Prostate specific antigen (PSA) testing

What is the prostate?

The prostate is a gland that sits beneath the bladder and produces fluid to help keep sperm healthy. It is approximately the size of a walnut. As a man gets older it is common for the gland to increase in size. Problems with the gland can affect sexual function and cause problems with passing urine. Some men may also develop prostate cancer as cells grow out of control.

Prostate cancer is the second most common cause of cancer deaths in men in the UK. About 48,000 men will be diagnosed each year and 11,000 will die from the disease (Cancer Research UK*).

What is PSA and how is it tested?

Prostate specific antigen (PSA) is a protein produced by both normal and cancerous prostate cells. It is normal for all men to have some PSA in their blood. A high level of PSA can be a sign of cancer. However, your PSA level can also be raised in prostate conditions that are not cancer. A diagnosis of cancer is not made on a PSA level alone. Your PSA will be tested from a blood sample taken.

What are my risks of prostate cancer?

Individuals at a higher risk of Prostate Cancer include men aged 50 or over, men with a family history of prostate cancer, black ethnic origin and being overweight or obese.

What will the PSA test tell me?

If your result is raised this could be a sign of a problem with your prostate. Therefore, if your result is raised, further testing may be required to find out what is causing the raised level.

Be aware that:

Approximately 15 out of every 100 men with a normal PSA level have prostate cancer so a prostate examination is also recommended.
Approximately 75 out of every 100 men with a raised PSA level do not have prostate cancer.

What else could affect my PSA level?**

Urine infection – you should not have a PSA test for 1 month after resolution of an infection.
Vigorous exercise – it is recommended you avoid this 48 hours prior to a PSA test.
Ejaculation and prostate stimulation – it is recommended that you avoid ejaculating or having your prostate stimulated for 48 hours prior to a PSA test.
Rectal examination – having a rectal examination prior to a PSA test may elevate your levels. Your blood will always be taken prior to a rectal examination if you chose to have a PSA done.
Prostate biopsy/surgery or catheterisation – if you’ve had recent prostate surgery or a urinary catheter you should wait 6 weeks until having a PSA test.
Medicines – it is important to discuss any medications you are taking with your clinician.

*https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/pro...
**Please note, to minimise the risk of false positive results your clinician may reschedule the PSA test to another date if this guidance is not adhered to.

What will the test results tell me?

It’s important to think about whether the PSA test is right for you before you decide whether or not to go ahead. Before you decide, try asking yourself the following questions:

Am I at higher risk of prostate cancer?
If my PSA level was normal, would this reassure me?
If my PSA level was raised, what would I do?
If I was diagnosed with slow-growing prostate cancer that might never cause any problems, would I want treatment that could cause side effects?

Should I have the test?

It’s important to consider the pros and cons of any clinical test, PSA is no different. It is therefore important you make an informed decision.

There will be an opportunity to discuss any questions you have with the clinician at your assessment before you need to make this decision. It is best to have the PSA test with a prostate examination to also ensure the gland feels healthy.

What may happen if my PSA result is raised?

Further tests will be considered dependent on your individual case. You may be referred on to a specialist called a urologist.

The specialist will discuss further tests that may include an MRI of the prostate, or a transrectal ultrasound guided biopsy of the prostate. A biopsy involves taking small samples of your prostate and checking them for cancer. Biopsies miss 1 in 5 prostate cancers and can sometimes cause complications. The most common are bleeding and infections.

If you are diagnosed with prostate cancer, your specialist will discuss your options with you. Possible treatments include watchful waiting, active surveillance, radical prostatectomy (surgery) and radiotherapy.

What are the advantages of having the PSA test?

It may reassure you if the test result is normal.
It can help pick up prostate cancer before you have any symptoms; most early cancers do not have symptoms.
It may help to pick up a fast-growing cancer at an early stage when treatment may stop the cancer spreading and causing problems.
Having regular PSA tests could be helpful for men who are more at risk of prostate cancer. This can help spot any changes in your PSA level, which might be a sign of prostate cancer.

What are the disadvantages of the PSA test?

You might have a raised PSA level, even if you don’t have prostate cancer. Many men with a raised PSA level don’t have prostate cancer.
The PSA test can miss prostate cancer. Approximately 15 out of every 100 men with a normal PSA level have prostate cancer. 1 in 50 men with a normal PSA may have a fast-growing prostate cancer.
If your PSA level is raised you may need more tests, including a biopsy. The biopsy can cause complications.
It may lead to unnecessary worry and medical tests when there’s no cancer.
You might be diagnosed with a slow-growing prostate cancer which would never have caused you any problems or shortened your life. But being diagnosed with cancer could make you worry, and you might decide to have treatment that you didn’t need.
Treatments for prostate cancer have side effects that can affect your daily life, including urinary, bowel, and erection problems.

Where eligible, your PSA levels can be tested during your health assessment. For more information, contact us on 03452 302040.