Should I get my PSA checked?
Prostate cancer is one of the commonest cancers in the United Kingdom but early screening and treatment can make a huge difference. In this article we explained more about prostate cancer and whether men should consider getting a PSA test
Should I get screen for prostate cancer?
Prostate cancer is the second most common cause of cancer deaths in men in the United Kingdom. Each year, just under 50,000 men will be diagnosed with prostate cancer and up to 11,000 will die from the disease (Cancer Research, UK).
Prostate cancer tends to be very slow in its growth which therefore means that screening for prostate cancer can be an effective way of detecting it early. Early detection and treatment can improve the chance of survival.
What is the prostate?
The prostate is a gland is only present in men. It sits between the bladder and the penis and its function is to produce fluid which helps to keep our sperm healthy. It is usually about the size of a walnut however it tends to increase in size as a man gets older. This increase in size is not cancerous and is usually termed benign prostatic hypertrophy. If individual cells of the prostate start growing out of control then prostate cancer may develop as a result.
What is PSA?
PSA or prostate-specific antigen is a small protein which is made in the prostate gland. It is made in normal prostate cells but cancer cells can sometimes produce increased levels of PSA. For this reason, high PSA levels can be a useful way of detecting prostate cancer. The difficulty is that PSA levels can also be raised in common prostate conditions that are not cancer. For this reason a diagnosis of prostate cancer is never made on a PSA level itself, but usually a combination of PSA level, prostate examination and an understanding of a man's individual risk factors for prostate cancer.
How is PSA tested?
Since PSA is present in the blood it can be tested on a routine blood sample. This is often performed during health screening checkups or if a man presents with certain symptoms which may be suggestive of problems in the prostate gland.
What will a PSA test tell me?
A raised PSA test does not mean you have prostate cancer, but could be an indication of an underlying problem with your prostate gland. If therefore you have a raised PSA blood test then your doctor may recommend further testing to find the cause
“Up to 75% of men who have a raised PSA blood test do not have prostate cancer. This can cause concern and anxiety for the patient and their family.”
How accurate is the PSA test?
Whilst the PSA blood test is very accurate at detecting raised levels of PSA, these increased levels do not always mean prostate cancer. For this reason the test must always be taken by a healthcare professional who has fully explained to you the implications of a result.
It is important to be aware that approximately 15% of men with a normal PSA level have prostate cancer which is why a thorough history and prostate examination is always recommended in addition to the blood test alone. Further to this, up to 75% of men who have a raised PSA blood test do not have prostate cancer. This can cause concern and anxiety for the patient and their family.
What is my risk of prostate cancer?
Prostate cancer can affect all men, but there are certain men who are at an increased risk:
Men over the age of 50
Men with a family history of prostate cancer
Men of Black ethnic origin
Men who are overweight or obese
What other factors affect PSA levels?
There are many other things which can affect your PSA levels. It is important to discuss your health concerns and symptoms in detail with a professional prior to having the test. Here are a few things which could change your PSA level on a blood test:
Prostatitis (prostate infection). If your prostate is inflamed for other reasons, for example sexually transmitted infections, then levels of PSA are likely to be high.
Vigourous exercise. Heavy exercise can raise the PSA level so it is always recommended that you avoid any vigourous exercise for 48 hours prior to your PSA blood test
Ejaculation. It is best to avoid ejaculating via either sexual intercourse or masturbation for 48 hours prior to the PSA test.
Rectal examination. Having a rectal examination may elevate your PSA levels. For this reason when seeing health care professional your blood test will always be taken prior to rectal examination.
Urine infection. Because urine infections create local inflammation, you should not have a PSA test for 1 month after the resolution of an infection
What are the advantages of having a PSA test?
Here some of the advantages of having a PSA blood test:
If the test result is normal, and any other investigations and risk assessment to have had are also normal, it can be significantly reassuring with regards to your risk of having prostate cancer.
It can help pick up prostate cancer if you are suffering with it without having any symptoms. Remember that prostate cancer is slow growing and in the early stages has no symptoms.
PSA testing may help to pick up more fast growing aggressive cancers at the earliest possible stage. In these situations early treatment is vital to prevent the cancer spreading and causing long-term problems.
If you have a strong family history of prostate cancer then PSA testing can be part of an effective strategy to monitor you for signs of early prostate cancer over time.
What are the disadvantage of a PSA test?
Although PSA testing can be advantageous in terms of health screening, there are some potential disadvantages which it is important to remain aware of:
Up to 75% of men with a raised PSA level do not have prostate cancer. If your PSA level is raised you may need more tests including invasive tests like biopsies which carry a risk of complications. This may lead to unnecessary anxiety and medical testing when there is no prostate cancer.
Remember that approximately 15% of men with a normal PSA have prostate cancer. This means that the test can and does miss prostate cancer in some cases.
Some men are diagnosed with very slow growing prostate cancers. These cancers are unlikely to have caused any significant problems or even shorten their lives, but being diagnosed with that cancer could cause huge amounts of worry, distress and may lead them to have investigations or treatment that they did not need.
Should I have a PSA test?
Having a PSA test is not necessarily a simple decision and it is very important to consider the risks and benefits. If you are uncertain whether to proceed, have a discussion with a qualified healthcare professional. There are some specific questions you may wish to ask yourself such as:
What is my actual risk level for prostate cancer?
Does my doctor/healthcare professional advise that I proceed with a PSA test?
If my PSA level was normal, with this reassure me?
If my PSA level was raised, what would I do and how would it affect me?
Remember that it is always best to have a PSA test done in combination with a screening examination of your prostate so that clinician can best advise you as to how to interpret the results. For this reason it is best to only get a PSA blood test done within the context of a suitable health screening appointment.
