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PSA testing for prostate cancer

Imagine the scenario. You’re a 56-year-old man, your father had prostate cancer ten years ago and you’ve been told that this increases your chance of developing it too.

You’ve heard about a test, a ‘simple’ blood test that could indicate whether you have the early stages of prostate cancer or not. You would obviously take the test, wouldn’t you? In fact, many people, including a good percentage of health professionals, would argue that you should think long and hard before deciding whether to have it or not.

Details

  • The PSA test The PSA test

    This blood test is known as a PSA test. It measures the level of prostate specific antigen in your blood, a protein which is produced by your prostate gland. A high PSA level could indicate that you have prostate cancer.

    However, more often than not, a raised PSA level is caused by something much less serious. For example, benign prostatic hyperplasia – an enlarged prostate, which is common in older men and easily treated. Your PSA level can also be raised by infections, such bacterial prostatitis (a condition that affects your prostate gland and may cause swelling) or having a urinary catheter. Even a prolonged exercise session can raise it.

    On the other hand, one in five men with prostate cancer will have a normal PSA result. Are you starting to see why it’s worth thinking twice about being screened for prostate cancer? Your PSA level alone can not guarantee whether you have cancer or not.

  • Deciding to have a PSA test Deciding to have a PSA test

    It’s important to remember that the PSA test is not a test for prostate cancer. It tests for abnormalities of the prostate, one of which may be prostate cancer. In fact, two-thirds of men with a higher than normal PSA level won’t have any cancer cells in their prostate biopsy. For a prostate biopsy, a doctor uses a needle to remove a small piece of tissue from your prostate.

    And even if you’re diagnosed with prostate cancer following a biopsy or ultrasound scan, there is still the question about whether it should be treated or not.

    Around half of all men in their 50s have some cancer cells in their prostate. And eight out of 10 over the age of 80 have a small area of cancer within their prostate. Prostate cancer often grows extremely slowly and will never cause any problems. The side-effects of having treatment can often be more harmful than not receiving any treatment at all.

    Simply knowing that you have early prostate cancer can sometimes cause more harm than good. This is why each man should weigh up the pros and cons of a PSA test before going ahead with it.

  • Worried about prostate cancer?

    Get a picture of your current health and potential future health risks with a Bupa health assessment. Find out more today.

  • False-positives and false-negatives False-positives and false-negatives

    A false-positive PSA result (when your PSA level is elevated, but there is no cancer) can cause great anxiety for both you and your family. It can also lead to additional unnecessary medical procedures. As well as being uncomfortable, prostate biopsies can sometimes cause serious infections and bleeding.

    A false-negative result is when your PSA level is low even though you have prostate cancer. This can give you and your family false reassurance that you don’t have cancer, when you may in fact need treatment.

  • Weighing up the options Weighing up the options

    A PSA test can be a useful indicator about where further investigation is needed. And treatment at the early stages of cancer can often be most effective. But the problem remains – a single PSA test can't show whether prostate cancer is present, or even whether it's slow or fast-growing. Putting it into perspective, only one life is saved for every 48 men who receive treatment for prostate cancer.

    Currently, there is no national screening programme for prostate cancer in the UK, nor is there enough evidence to suggest that a screening programme would be worthwhile.

    However, a PSA test is a very personal decision. If you’re thinking about having the test or have been offered it, talk to your doctor about the pros and cons in detail. Remember, it’s your body, your life and your future. Being well informed about all of your options and the advantages and disadvantages of any treatment is imperative to making the right decision for you.

  • Resources Resources

    Further information

    Sources

    • Wilt TJ, Ahmed HU. Prostate cancer screening and the management of clinically localized disease. BMJ 2013; 346:f325. doi:10.1136/bmj.f325
    • The PSA test. Macmillan Cancer Support. www.macmillan.org.uk, last reviewed January 2013
    • PSA (prostate specific antigen) testing for prostate cancer. NHS Cancer Screening. www.cancerscreening.nhs.uk, accessed 13 November 2013
    • Heijnsdijk E, Wever EM, Auvinen A. Quality-of-life effects of prostate-specific antigen screening. N Engl J Med 2012; 367:595-605
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    Produced by Alice Rossiter, Bupa Health Information Team, November 2013.

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