PSA testing for prostate cancer
- Professor Andrew Protheroe, Consultant Oncologist
The PSA test is a blood test that can help to diagnose prostate problems including prostate cancer. It measures the amount of a protein called prostate specific antigen (PSA). Not everyone with a high blood level of PSA has prostate cancer. It’s important to understand the risks and benefits before you decide to have PSA testing.
About PSA testing
PSA is a protein that’s made by your prostate gland. It’s made by both normal and cancerous prostate cells. So if you have a prostate gland, you’re likely to have a small amount of PSA in your blood.
Your PSA level rises as you get older and your prostate gets bigger. A PSA blood test can detect your PSA level. If you have prostate cancer, this can increase how much PSA is in your blood. But for some people with prostate cancer, their PSA level isn’t higher than normal.
Around one in seven people with prostate cancer won’t have a raised PSA. So the PSA test isn’t a perfect test for prostate cancer – it can’t be used for prostate cancer screening on its own.
Prostate cancer doesn’t always cause symptoms. It becomes more common as you get older. Prostate cancer often grows very slowly. It may cause problems for some people, but others live with it for many years without any major problems.
A raised PSA level can be caused by other prostate problems besides cancer. Less serious causes of raised PSA include:
- having an enlarged prostate (benign prostatic hyperplasia) – a very common condition in older men
- urinary infections
- inflammation or infection of the prostate gland
- having a urinary catheter (a tube from your bladder to drain urine)
- recent vigorous exercise
- recent ejaculation
Cancer awareness: Prostate Cancer
Prostate cancer | PSA testing, potential symptoms and simple checks | Watch in 1:06 minutes
This Bupa animation explains how prostate specific antigen (PSA) testing checks for raised levels of PSA which maybe a sign of prostate cancer or other prostate problems. Also symptoms to look out for.
A PSA test is a blood test that measures the amount of prostate specific antigen in your blood, a raised PSA level may suggest you have a problem with your prostate, but not necessarily cancer.
This is why it's not offered as part of a national screening program, but you can request one.
You may also be offered a PSA test as part of a general health check.
There are advantages and disadvantages of having a PSA test, and it's a good idea to learn more about these before deciding to have it.
There are certain symptoms to be aware of that can indicate prostate cancer. Always said if you have any of the following.
- Problems passing urine, such as needing to go urgently or often or being unable to go at all.
- Blood in your urine.
- Pain when you wee.
- A urine infection, difficulty getting an erection.
Who can have a PSA test?
If you have symptoms
Your GP may offer you a PSA test if you have symptoms that could be caused by problems with your prostate. These symptoms include:
- having to keep getting up at night to pee
- having to pee more often
- difficulty in starting to pee
- needing to pee more urgently
- not being able to pee when you really need to
- feeling that you haven’t emptied your bladder fully
- dribbling after you pee
- blood in your pee
A PSA test may also be offered if you have other symptoms that your GP feels might be due to prostate cancer – for example, problems getting an erection. If you have no symptoms (screening)
PSA testing isn’t part of a national screening programme for prostate cancer. This is because doctors don’t know if the benefits of the test outweigh the risks. Instead, you can decide for yourself if you want to have your PSA level checked once you’re 50. This is called the Prostate Cancer Risk Management Programme.
So even if you don’t have symptoms but you’re 50 or over, you can request a PSA test at your GP surgery.
It’s important to think about the benefits and risks of having the test as well as its limitations. Your GP or practice nurse should give you detailed information about the pros and cons of the test to help you think this through. They’ll also discuss other tests you would be advised to have if your test shows your PSA level is raised.
Your GP or practice nurse will be able to discuss what 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 PSA test.
What are the benefits of a PSA test?
Before offering you a PSA test, your GP should talk to you about the benefits and risks of having the test. The following are some of the main benefits of a PSA test.
- Having normal PSA test results may help to reassure you.
- If you have a prostate cancer that could go on to cause problems, the PSA test can help to diagnose it at an early stage.
- Being diagnosed early means you can get treatment earlier and this is when treatment is most likely to help you.
- PSA testing can be useful for monitoring you if you’ve been diagnosed with prostate cancer and are under surveillance or having treatment.
Everyone will value these benefits and risks differently. Your decision about having the test will depend on your own feelings and preferences.
What are the risks of a PSA test?
Before offering you a PSA test, your GP should talk to you about the benefits and risks of having the test. The following are some of the risks associated with a PSA test.
- You may have normal PSA levels even if you have prostate cancer (called a false negative). So your doctor may think you don’t have cancer when you do have cancer (called false reassurance). These types of prostate cancer are often low grade (less harmful) cancers and may not cause problems in the future.
- You may have a raised PSA result even if you don’t have prostate cancer (called a false positive). This can make you feel anxious unnecessarily. It may mean you have unnecessary invasive tests that can cause side-effects. You may be diagnosed with a very slow-growing cancer that would never have caused problems. So, you may end up having treatment for your cancer that isn’t really necessary.
Everyone will value these benefits and risks differently. Your decision about having the test will depend on your own feelings and preferences.
Having a PSA test
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 should not have the PSA test if you:
- have an active urine infection
- have had a prostate biopsy within the last six weeks
- have had a rectal examination within the last week
- have done vigorous exercise (such as cycling) within the last two days
- have ejaculated within the last two days
If your sex life includes prostate stimulation or being the receptive partner in anal sex, try to avoid these for a week before your test. This is because these things and everything in the bullet list above can raise your PSA level and may give an inaccurate result.
Your GP or nurse may suggest you have a rectal examination after your blood test. Your GP or nurse will gently feel inside your back passage (rectum). They’re checking for any hard or irregular areas that could be a sign of prostate cancer.
Together with the PSA test results, the rectal examination helps your doctor decide whether or not to offer you a referral for further tests. These further tests may include an MRI scan and then possibly a biopsy.
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Your PSA test results
When will I get the results of my PSA test?
It can take one to two weeks to get the results of your PSA test, but your GP surgery may differ slightly from this.
What is a high level of PSA?
PSA is measured in nanograms per millilitre of blood (ng/ml). The level that’s considered normal depends on your age and ethnicity. If you’re aged 50 to 69, your PSA level is considered to be raised if it’s 3.5ng/ml or higher. But this is just a guide. As you get older, your prostate gets bigger and your PSA level rises. Your PSA level can also be affected by a urinary infection or vigorous exercise – for more information, see our section on having a PSA test.
What happens if I have a high PSA level?
If you have a high PSA level, your GP will refer you to a urological cancer specialist. You can usually expect to be seen within two weeks. In some cases, your GP may repeat the PSA test first, before referring you. Remember, a PSA test on its own can’t show for sure if you have prostate cancer.
Your doctor will look at several other factors to help decide if you need further tests. These factors will include results of your rectal examination, if you’ve had one. Your doctor will also take into account whether or not you have risk factors for prostate cancer. These include your:
- age
- family history
- ethnicity – for example, Black men have a higher risk of prostate cancer
If your PSA level is normal, your GP might still wish to refer you to a specialist. This may be because your rectal examination showed something abnormal or you’re at high risk of prostate cancer. Your GP might ask you to repeat the test if your PSA level is borderline or just above normal. They may also want you to repeat the test if something else could have affected the result. This could include having a recent urine infection.
In men aged 50 to 59, a PSA of 3.5 ng/ml or above is usually considered to be high. But this cut-off point will vary depending on your age and ethnicity. Having a raised PSA doesn’t necessarily mean you have prostate cancer. Your GP will explain your test result to you.
There isn’t an accurate test for prostate cancer. Your PSA blood levels can be raised in prostate cancer. But you can also have prostate cancer with normal PSA results. Your GP may also do a rectal examination to check for prostate cancer. You may then be referred to a specialist for more tests including an MRI scan and a biopsy.
No specific PSA level can be used to diagnose prostate cancer. This is because PSA levels vary, depending on your age and ethnic background. Having a raised PSA also doesn’t necessarily mean that you have prostate cancer.
For more information, see our section about PSA testing.
There are several things you shouldn’t do before you have a PSA test because these could affect your results. This includes not doing vigorous exercise such as cycling in the two days before your test. You also shouldn’t ejaculate in the two days before a PSA test.
For more information, see our section on having a PSA test.
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- Victoria Goldman, Freelance Health Editor
