Navigation

PSA testing for prostate cancer


Expert reviewer, Professor Raj Persad, Consultant Urological Surgeon,
Bristol Urological Institute
Next review due January 2020

The PSA test is a blood test men can have to check for a protein called prostate specific antigen (PSA). This screening test can help spot early signs of prostate cancer. However, like all screening tests, it’s not always reliable – the test may sometimes suggest you have cancer when you don’t, or it may miss some cases of cancer. But at the moment, it's the best non-invasive screening test we have. It’s worth thinking about the possible drawbacks, as well as the potential benefits, before you decide whether or not to have this test.

An image showing a man relaxing in a chair

What is PSA?

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 a number of 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, bladder and kidneys, and having a urinary catheter. A prolonged exercise session and ejaculation 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.

Who can have a PSA test?

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.

At present, any man over the age of 50 can request a PSA test at their GP surgery, even if they don’t have symptoms. However, it’s important to think about the benefits and risks of having the test, and its limitations. Your GP or practice nurse should provide you with some information to help you think this through. They’ll also go over what other tests you may be advised to have following a raised PSA result and 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 test.

What are the benefits and risks of a PSA 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.

Benefits

  • 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.

Risks

  • 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.

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’ll be asked not to book the test if you have an active urinary tract infection (an infection of the bladder, kidneys or prostate) or within at least:

  • 6 weeks of a having a prostate biopsy
  • 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, phlebotomist (a health professional trained in taking blood) 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 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 better idea of whether you need to be referred for further tests. But it’s important to note that like the PSA test, the DRE doesn’t always detect prostate cancer, especially in its early stages.

Your results

PSA is measured in nanograms per millilitre of blood (ng/ml). The level that's considered normal can depend on your age and race. If you’re aged 50 to 69, your PSA level is considered to be raised if it’s 3.0 ng/ml or higher. However this is just a guide. As you get older your prostate gets bigger and your PSA level rises. It can also be affected by other things such as a urine infection or vigorous exercise (see our section: Having a PSA test for more information).

What happens if I have a high PSA level?

If you have a high PSA level, your GP may refer you to a urological cancer specialist. Remember, PSA level alone can’t conclusively show whether you have prostate cancer. Your GP will look at several other factors, in addition to the results of 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 symptoms and risk factors for prostate cancer.

If your PSA level is low or normal, you may sometimes still need to be referred to a specialist. This may be because you have an abnormal DRE, you have certain urinary symptoms or you’re considered to be 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 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.

It can take around a week to get the results of your PSA test.


About our health information

At Bupa we produce a wealth of free health information for you and your family. We believe that trustworthy information is essential in helping you make better decisions about your health and care. That’s why our content is produced to the highest quality standards. Look out for the quality marks on our pages below. You can find out more about these organisations and their standards on The Information Standard and HON Code websites.

Information standard logo  This website is certified by Health On the Net Foundation. Click to verify.

Learn more about our editorial team and principles >

Related information

    • 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
  • 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



Has our health information helped you?

We’d love to know what you think about what you’ve just been reading and looking at – we’ll use it to improve our information. If you’d like to give us some feedback, our short survey on the right will take just a few minutes to complete. And if there's a question you want to ask that hasn't been answered here, please submit it to us. Although we can't respond to specific questions directly, we’ll aim to include the answer to it when we next review this topic.



ajax-loader