All you need to know

What is PSA?

PSA stands for Prostate Specific Antigen.
It is a protein made by the prostate gland, which naturally leaks out into the bloodstream. From puberty, a man’s prostate gland will begin to enlarge and produce an increase in PSA,
therefore ‘normal’ levels increase with age. So a blood test can be used to measure the level of prostate activity. The prostate’s function is to produce some of the fluid that helps carry sperm when men ejaculate.

How is it measured?

The level of PSA in the blood is measured by a blood test, which can be analysed at most NHS or private laboratories. Only a small amount of blood is taken from a vein in the arm by a trained phlebotomist, so you shouldn’t feel any significant after-effects. This is called a venous blood test. The result is usually available in about a week to 10 days.

What does it tell me?

The PSA test is NOT a test to diagnose prostate cancer. An abnormally high reading can sometimes indicate the presence of prostate cancer or other abnormalities such as –

  • a normal enlargement of the prostate;

  • a urinary infection;

  • inflammation of the gland (prostatitis);

  • urinary retention;

  • any recent prostate procedure such as a biopsy or TURP operation;

  • or it could be prostate cancer, especially if the PSA reading is very high.

The rate at which the PSA level increases over time may give the doctor a better indication of a problem with the prostate. Therefore monitoring the PSA level regularly, say yearly, is a more reliable indicator than a one-off test. Evidence from a European Trial, suggests PSA screening could reduce prostate cancer related mortality by 21%.

What are the advantages and disadvantages of the test?

Advantages:

  • The PSA test is currently the best method of identifying increased risk of prostate cancer in men with or without symptoms.

  • It can lead to an early indication of cancer at a potentially curable stage, before symptoms appear.

  • It may reassure you If the result Is normal.

However:

  • Typically three out of four men with a raised PSA do not have cancer. Called a ‘false positive’ result.

  • A definitive diagnosis requires an MRI scan and possibly a biopsy of the prostate.

  • A raised PSA may therefore lead to further invasive tests, which may later prove to have been unnecessary.

  • In around 15% of men who have a normal PSA, cancer is present, as some rare forms of prostate cancer do not raise the PSA level. This is called a ‘false negative’ result.

Your rights

All men over the age of 50 can access quality information about the PSA test and discuss the option of having a free test with their GP as part of a scheme called the Prostate Cancer Risk Management Programme (PCRMP, Public Health England, Mar 2016). Despite this document being distributed to all GPs, many are unaware of this or counsel against the test.

The PCRMP is there to help GPs give clear and balanced information to men without symptoms who ask about PSA testing. Your GP will be expected to discuss with you the benefits, limitations, and risks of the PSA test to help you decide whether or not to have it. Under the guidelines of the PCRMP, after such a discussion, it is the right of any well man over 50 years to decide for himself whether to have the test or not free on the NHS.

GPs should use their clinical judgement to manage men who have symptoms and those aged under 50 who are considered to have a high risk for prostate cancer.

Knowing your result

It is important that you know the actual result. You are advised to keep a record of the figures from each test in order to check for any abnormal rise.

PSA rises naturally with age, the following age related levels are recommended under the PCRMP guidelines:

Age PSA score

Under 50 Less than 2.0 ng/ml*

50 to 69 Less than 3.0 ng/ml

70 to 79 Less than 5.0 ng/ml

80 and over Less than 10.0 ng/ml

A raised level of PSA should prompt further investigation by your GP, who may wish to give you a Digital Rectal Examination (DRE for short) which may provide further information. If there is cause for concern, you will be referred to a urologist at your local hospital, who may decide to give you further tests to identify the cause.

*(PSA is measured in nanograms per millilitre – ng/ml.)

Can I have the test at any time?

Under the NHS it is only recommended for men over 50. You should avoid any vigorous exercise (particularly cycling) or ejaculation (low risk), for 48 hours before the test as both, in some men, can cause mild elevation. Conversely, if a man is taking medication for an enlarged prostate (finasteride/dutasteride/combodart), the true PSA reading will be halved.

Risk

If you are at special risk (have a family history of prostate or breast cancer, faulty BRCA gene, or are African-Caribbean), we suggest you should start screening in your 40s as you are potentially 2 to 3 times more at risk of developing prostate cancer.

Every year in the UK over 47,000 men are diagnosed with prostate cancer (180 every working day). It is the most common cancer in men over the age of 55 years and an estimated 1 in 8 men will develop the disease in their lifetime. 1 in 2 men, however, will have a prostate problem in their lifetime, usually caused by an enlarged benign prostate.

If cancer is diagnosed

Don’t panic! Many cancers are low grade and may never cause problems. Such cancers are just regularly monitored – called Active Surveillance. If it is found to be more serious, then treatment such as surgery or radiotherapy is advised. Your cancer may well be cured by such treatment if it is confined to the gland.

Have you some concerns about the test?

The main concerns of some medical practitioners are – “it is inaccurate” and “it risks over-treatment”

However, the PSA test alone is never used to diagnose but simply to help identify men with a prostate health problem or risk of cancer.

Those found to have low risk disease are put on Active Surveillance. Only those found to have a more aggressive cancer are offered treatment.

Yes, some treatments may have implications with sexual and/or bladder function, but many men may prefer this to being one of the 11,800 men who die in the UK each year of the disease.

Conclusions

The death rate from prostate cancer in the UK is far higher than other western developed countries as a direct consequence of our lack of awareness and lack of effective screening – over half of those diagnosed in the UK are with advanced disease. We recommend:

> Don’t be put off having a PSA test, if necessary quote the PCRMP.

> Always “know the score” and record your result.

> A single random PSA test is of minimal benefit, The biggest gains (40 to 50% fall in mortality in Europe) are achieved by having repeated regular PSA tests starting in your 40s or early 50s.

> Active Surveillance is now used extensively to prevent over treatment of insignificant prostate cancer.

> UK “over treatment” rate is down to 8% and falling.

> The use of multi parametric MRI scanning has safely reduced the need for biopsy and subsequent over diagnosis of the cancer.

Here to help

PCaSO Prostate Cancer Support Organisation is your point of contact for advice and support if you live in Sussex, Hampshire or Dorset. We are an entirely volunteer patient-run charity with around 1000 members.

Ask for our acclaimed Prostate Cancer Information Booklet “Knowledge Empowers” if you need further information.

Website: www.pcaso.org Email: info@pcaso.org

National helpline number: 0800 035 5302

Postal address: PO Box 66, Emsworth, Hants PO10 7ZP

For information about PSA test events being held in our region:

Sussex – Roger Bacon 01903 775783

Hampshire – Peter Weir 01489 892168

Dorset – Jim Davis 01202 580436

or check the website: www.pcaso.org

Our Medical Advisers:

Prof. Christopher G. Eden, MS, FRCS (Urol.)
(Royal Surrey County Hospital)

Dr Chris Parker, BA, MD, MRCP, FRCR
(Royal Marsden Hospital and Institute of Cancer Research)

Dr Angus Robinson, MBBS, MRCP, FRCR
(Royal Sussex County Hospital)

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