Having the PSA test

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.

The PSA level can be raised by common prostate problems. It can also be raised by things like infection or some types of exercise such as cycling. Some drugs can also affect the levels.

  • If both the PSA level and the rectal examination results are normal, you will not need any more tests.
  • If the PSA level is raised or the rectal examination results are not normal, you may need more tests.

In the UK, there is no screening programme for prostate cancer but men aged over 50 can ask their GP for the PSA test. Trans (transgender) women who were assigned male at birth still have a prostate gland. If you identify as a trans woman and would like to have the PSA test, talk to your GP.

You can talk to your GP or nurse about the PSA test and the benefits and disadvantages of having it.

Having the PSA test

What does the test involve?

The PSA (prostate-specific antigen) 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 deciding whether having the PSA test is right for you.

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.

Rectal examination

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 rectum (back passage) to feel the prostate. It is sometimes called a digital rectal examination. It may be uncomfortable, but it is quick and should not 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.

The examination can be embarrassing but it is important to remember that no matter how uncomfortable you feel about it, get yourself checked out. It could save your life.

Bill


PSA test results

What is a normal PSA level?

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:


AgeNormal PSA level
50 to 59Up to 3 nanograms per millilitre of blood (3ng/ml)
60 to 69Up to 4 nanograms per millilitre of blood (4ng/ml)
70 to 79Up to 5 nanograms per millilitre of blood (5ng/ml)
80 and overNo limit

What can affect the PSA level?

As men get older, the level of PSA in the blood rises slowly. It may also be raised by some common prostate problems or by cancer in the prostate. The level of PSA in the blood can also be raised by:

  • infections
  • ejaculation
  • some types of exercise, such as cycling
  • having a urinary catheter (a tube to drain pee)
  • receiving anal sex or prostate stimulation during sex – it is best to avoid this for 1 week before the PSA test
  • prostate or bladder surgery
  • having a prostate biopsy.

These will usually only raise the PSA for a short time. If you decide to have the PSA test, your doctor can give you advice about how long you may have to wait for the level to come back down.

Some men take medicines that help with urinary symptoms caused by an enlarged prostate. These can lower the PSA level in your blood. They include:

  • finasteride (Proscar®)
  • dutasteride (Avodart®, Combodart®).

If you have the PSA test, it is important to let your GP or nurse know about any medicines you are taking. This includes any drugs you can buy over the counter, complementary therapies or herbal drugs.

I phoned to get my result. The nurse said it was nothing to worry about. She explained the normal range and that my result was at the bottom of that.

Yusuf


What happens after the PSA test?

What happens next depends on the results of the PSA test and the rectal examination.

If both the PSA level and the rectal examination are normal, you will not need any more tests as there is no reason to think you might have prostate cancer.

Your GP will refer you to see a specialist if:

  • your PSA level is higher than 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.

The specialist will talk to you about your results and what will happen next. They may recheck your PSA level and do another rectal examination. They will talk to you about:

  • your PSA level and whether anything could have raised it
  • how your prostate felt during the rectal examination
  • your personal risk of prostate cancer
  • your general health and any medical conditions you have.

After this, your specialist may talk to you about having an MRI scan and a sample of tissue taken from your prostate (a biopsy). They will explain the risks and benefits of this to help you make a decision. If the biopsy shows that you have prostate cancer, you may need some further tests to give doctors more information about the stage of the cancer. The stage of the cancer is its size and whether it has spread. We have more information on having tests for prostate cancer.

If you have prostate cancer, there are ways of treating and managing it. Your healthcare team can talk to you about your options.


How reliable is the PSA test?

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.

National screening for prostate cancer

Screening is a way to try to find cancer early in people who do not have any symptoms. In the UK, there are screening programmes for breast, bowel, and cervical cancer. But there is currently no national screening programme for prostate cancer. On its own, the PSA test is not accurate enough to find prostate cancer to be used as part of a screening programme.

Some studies show that the lives of some men may be saved by PSA screening. But they also show the following:

  • Screening may lead to more men having invasive tests, such as a biopsy, which can cause complications.
  • Screening may lead to more men being treated for prostate cancers that would not cause them serious harm. They may be given treatments that have side effects, such as erection problems or urinary incontinence.

For a screening programme to be effective, the benefits need to outweigh the disadvantages.

Who can have a PSA test?

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.

You may feel worried about talking to your doctor or practice nurse about this, but doctors and nurses are used to talking about many different needs. If you find it difficult to start the conversation, you could try showing them this information. You should talk about any worrying symptoms or concerns with your GP or nurse.

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.

Back to PSA test

What is the PSA test?

The prostate specific antigen (PSA) test is a blood test that measures levels of PSA protein in the blood.