“I’d like a PSA test, please — my brother’s just been diagnosed.”

An asymptomatic man asking for a PSA test is entitled to one after informed discussion (Prostate Cancer Risk Management Programme), and his risk changes the balance: a first-degree relative with prostate cancer, Black ethnicity and BRCA2 variants all increase risk, and BRCA2 is linked to earlier, more aggressive disease. The most valuable question in this consultation is about genetic testing in the family. A pathogenic BRCA2 variant in a brother, with maternal breast cancer and possible ovarian cancer, means Rhys has a 50% chance of carrying it; predictive testing through clinical genetics is straightforward when the familial variant is known. A positive result would mean annual PSA from age 40 under specialist high-risk guidance (for example ESMO 2022 and risk-stratified high-risk pathways; this is not a UK NSC population screening recommendation), and has implications for male breast and pancreatic cancer and for his children, who can choose testing from 18 with counselling. The GP role is to recognise the pattern, refer, support decisions at the patient’s pace, and avoid either refusing the PSA or ordering it without discussion.