Prostate cancer is the most common type of cancer in men. Each year, about 47,000 men in the UK are diagnosed with prostate cancer. It is usually diagnosed in men aged over 65. Prostate cancer can happen in younger men, but it is uncommon in men aged under 50.
The PSA test is a blood test. Prostate-specific antigen (PSA) is a protein made in the prostate. Some of this PSA leaks into the blood. This can be measured in the PSA test.
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The PSA test may help diagnose very early prostate cancer, before any symptoms develop. But there are advantages and disadvantages of having treatment for early prostate cancer.
There is no right or wrong answer about whether or not to have the PSA test. But it may help to think about whether you have any risk factors for prostate cancer and about your own preferences.
- If the test result is normal, you may feel more reassured.
- If your PSA level is slightly high, you can continue to have it monitored, especially if you have an increased risk.
- It can help to find prostate cancer before you have any symptoms.
- If further tests show you have an early, faster-growing prostate cancer, treatment may cure it or help you live longer.
- If your PSA level is raised, you may feel anxious and worry about having more tests.
- It is possible to have a normal PSA level even in men who have prostate cancer.
- Although a raised PSA level does not always mean you have cancer, you may still need more tests, such as a biopsy, which can cause complications.
- If you are diagnosed with prostate cancer, you will need to make decisions about treatments, which can have difficult side effects.
- Treating prostate cancer may not help you to live for longer, and treatments with possible risks and side effects can affect your quality of life.
Questions to think about before having a PSA test
To help you make your decision, you could think about the following questions:
- What would you do if your PSA level is 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 about an early prostate cancer?
Before you decide whether to have the PSA test, you may want to talk to your GP about it. You can also call our cancer support specialists on 0808 808 00 00. They can discuss the options with you and send you more information.
Benign prostatic hyperplasia (also called benign prostatic hypertrophy, or BPH)
Benign prostatic hyperplasia (BPH) is when the prostate increases in size. It is part of the normal ageing process and is common in men over the age of 50.
If you decide to have the PSA test, your GP or nurse will take a blood sample and send it to a laboratory to be tested.
If you are having the PSA test, you will usually have a rectal examination as well. This is when the doctor or nurse inserts a lubricated, gloved finger into your back passage (rectum) to feel the prostate. It may be uncomfortable, but it is quick and should not be painful.
Although there is no screening programme, men aged over 50 can ask their GP for 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 your PSA checked. If you are aged under 50 but at higher risk of prostate cancer, you can talk to your GP about having the PSA test.
If you are a trans woman
Trans (transgender) women who were assigned male at birth still have a prostate gland, whether they have had genital reconstructive surgery or not. This means trans women can still get prostate cancer. If you identify as a trans woman and would like to have the PSA test, talk to your GP.
The LGBT Foundation has a helpline that can give you confidential advice and support – call 0345 3 30 30 30. You can also talk to one of our cancer support specialists on 0808 808 00 00.
Your doctor may talk about a normal PSA level. Unlike some other blood tests, there is not one normal PSA level for everyone. The PSA level naturally gets higher as you get older and varies depending on the size of your prostate. The size of the prostate is different for each man and the prostate gets bigger with age.
Your doctor will tell you what they think the normal level of PSA should be for you. They generally use these levels:
- For men in their 50s, a PSA level of up to 3 nanograms per millilitre of blood (3ng/ml).
- For men in their 60s, a PSA level of up to 4ng/ml.
- For men in their 70s, a PSA level of up to 5ng/ml.
- There are no PSA level limits for men aged 80 and over.
Your GP will refer you to see a specialist if:
- the PSA level is higher than normal and your rectal examination is not normal
- the PSA level is normal but your rectal examination is not normal.
If your PSA level is higher than normal but your rectal examination is normal, your GP usually checks your PSA level again before referring you to a specialist.
You will usually be seen within 2 weeks of your GP making a referral.
Research has shown that 1 PSA test is not reliable on its own:
- 75 out of 100 men who have a raised PSA level (75%) will not have prostate cancer.
- 1 out of 7 men who have a normal PSA level (14%) will have cancer.
Most men will have more than one PSA test before they are offered a biopsy or an MRI scan of the prostate. If the level of PSA is high in several tests, or is increasing each time the test is taken, you will be offered further tests.
Below is a sample of the sources used in our PSA test information. If you would like more information about the sources we use, please contact us at email@example.com
Guidelines on Prostate Cancer. European Association of Urologists (2016). Available from: uroweb.org/guideline/prostate-cancer
National Institute for Health and Care Excellence (NICE) Prostate cancer overview. NICE Pathways. Available from: www.pathways.nice.org.uk/pathways/prostate-cancer (accessed online from March 2017 until November 2017).
Prostate cancer: diagnosis and treatment. NICE Clinical Guideline (January 2014). Available from: www.nice.org.uk/guidance/cg175
Prostate cancer risk management programme: overview. Public Health England. Available from: www.gov.uk/guidance/prostate-cancer-risk-management-programme-overview
Surveillance report 2016 – Prostate cancer: diagnosis and management (2014). NICE guideline CG175.
Suspected cancer: recognition and referral. NICE Clinical Guideline (2015). Available from: www.nice.org.uk/guidance/NG12.
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editors, Dr Jim Barber, Consultant Clinical Oncologist and Dr Lisa Pickering, Consultant Medical Oncologist.
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