It’s common to be confused about PSA: what it is, what your PSA level means, whether you should have a PSA test and where you can get one.
PSA stands for prostate-specific antigen. PSA is a chemical made by the prostate, which is secreted into the semen. However, small amounts of PSA find their way into the blood.
PSA is used as a prostate cancer test, but it’s normal to have a small amount of PSA in your blood.
A PSA test is a blood test for prostate cancer. A small amount of blood will be taken from a vein in your arm and sent to a laboratory to measure your PSA levels. This can be done in your GP surgery.
You may also be offered a digital rectal examination, and some urine tests.
What happens after your PSA tests depends on your results. If you have slightly elevated PSA, you will be called back to have the test repeated at a later date. If you have a high PSA, your GP may discuss referring you to a specialist, and you will be offered further tests such as a biopsy and/or an MRI.
For those aged between 50 and 69, a PSA level of above 3 nanograms per millilitre is considered raised. However, only one in four men with a PSA level between 4 and 10 micrograms per litre has prostate cancer. There are various reasons for a raised PSA level. A high PSA does not necessarily mean you have cancer, nor does a lower level mean you do not.
About 3 out of 4 men with a raised PSA level will not have cancer.
A high PSA (also called raised PSA or elevated PSA) can be a sign of common prostate problems which are not related to cancer, such as prostatitis, or even a urine infection. Certain sports and medications may also temporarily affect PSA levels. You should avoid sexual activity for 48 hours before a PSA test. This is because ejaculation can temporarily increase your PSA levels.
If you decide to have a PSA test, your GP will talk to you about what you should do before your test to help get an accurate result. It is important that you tell your GP about any medications you are taking, including over the counter remedies and any kind of herbal or natural health supplements.
PSA tests can pick up some prostate cancers before they have any symptoms. This means that the patient can then make a decision about whether they should undergo treatment or watchful waiting for their cancer.
It can also mean that if the cancer is fast growing, it may be possible to start treatment early enough to stop the cancer spreading beyond the prostate and becoming advanced prostate cancer.
There are concerns about a PSA test’s real ability to detect prostate cancer. About 3 out of 4 men with high PSA will not have cancer and about 1 in 7 prostate cancers can be missed.
Most men with high PSA tests will undergo a biopsy, which is a painful and invasive procedure. There are also concerns that many prostate cancers detected by PSA will never cause any problems, leading to unnecessary treatment and worry.
That’s a decision only you can make.
We hear from many men who did get PSA tests and want more people to get tested. This is because they believe catching their cancer early saved their life.
Some people argue that PSA testing should be given to all men, as it’s the best test we currently have. Others feel that it is not accurate enough and that the potential risks, especially of unnecessary biopsy and treatment and the related quality of life issues, mean that PSA is not a good option.
Speaking to your GP about a PSA test does not commit you to having one.
Other good sources of information include:
There is no national screening programme for prostate cancer. This is because the government doesn’t believe that PSA is accurate enough.
However, the NHS runs an Informed Choice Programme, called Prostate Cancer Risk Management. Under this programme, any man over 50 can get the PSA test for free on the NHS.
To avail of this, simply ask your GP.
Your GP will discuss the pros and cons of PSA testing with you in light of your personal medical history, and can arrange a free PSA test for you.