PSA is a protein that’s produced by your prostate gland. All men have a prostate gland and it’s normal to have a small amount of PSA in your blood. Your PSA level rises as you get older, and your prostate gets bigger.
If you have prostate cancer, this can raise the level of PSA in your blood. A PSA test will detect this. However, it’s important to bear in mind the following points.
- A raised PSA level can be caused by something other than cancer. There are many, much less serious, causes of raised PSA. These include having an enlarged prostate (benign prostatic hyperplasia) – a very common and easily treatable condition in older men. Other causes can include infections of the prostate and having a urinary catheter. A prolonged exercise session can also raise your PSA.
- Prostate cancer doesn’t always raise PSA. This is particularly true for early-stage cancers. It’s possible to have prostate cancer but your PSA level remains at a normal level. There’s no way of knowing if these cancers will be ones that will eventually grow and cause problems.
- Prostate cancer doesn’t always cause problems. Prostate cancer becomes more common in men as they get older. And although it can cause problems for some men, others live with it for many years – even the rest of their lives – without it causing any major problems.
Your GP will usually offer you a PSA test if you have symptoms that could be due to an enlarged prostate or prostate cancer. These can include having a weaker flow of urine, a more urgent need to urinate, or feeling that you haven’t emptied your bladder fully. These symptoms could also be due to other problems, but your GP will want to rule out prostate cancer.
Any man over the age of 50 can request a PSA test at their GP surgery, even if they don’t have symptoms. Your GP or practice nurse should provide you with some information about the benefits and risks of the test. They’ll also go over what other tests and treatments you may need if you’re diagnosed with prostate cancer. Talking to your doctor or nurse will help you make an informed decision about whether or not to have the test.
Before offering you a PSA test, your GP will want to talk to you about the benefits and risks of having the test. We summarise some the main points here.
- If you have a normal result, it may help to reassure you.
- If you have a prostate cancer that could have gone on to cause problems, the PSA test can help to diagnose it at an early stage, before you get symptoms.
- Being diagnosed early means you can get treatment at an earlier stage, when it will be most beneficial.
- You may get a normal PSA result even if you do have cancer (a false negative) – this can provide false reassurance. Up to about 15 in 100 men who have a negative PSA test do actually have prostate cancer, although these are often very early cancers, and may not all be ones that go on to cause problems.
- You may have a higher than normal PSA result even if you don’t have prostate cancer (a false positive). This can cause unnecessary anxiety and may mean you end up going for unnecessary invasive tests.
- You may be diagnosed with a very slow-growing cancer, that would have never caused any symptoms or affect your lifespan. You may end up seeking treatment for your cancer, even if it’s not really necessary.
Every man will value these benefits and risks differently. Your own decision about whether to have the test will be based on your own personal feelings and preferences.
If you decide to go ahead with the test, your GP will ask you to book a blood test at a suitable time. You should be able to have a PSA test at your GP surgery.
You’ll be asked to make sure you don’t book the test within at least:
- 6 weeks of a having a prostate biopsy
- 4 weeks of having a urine infection
- 1 week of having a digital rectal examination (DRE)
- 2 days of vigorous exercise
- 2 days of ejaculation
All these things can raise your PSA level and so give an inaccurate result.
When you have the test, your GP or a practice nurse will take a sample of blood. This will be sent to the laboratory for testing. Your GP or nurse may also suggest having a DRE straight after your blood test. This is another test for prostate cancer. Your GP or nurse will gently feel inside your back passage (rectum) for any hard or irregular areas that could be a sign of prostate cancer. Having the DRE in combination with the PSA test will give your doctor a much better idea of whether you need to be referred for further tests.
It can take around a week to get the results of your PSA test.
The following criteria are usually used to define what is a high PSA level – however, this can vary slightly between different doctor’s surgeries.
- Age 50–59 – level of 3.0 ng/ml or higher
- Age 60≠69 – level of 4.0 ng/ml or higher
- Age 70 or older – level higher than 5.0 ng/ml
A very high level (in the hundreds or thousands) makes it more likely that you have prostate cancer.
If you have a high PSA level, your GP may refer you to a urological cancer specialist. Remember, PSA level alone is not a good indicator of prostate cancer. Your GP will look at several other factors, in addition to the results or your PSA test, to decide whether or not to refer you. These will include results of your digital rectal examination (DRE), if you’ve had one, and any risk factors for prostate cancer.
If your PSA level is low or normal, you may still need to be referred if you have an abnormal digital rectal examination.
Your GP might ask you to repeat the test in 4 to 6 weeks if your PSA level is borderline or just above normal. They may also want you to repeat the test if there’s something that could have affected the result – such as having a recent infection.
If you are referred to a urologist, they’ll usually want to do a prostate biopsy to confirm or exclude a diagnosis. This is when small samples of tissue are taken from your prostate gland for analysis. The biopsy may be done using a needle inserted into your back passage, or into the area of skin between your testicles and back passage (the perineum). Sometimes, your urologist may recommend you have an MRI scan first. This can help indicate which areas to target with the biopsy.
Find out more about prostate cancer and how it’s treated in our information on prostate cancer.
- Prostate Cancer UK
0800 074 8383
- Prostate cancer risk management programme (PCRMP): benefits and risks of PSA testing. Public Health England. www.gov.uk, published 29 March 2016
- The PSA test. Prostate Cancer UK. prostatecanceruk.org, updated July 2014
- Raised PSA. British Association of Urological Surgeons. www.baus.org.uk, accessed 17 November 2016
- Renal medicine and urology. Oxford handbook of general practice. Oxford Medicine Online. oxfordmedicine.com, published April 2014
- Prostate cancer – PSA testing. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised January 2011
- Suspected cancer: recognition and referral. National Institute for Health and Care Excellence. www.nice.org.uk, published 23 June 2015
- Prostate Cancer UK
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Reviewed by Pippa Coulter, Specialist Health Editor, Bupa Health Content Team, January 2017
Expert reviewer, Professor Raj Persad, Consultant Urological Surgeon, Bristol Urological Institute
Next review due January 2020
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