Should I have a PSA test?

Information to help you decide if you should have a PSA test to check for the early signs of prostate cancer.

The PSA test is a blood test to help detect prostate cancer. It's not perfect and it won't find all prostate cancers.

The test, which can be done at a GP surgery, measures the level of prostate-specific antigen (PSA) in your blood.

PSA is a protein only made by the prostate gland. Some of it will leak into your blood. How much depends on your age and the health of your prostate.

There's currently no national screening programme for prostate cancer in the UK because the PSA test isn't always accurate.

Before deciding to have the PSA test, you may want to talk to your GP and practice nurse, as well as your partner or a friend or family member. 

What's a raised PSA?

The amount of PSA in your blood is measured in nanograms of PSA per millilitre of blood (ng/ml). 

  • If you're aged 50 to 69, a raised PSA is 3ng/ml or higher.

A raised PSA level in your blood may be a sign of prostate cancer. But it can also be a sign of another condition that isn't cancer, like:

Higher risk

You have a higher risk of prostate cancer if you:

  • have a family history of prostate cancer
  • are of black ethnic origin
  • are overweight or obese

How accurate is the PSA test? 

  • About 15 out of every 100 men with a normal PSA level have prostate cancer.
  • About 75 out of every 100 men with a raised PSA level don't have prostate cancer. 

Pros and cons of the PSA test

Pros:

  • It may reassure you if the test result is normal.
  • It can find early signs of cancer, meaning you can get treated early.
  • PSA testing may reduce your risk of dying if you do have cancer.

Cons:

  • It can miss cancer and provide false reassurance.
  • It may lead to unnecessary worry and medical tests when there's no cancer.
  • It can't tell the difference between slow-growing and fast-growing cancers.
  • It may make you worry by finding a slow-growing cancer that may never cause any problems.

Before having the test

If you're having a PSA test, you shouldn't have:

  • ejaculated in the last 48 hours
  • exercised heavily in the last 48 hours
  • a urinary infection 
  • had a prostate biopsy in the last 6 weeks

Each of these may give an inaccurate PSA reading.

DRE

Your GP may also perform a digital rectal examination (DRE) to feel for any changes to your prostate gland.

A DRE is done by inserting a gloved and lubricated finger into your back passage.

A DRE on its own isn't enough to detect cancer.

Biopsy

If you have a raised PSA level, you may need other tests, such as a biopsy. This 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 have prostate cancer

If you have prostate cancer, your specialist will discuss your options with you.

Possible treatments include:

  • watchful waiting
  • active surveillance
  • radical prostectomy (surgery)
  • radiotherapy

Side effects of some treatments can include problems with erections, loss of fertility and incontinence.

You should talk to your cancer specialist about the benefits and risks of any treatment before you begin.

Read more about treating prostate cancer.

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