What is the PSA test?

The prostate specific antigen (PSA) test is a blood test for prostate problems. PSA is a protein made in the prostate gland. Some of this PSA leaks into the blood and can be measured in the PSA test. PSA levels can be higher due to conditions, such as benign prostatic hyperplasia (BPH) or prostititis.

A raised level may sometimes be a sign of prostate cancer. This is the most common type of cancer in men. The causes of prostate cancer are still unknown, but some factors may increase the chance of developing it.

You can have the PSA test at your GP surgery. You may also have a digital rectal examination (DRE). This is when a doctor or nurse inserts a gloved finger into your rectum (back passage) to feel your prostate.

In the UK, there is no screening programme for prostate cancer. But you can talk to your GP or nurse about the PSA test and the benefits and disadvantages of having it. This can help you make the best decision for you.

Having the PSA test

What does the test involve?

The PSA test is a blood test that measures the level of PSA in your blood. You can have this test at your GP surgery. You can talk to your GP about the benefits and disadvantages before you decide whether having the test is right for you.

If you decide to have the test, your GP or nurse will take a blood sample to send to a laboratory for testing.

Digital rectal examination

You may also have an examination called a digital rectal examination (DRE). This is when the doctor or nurse inserts a gloved finger into your rectum (back passage) to feel the prostate. It may be uncomfortable, but it’s quick and shouldn’t be painful. If there is cancer in the prostate, it can feel different. Normally the prostate feels smooth, but if cancer is present, it can feel hard, rough or bumpy.


How reliable is the PSA test?

There are still questions about how reliable PSA testing is. Two out of three men with a raised PSA level (66%) will not have any cancer cells in their prostate biopsy. But up to one in five men with prostate cancer (20%) will have a normal PSA test result. You will not be offered a biopsy based on only one PSA result.

If you’re finding it difficult to cope with the emotions caused by your test results, you can visit our online community. You can get support there from people who’ve been through similar experiences to you.


Screening for prostate cancer

In the UK, there is currently no screening programme for prostate cancer. This is because we don’t know how reliable the PSA test is and there isn’t another reliable test.

Some studies show that the lives of some men may be saved by PSA screening. But they also show that screening may lead to more men being diagnosed and treated for cancers that would not cause them serious harm. This is called over-diagnosis or over-treatment.

Even though there is no screening programme, men over 50 can request the PSA test. Or they may be offered one as part of a general health check. Before you have the test, your GP or nurse will talk through the benefits and disadvantages of having it. If you are under 50 but at higher risk of prostate cancer, you can talk to your GP about having the test.

The NHS has an online decision making aid, which gives you information and helps you think about your options.

You should talk about any worrying symptoms or concerns with your GP or nurse.


Advantages and disadvantages of having the PSA test

Before deciding whether to have a PSA test, you may want to think about some of the possible advantages and disadvantages.

You can also discuss these with your GP or nurse practitioner.

Possible advantages

  • It could reassure you if the test result is normal.
  • It can help to find cancers before any symptoms develop.
  • Treatment in the early stages could help you live longer and avoid the complications of a more advanced cancer (although there is no good research evidence for this).

Possible disadvantages

  • You could get a normal result when there is cancer in the prostate, and be falsely reassured that all is well.
  • It could lead to anxiety if your PSA level is raised, even if you don’t have cancer.
  • It could lead to you having a biopsy, even if you don’t have cancer.
  • If you do have cancer, the test can’t tell you if it’s likely to cause problems in the future.

Bear in mind that, if you do have an early prostate cancer, treating it may not help you live longer and may have risks and side effects that can affect your quality of life.


Questions to help you decide

To help you make your decision, try answering these questions:

  • What would you choose to do if your PSA level is found to be high?
  • What would you do if further tests find that you have an early prostate cancer?
  • What difference will it make for you to know?

If you can answer these three questions, focusing on what is really important to you, you will be able to make a decision about the PSA test that’s best for you.

Deciding whether or not to have a PSA test can be very difficult and we hope that this information has helped you. If you have further questions, contact your GP. You can also call our cancer support specialists (0808 808 00 00) who can discuss the options with you and send you more information.