The PSA test is not a test for prostate cancer. It’s a blood test for prostate problems, one of which may be cancer. If the PSA test is used with other tests, it can help doctors diagnose prostate cancer. It may help diagnose very early prostate cancer, before any symptoms develop.

But it is unclear how reliable the test is and whether treatment is always needed for early prostate cancer.

Even when prostate cancer is diagnosed early, treatment might not help men live longer. Prostate cancer may grow very slowly. Most men with early prostate cancer will not die as a result of it, and the side effects of treatment may be worse than the effects of the cancer itself.

Some men may choose to have tests and treatment for early prostate cancer. Others don’t want to know if they have prostate cancer. They may think knowing would cause them to worry or that they would have to make decisions about treatment.

There’s no right or wrong answer about having the PSA test. It is important to consider the benefits and disadvantages associated with the PSA test. With the help of your doctor and this information, you can make the decision that’s right for you.

Only men have a prostate gland. The gland is about the size of a walnut and gets a little bigger with age. It surrounds the first part of the tube (urethra) that carries urine from the bladder along the penis. The back of the prostate gland is close to the rectum (back passage).

The prostate produces a thick, white fluid that mixes with the sperm made by the testicles to make semen. The prostate gland also produces a protein called prostate-specific antigen (PSA) that turns the semen into liquid. Some of this PSA leaks into the blood and can be measured in the PSA test.

Larger amounts of PSA leak into the blood if the prostate gland is enlarged, inflamed or infected, or if there’s cancer in the prostate.

You may not be aware of your prostate gland unless it causes you problems. The two most common prostate problems are benign prostatic hyperplasia (also called benign prostatic hypertrophy or BPH) and prostatitis.

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

Benign prostatic hyperplasia

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.

BPH can cause the following symptoms:

• difficulty starting to pass urine
• having a restricted flow of urine
• passing urine more often than usual, especially at night
• an urgent need to pass urine
• blood in the urine or semen, although this is rare.

Prostatitis

This is when the prostate gland is inflamed or has an infection. It can also be caused by injury to the prostate gland, or by some autoimmune diseases where the body’s immune system damages the body’s own cells.

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

• repeated urine infections (which can be treated with antibiotics)
• pain at the end of the penis
• a dull ache in the 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.

Prostate cancer is the most common type of cancer in men. About 42,000 men in the UK are diagnosed with prostate cancer each year. It generally affects men over 50 and is rare in younger men.

Prostate cancer is different from most other cancers, because small areas of cancer in the prostate are very common. Prostate cancer may also stay inactive (dormant) for many years.

Cancer that is contained in the prostate gland (has not spread anywhere else) 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, and presses on the bladder or the tube (urethra) that drains urine from the bladder.

If you have any problems passing urine, speak to your doctor or nurse. The symptoms are often caused by non-cancerous conditions such as BPH or prostatitis.

You can talk to one of our cancer support specialists about prostate cancer. Call them on 0808 808 00 00.

The number of men diagnosed with prostate cancer in the UK has increased in recent years. It is thought that this is because more men are having tests that detect very early prostate cancers, which would previously not have been found. These tests include the PSA test, digital rectal examinations and looking at risk factors.

The causes of prostate cancer are still unknown, but there are some factors that increase a man’s chance of developing it:

Age

Your risk of developing prostate cancer increases as you get older. Prostate cancer is rare in younger men. Only 1 in 100 cases (1%) is diagnosed in men under 50.

Ethnicity

Black African and black Caribbean men are more at risk of developing prostate cancer than other ethnic groups.

Family history

Most prostate cancers are not caused by inherited cancer genes and most men who get prostate cancer don’t have a family history of it. But sometimes prostate cancer can run in families.

In general, the more men in a family who have been diagnosed with prostate cancer, the younger they were when diagnosed and the more closely related they are, the more likely it is that there is a family link.

A man’s risk of developing prostate cancer is increased if he has:

• one first-degree relative who developed prostate cancer at or under the age of 60 (a first-degree relative is a father, brother or son)
• two or more close relatives on the same side of the family who developed prostate cancer (a close relative is a father, brother, son, grandfather, uncle or nephew).

There isn’t one ‘prostate cancer gene’ that explains most cases of hereditary prostate cancer. It is thought that variations in several genes may be involved.

In a small number of men, prostate cancer is linked to variations in the genes BRCA1 and, particularly, BRCA2. These variations are also linked to some breast and ovarian cancers. If you have a relative with prostate cancer and there is also a strong history of breast or ovarian cancer on the same side of the family, this may be due to a variation in these genes.

But most families with a strong history of prostate cancer don’t have variations in these genes. Less than 1 in 10 prostate cancers (10%) are linked to an inherited faulty gene.

We have more information about the risk factors for prostate cancer and about having a family history of cancer. You may also find it helpful to talk to your GP.

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.

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.