What is the PSA test?

The prostate specific antigen (PSA) test is a blood test.  When it is used with other tests, the PSA test can help doctors to diagnose prostate cancer.

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 common prostate problems such as benign prostatic hyperplasia (BPH) or prostatitis.

A raised level may sometimes be a sign of prostate cancer. 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.

Prostate cancer is the most common type of cancer in men. The causes of prostate cancer are still unknown, but some factors may increase the risk of developing it.

If you are worried about your risk of prostate cancer talk to your GP about it. You can have the PSA test at your GP surgery.

What is the PSA test?

The PSA test is a blood test. When it is used with other tests, the PSA test can help doctors to diagnose prostate cancer.

Prostate-specific antigen (PSA) is a protein made in the prostate. Some of this PSA leaks into the blood and can be measured in the PSA test.

Most men have small amounts of PSA in the blood. If the prostate becomes enlarged, inflamed, or infected, then larger amounts of PSA get into the blood. The amount of PSA in the blood may also increase if there is cancer in the prostate.

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. For example, even when prostate cancer is diagnosed early, treatment might not help men live longer. Prostate cancer may grow very slowly, and very few men with early prostate cancer will die of it.

For some men, the possible side effects of treatment may be worse than the effects of the cancer itself. For example, some treatments may affect your ability to get an erection.

Some men may choose to have tests and treatment for early prostate cancer. Others do not want to know if they have prostate cancer. This is because they think knowing would cause them to worry, or that they would have to make difficult decisions about treatment. They may also be worried about the side effects of treatment.

Before you decide whether to have the PSA test, you may want to talk to your GP about it. It can help to think about some questions you would like to ask.

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.

We have more information on the benefits and disadvantages of the PSA test. Your doctor can also help you make a decision that is right for you.


Common prostate problems

You may not be aware of your prostate unless it causes you problems. The two most common prostate problems are:

  • benign prostatic hyperplasia (also called benign prostatic hypertrophy, or BPH)
  • prostatitis.

BPH and prostatitis can both cause a raised level of PSA in the blood, but they are not prostate cancer.

Benign prostatic hyperplasia (BPH)

This 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.

Symptoms of BPH can include:

  • difficulty starting to pee
  • having a weak flow of pee
  • needing to pee more often than usual, especially at night
  • feeling like you have not completely emptied your bladder after peeing
  • an urgent need to pee
  • blood in the pee or semen (this is rare).

Prostatitis

This is when the prostate is inflamed, usually because of an infection. It can also be caused by injury to the prostate, or by some autoimmune diseases. Autoimmune diseases cause the body’s immune system to damage healthy cells in the body.

In some men, prostatitis may not cause any symptoms. Other men may have symptoms, including:

  • repeated urine infections (infections in your pee) – this can be treated with antibiotics
  • pain in or around the end of the penis, testicles, inner thighs, the area between the testicles and back passage (perineum), or the lower back
  • pain during ejaculation or blood in the ejaculated semen.

I was going to the toilet often. I went for a while without coffee just to check what was going on. I still had symptoms, so I saw my GP.

Aaron


Prostate cancer

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.

Cancer that has not spread outside the prostate is called early (localised) prostate cancer. Men with early prostate cancer may not have any symptoms. Prostate cancer normally only causes symptoms if it becomes larger. When this happens, it presses on the bladder or the tube that drains pee (urine) from the bladder (urethra).

Problems with peeing are common as men get older. These symptoms are often caused by non-cancerous (benign) conditions of the prostate. But it is important to talk to your doctor or nurse if you have any symptoms.

More men are diagnosed with prostate cancer because of PSA testing. But not all these cancers will need to be treated. Even without treatment, some prostate cancers will not shorten a man’s life.

Dave carries his golf clubs to his car. Dave on diagnosis

'Fortunately the cancer was very low grade and not aggressive, but the initial reaction was terror.'


Risk factors and causes

Doctors do not know the exact causes of prostate cancer. But there are risk factors that can increase a man’s chance of developing it. Having one or more risk factors does not mean a man will get prostate cancer. Having no risk factors does not mean a man will not develop prostate cancer. Different risk factors may affect the risk of getting prostate cancer.

Age

This is the strongest risk factor for prostate cancer. Men aged under 50 have a much lower risk of prostate cancer, although they can still develop it. The risk increases as men get older. More than half of all prostate cancers diagnosed in the UK are in men aged 70 and over.

Ethnicity

Black men have a much higher risk of developing prostate cancer than white men. The reason for this is not clear, but it may be due to genetic factors. Black men are also usually diagnosed with prostate cancer at a younger age.

Prostate Cancer UK provide an information pack for black men aged 45 and over who are concerned about their risk. It gives advice on talking to your GP about your risk of prostate cancer, to help you to decide whether to have tests.

Asian men have a lower risk of developing prostate cancer. The reason for this is unknown.

Family history

Most men who get prostate cancer do not have a family history of it. Getting older is much more likely to be the significant risk factor.

But occasionally there may be a possible family link (inherited). Certain things make this more likely. For example, the more men in a family that have prostate cancer, the younger they were when diagnosed and the more closely related they are.

A man’s risk of developing prostate cancer is higher if they have:

  • either a father or brother who had prostate cancer – the risk is greatly increased if they were diagnosed under the age of 60
  • 2 or more close relatives on the same side of the family who had prostate cancer – close relatives include a father, brother, grandfather, half-brother, and an uncle
  • certain inherited cancer gene changes (mutations).

We inherit our genes from our parents. Doctors think 5% to 10% of prostate cancers are linked to inherited gene changes (mutations). But they do not think there is a specific prostate cancer gene. It is thought that changes in a few genes are involved.

In a small number of men, prostate cancer may be linked to changes in the breast and ovarian cancer genes BRCA1 and BRCA2. Men with the BRCA2 gene mutation may have up to a 5 times higher risk of prostate cancer compared with the general population. The BRCA1 gene may also increase risk, but this is not as clear. Prostate cancer risk is also higher in men with Lynch syndrome, also known as hereditary non-polyposis colorectal cancer (HNPCC).

Talk to your GP if you have a family history of cancer and are concerned about your prostate cancer risk.

We have more information about family history and cancer.

Body weight and diet

Being very overweight (obese) may increase the risk of having a more advanced prostate cancer. It may also increase the risk of having a fast-growing (high grade) type of prostate cancer.

A diet high in animal fats may increase the risk of prostate cancer. This includes foods like red meat (such as beef, lamb and pork) and high-fat dairy products (such as butter, full-fat milk, cheese and cream).

A healthy, balanced diet is better for your general health. For most people, this includes:

  • foods high in fibre (such as wholemeal bread, brown rice, oats, beans, and lentils)
  • lots of fruit and vegetables
  • less red meat and less processed meat (such as sausages, burgers, bacon, and ham)
  • less fat and less sugar.

Eating a balanced diet and doing regular physical activity keeps you to a healthy weight. This may reduce your risk of certain types of cancers and other conditions, such as heart disease and diabetes.

There was some family background of this illness. So, on my next visit to my GP, I mentioned it. I thought it wise to ask about me having the test.

Kwame

Back to PSA test

Having the PSA test

Your PSA test results will help your doctor decide if you need further tests.