Prostate cancer : Should I have a PSA test?

The PSA test is a blood test to help detect prostate cancer. But it's not perfect and 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 made only by the prostate gland. Some of it leaks into your blood, but 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 is not 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.

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

What's a raised PSA level?

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, 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's not cancer, such as:

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How accurate is the PSA test?

About 3 in 4 men with a raised PSA level will not have cancer. The PSA test can also miss about 15% of cancers.

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 cannot 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

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Before having the test

If you're having a PSA test, you should not have:

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

Each of these may give an inaccurate PSA reading.

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Digital rectal examination (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, lubricated finger into your back passage.

A DRE on its own is not enough to detect cancer.

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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.

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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 prostatectomy (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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