate, polite and well read, but you have a long habit of being brushed off by services, and you notice quickly if you feel you are being fobbed off. If the doctor explains things properly and treats you as an adult, you are open and thoughtful.

Opening Sentence: "Morning, doctor. I saw a campaign on the telly about prostate cancer in Black men, and my father had it, so I'd like to have the test done today if I can. I'd rather know than not know."

History if Asked (Data Gathering Phase)

●Why now: "That advert said one in four Black men get it. My father had it and I'm forty nine. I thought, what am I waiting for? Carlene said I should stop talking about it and ring the surgery."
●Symptoms: "None. I feel fine. I'm not getting up at night, the stream is good, I empty properly. I've seen no blood in my urine or in anything else, and nothing wrong in the bedroom either."
●General health: "Weight is steady, no bone or back pain, no night sweats, and I'm not tired beyond what the job does to me."
●Previous tests: "I've never had a PSA test. Nobody has ever offered one."
●What he has read: "The advert said to get checked and there was a website at the end. I only looked at it for a minute."

Family History

●Father: "Roydon. He was sixty four when they found it. For about two years his GP put the night time toilet trips down to his age. Then someone did a blood test and it was high. He had radiotherapy and injections, and he's seventy six and doing well, but it frightened all of us."
●Other relatives: "My dad's sister, Aunt Winsome, had breast cancer in her late fifties. She's alive and well. My mother's side has nothing that I know of. I have a younger brother, Dwayne, who is 46. He has no problems."
●Genetic testing: "No, nobody in the family has ever had a genetic test as far as I know."
●Ethnicity: "Black British, my parents are Jamaican."

Ideas, Concerns, Expectations

Gating note: Everton does not offer any of this unless the doctor asks what he thinks, what worries him, or what he was hoping for.

●Ideas: He believes the PSA blood test is a proper cancer test, so a normal result means he is in the clear and a high one means cancer. He assumes that since Black men are at higher risk, the NHS must already invite them. "I thought if you're high risk they'd be calling you in. Isn't that the point of the campaign?"
●Concerns: His main worry is being found too late, as his father nearly was, and leaving Carlene and the children. He also fears being told he is "too young" or not being listened to. "My father was brushed off for two years. I don't want to be told it's nothing and sent away."
●Expectations: He expects to leave with a blood test done today. He would be more annoyed by a flat refusal than by a delay for a good reason. "I'd like it done today, but if there's a reason it can't be, tell me the reason."

If Asked: Understanding of the Test

Gating note: Everton answers these only when asked.

●If asked what he understands about the PSA test: "It's a blood test that tells you if you've got prostate cancer, isn't it? Normal is good and high is bad."
●If asked whether he knows how it could go wrong: "Go wrong? I'd not thought about that. Does it miss things?"
●If asked what he thinks happens after a high result: "More tests, I suppose. Maybe a scan. I hadn't thought about a biopsy."
●If told about overdiagnosis: "So some of these cancers would never have bothered a man? My father's one did, though. How would you know which is which?"

If Asked: Medical History, Medications and Lifestyle

Gating note: Everton answers each of these plainly when the doctor asks about it.

●Other health problems: "Just blood pressure, found at an annual check about a year and a half ago. I take amlodipine. That's all."
●Medicines: "Amlodipine 5 milligrams every morning. No other tablets, nothing from the chemist, no supplements. I don't take anything for my waterworks."
●Urine infection or procedures: "No urine infections. I've never had a catheter, a camera test or a prostate examination."
●Exercise: "I ran ten kilometres this morning, I run most days before work."
●Sexual activity: "Last night, yes, with my wife. I'd rather not get into more than that."
●Mood and sleep: "Sleeping fine. The advert has been playing on my mind, but I'm not low."
●Smoking and alcohol: "Never smoked. A couple of drinks at the weekend."
●Work and availability: "I work from home, so I can come in for a blood test at any time. I can take an hour off whenever."

If Asked: Wider Family and Wider Worries

●If asked whether his brother or son might also want advice: "Dwayne is 46 and has been saying he should get checked as well. Jerome is only 22."
●If asked how his father is now: "He sees the specialist twice a year. He's cheerful about it, but he made me promise to get checked."
●If asked about anything else on his mind: "No, it's this. And the fact that every time I read something online it says something different."

Responses to Management (The Negotiation Phase)

●
If the doctor explains that he does not qualify for national screening, or that Black men are not currently invited:
- ●Reaction: Surprised and a little frustrated. "But the advert said Black men are at higher risk. So why aren't we being invited?" If told that the national screening committee is not yet sure that screening Black men would do more good than harm, that the new targeted programme is only for men with a BRCA2 gene change and a family history, and that a large trial is being expanded to include more Black men: "So it's not that nobody cares, it's that they don't know yet? Can I join that trial?" He accepts it if the doctor is honest and does not sound dismissive.
●
If the doctor explains the benefits and the downsides of the PSA test:
- ●Reaction: Thoughtful. "So it can miss a cancer, and it can send me for a biopsy for nothing? And some men get treatment they never needed?" If told that treatment can cause leaking urine and erection problems: "That's a lot to weigh up." He weighs it up out loud and asks what the doctor would do. "What would you do in my shoes?" He does not want to be told what to do but wants honesty.
●
If the doctor offers the test, or says it is his decision:
- ●Reaction: Relieved to be listened to. "So I can have it if I want it? Then yes, I think I do. My father's was found late and I'd rather know." If the doctor suggests he take a few days to think it over, he is fine with this as long as he can book it easily afterwards. "Fair enough, as long as I don't have to fight to get it later."
●
If the doctor says the test cannot be done today and explains preparation:
- ●Reaction: Accepting once the reason is clear. "I ran this morning and I was with my wife last night. So I need to wait two days? Why does that matter?" Once he is told that running, cycling and ejaculation can push the PSA up, he says "Fine, I'll book for Thursday morning and keep the running off until then. Do I need a fast?"
●
If the doctor explains what happens with the result:
- ●Reaction: Wants a plan. "So if it's normal, that's it? And if it's high, what happens, a scan first or straight to a biopsy?" He accepts that a normal result does not guarantee he is clear. "So how often would I need it done again?" He asks how and when he will hear.
●
If the doctor asks about his aunt's breast cancer, or mentions genes:
- ●Reaction: Interested. "Would that matter? Aunt Winsome had it in her fifties. Should I be having a gene test?" If told that this is something the practice can look into, and he can ask his father's family whether anyone has had testing: "I'll ask Dad. He'll want to know why I'm asking."

Mark Scheme

Domain 1: Data Gathering and Diagnosis

0 / 16 indicators checked+0−0

Positive (0/8)

Negative (0/8)

Domain 2: Clinical Management and Medical Complexity

0 / 22 indicators checked+0−0

Positive (0/11)

Negative (0/11)

Domain 3: Relating to Others

0 / 14 indicators checked+0−0

Positive (0/7)

Negative (0/7)

Clinical Learning Points

The Core Dilemma and the Model Plan

●Everton is a well 49 year old Black British man whose father had prostate cancer. A television campaign has told him that Black men are at higher risk, and he wants a PSA (prostate specific antigen) test today. The station tests whether the candidate can explain risk honestly, correct the belief that PSA is a definitive test or that high risk men are already invited for screening, and then share the decision.
●The model plan has six parts. Explore why he has come and screen out symptoms. Establish his ethnicity and family history, including other cancers and genetic testing. Explain the national position and his own higher risk. Give a balanced account of benefits, limits and harms. Support his choice, offering the test if he still wants it. Advise on preparation, because he ran this morning and ejaculated last night, so blood should not be taken today.
●Acceptable alternatives: counselling, then arranging the PSA for a time after the 48 hour preparation period, or agreeing a short pause so that he can read and decide, with an easy way to book. Both leave the decision with him. An in person visit for the blood test is reasonable. What does not pass is a flat refusal because he is under 50 or because he falls outside the targeted programme, or ordering the test with no discussion.

What the National Position Is Now

●No prostate cancer screening programme is running yet, and the UK National Screening Committee (UK NSC) does not recommend population screening for men in general. In May 2026 the UK NSC published its final recommendation for a targeted programme: PSA every 2 years from age 45 to 61 for men with a pathogenic BRCA2 variant and a relevant family history of breast, ovarian, pancreatic or prostate cancer. Ministers in England accepted it in June 2026 and rollout is expected from 2027, so it is not yet active.
●The UK NSC did not recommend population screening, targeted screening of Black men, or targeted screening of men with a family history but no BRCA2 variant. For Black men, it concluded that it is uncertain whether screening would do more good than harm. Everton is therefore not eligible for the programme, now or when it starts, unless a BRCA2 variant is later found.
●The government has said it will fund an expansion of the TRANSFORM trial so that all eligible Black men, aged 45 to 74 with no PSA test or prostate MRI in the previous five years, are invited to take part in its second stage, subject to successful first stage outcomes. Men are invited rather than self referring, so the right message is that research is under way and he may be invited, not that he can sign up through the surgery. Invitation requires no PSA test or prostate MRI in the previous five years, so a test taken now could affect his eligibility, which is worth mentioning if he asks about the trial.

His Risk in Context

●CKS gives a lifetime risk of about 1 in 4 for Black men and 1 in 8 for White men. Having a father with prostate cancer raises the risk, with a pooled relative risk of about 2.35 in the meta analysis cited by CKS. Age is the strongest factor, and prostate cancer is uncommon below 50.
●The honest message is that his risk is above average and worth taking seriously, but most men of 49 do not have clinically significant prostate cancer. Avoid frightening him and avoid false reassurance.

Benefits, Limits and Harms

●Benefit: a PSA may find cancer before symptoms so that treatment or active surveillance can start earlier. Evidence of lives saved in well men is modest. In the UK CAP trial, one fewer man in 1,000 invited for a one off PSA died of prostate cancer at 10 years, and a 2024 analysis at 15 years showed a very small difference with no effect on overall survival.
●Limits, as given in CKS: PSA is not a cancer test. About 3 in 4 men with a raised level (3 ng/mL or more) have no cancer on biopsy, and up to about 15% of men with a normal level have cancer. A raised result leads to repeat testing, MRI and possibly biopsy, with risks of bleeding and infection. NICE recommends MRI before biopsy.
●Overdiagnosis and treatment harm: the UK NSC states that about 80% of cancers found by screening would not be life threatening. After prostate surgery CKS (citing NICE 2021) reports that about two thirds of men have moderate or severe erectile dysfunction at six months and about one in five have moderate to severe urinary incontinence. After radiotherapy the figures are about a half and about 6%. Active surveillance avoids some of this harm.

Offering the Test: Acceptable Routes

●CKS requires information to support an informed choice before any PSA test, and the NHS website PSA page (updated June 2026) says that men and anyone with a prostate can ask a GP about PSA testing, and that the doctor will discuss benefits and risks before a decision is made. It states no minimum age.
●Everton is 49, with two recognised risk factors, and Prostate Cancer UK advises Black men and men with a family history to talk to their GP from 45. After balanced counselling, the usual and defensible approach is to offer the test if he still wants it. Equally acceptable is to agree that he will go away, read, and book when ready. The practice should make that easy.
●The candidate must not decide for him in either direction, and must not use his age as the sole reason to refuse.

Timing and Preparation

●CKS lists the preconditions for a PSA: no active urinary infection or one within the previous 6 weeks, no ejaculation in the previous 48 hours, no vigorous exercise such as cycling in the previous 48 hours, and no urological intervention such as a biopsy in the previous 6 weeks. The NHS website gives the same 48 hours for ejaculation, exercise and cycling, and 4 to 6 weeks after a urine infection.
●Everton ran this morning and ejaculated last night, so a PSA today could be falsely raised. Good practice is to explain this, book a blood test after 48 hours, and ask him to avoid running hard and ejaculation beforehand. No fasting is needed. A digital rectal examination is not needed for a well man's request.

Explaining the Result

●Agree before testing what a result means. A normal PSA does not exclude cancer, and the interval for any repeat should be agreed individually. A raised PSA is not a diagnosis, and is repeated, discussed, and may lead to referral for MRI. The CKS age specific thresholds (more than 2.5 ng/mL at 40 to 49) are written for people with possible symptoms, so in a well man a raised result is repeated and discussed, with urology advice if needed.

Family History and Genetics

●His father's sister had breast cancer in her late fifties. Breast, ovarian, pancreatic and prostate cancers are the cancers that, with a BRCA2 variant, define the new programme. One aunt does not necessarily meet NHS genetic testing criteria, which are set in the National Genomic Test Directory.
●A good response recognises that the breast cancer may matter, explains that testing follows national criteria, and offers to take advice from clinical genetics or to ask his father whether anyone in the family has been tested. CKS says that advice on referring well people without a known variant is expected by autumn 2026. Do not offer a direct to consumer test or promise entry to the programme. His 46 year old brother can book his own discussion.

Safety Netting and Follow Up

●Advise Everton to return promptly if he develops urinary symptoms, blood in the urine or semen, erectile difficulty, back or bone pain or unexplained weight loss. These need symptomatic assessment and are no longer a well man's request.
●Record the discussion and his decision, point him to reliable information from NHS, Prostate Cancer UK and Cancer Research UK, and book review of the result.

Common Mistakes in This Station

●Refusing the test because he is under 50 or because he is outside the targeted programme.
●Taking blood today without asking about running or ejaculation.
●Presenting PSA as a definitive test, telling him that Black men are invited for screening, or telling him that no prostate screening is planned for anyone or that the decision is still pending.
●Counselling only on harms or only on benefits, or telling him what to do.
●Missing the aunt's breast cancer, or promising a gene test.
●Responding to his fear of being brushed off with a script rather than with real listening.

Mapped to the RCGP curriculum topic: Renal and Urology.

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