PSA Testing for Prostate Cancer
An information sheet for men considering a PSA Test

What is the aim of this leaflet?

Prostate cancer is a serious condition. The PSA test, which can give an early indication that prostate cancer may be present, is now available to men who wish to be tested. However, experts disagree on the usefulness of the PSA test. It is not yet known whether or not PSA testing will save lives from prostate cancer. The aim of this information sheet is to give you balanced information about the PSA test, which we hope will help you decide whether or not having the test is the right thing for you. You may wish to discuss this information with your doctor or practice nurse.

What do we know about Prostate Cancer?

Prostate cancer is the second most common cause of cancer deaths in men. Each year in the UK about 22,000 men are diagnosed with prostate cancer and 9,500 die from the disease. Prostate cancer is rare in men below the age of 50 years, and the average age of diagnosis is 75 years. The risk is greater in those with a family history and is also known to be greater in African American men. Prostate cancer is also more common in the West, suggesting that
there may be a link with western lifestyle factors, such as diet.

The prostate gland lies below the bladder. Prostate cancers range from very fast growing cancers to slow growing cancers. Slow growing cancers are common and may not cause any symptoms or shorten life.

Prostate cancer is the second most common cause of cancer deaths in men
Prostate cancer is rare in men under the age of 50 years

What is a PSA test?

The PSA test is a blood test that measures the level of PSA in your blood. PSA (Prostate Specific Antigen) is a substance made by the prostate gland, which naturally leaks out into the blood stream. A raised PSA can be an early indication of prostate cancer. However, other
conditions which are not cancer (e.g. enlargement of the prostate, prostatitis, urinary infection) can also cause a rise in PSA.

Approximately 2 out of 3 men with a raised PSA level will not have prostate cancer.The higher the level of PSA the more likely it is to be cancer.

The PSA test can also miss prostate cancer.

A PSA test involves a blood test
If the level of PSA in the blood is raised, this may indicate that prostate cancer is present.
However, many men with a raised PSA will not have prostate cancer
The PSA test can also miss prostate cancer

What happens after the PSA test?

As a rough guide there are three main options after a PSA test:

PSA level is not raised

Unlikely to have cancer.
No further action.

PSA slightly raised

Probably not cancer, but you might need further tests.

PSA definitely raised

Your GP will refer you to see a specialist for further tests to find out if prostate cancer is the cause.

If the PSA level is raised, what further tests would be carried out?

If your PSA is definitely raised, a prostate biopsy is required to determine if cancer is present. This involves taking samples from the prostate through the back passage (bottom). Most men find this an uncomfortable experience, and some describe it as painful. Sometimes complications or infection may occur. Approximately 2 out of 3 men who have a prostate biopsy will not have prostate cancer. However, biopsies can miss some cancers and worry about prostate cancer may remain even after a clear result.

While a raised PSA level in the blood may indicate cancer, a prostate biopsy is still required to determine if cancer is present
About 2 out of 3 of men who have a biopsy will not have prostate cancer

If early prostate cancer is detected, what treatments are used?

There are three main options for treating early prostate cancer which are summarised below:

Radiotherapy: This involves a course of radiotherapy treatment on the prostate gland at an outpatient clinic. The aim is to cure, although there are possible side effects. Impotence (erection problems) may be suffered by between 2 and 6 out of every 10 men (25-60%). Up to 1 in every 10 men (10%) may experience diarrhoea or bowel problems, and up to 1 in every 20 men (5%) may experience bladder problems.

Surgery: This involves an operation to remove the prostate gland. The aim is to cure, although again there are possible side effects. Up to 2 in every 10 men (20%) may experience some bladder problems, and between 2 and 8 out of every 10 men (20-80%) may experience impotence (erection problems) after surgery.

Active monitoring: This involves regular check-ups to monitor the cancer and check it is not growing. The advantage is that for many men it avoids the side effects of radiotherapy and surgery. If there are signs that the cancer is developing, treatment would be offered. The disadvantage is that the cancer may grow to a more advanced stage. Some men find the uncertainty difficult to cope with.

So should I have the PSA test?

Benefits of PSA testing

It may provide reassurance if the test result is normal
It may find cancer before symptoms develop
It may detect cancer at an early stage when treatments could be beneficial
If treatment is successful, the consequences of more advanced cancer is avoided

Downside of PSA testing

It can miss cancer, and provide false reassurance
It may lead to unnecessary anxiety and medical tests when no cancer is present
It might detect slow-growing cancer that may never cause any symptoms or shortened life span
The main treatments of prostate cancer have significant side-effects, and there is no certainty that the treatment will be successful

Further information

If you have any questions or wish to receive more information about PSA testing and prostate cancer you can discuss it further with your doctor or practice nurse, or look at one of the following sources of information:

Book:
Understanding Prostate Disorders
Professor D Kirk
British Medical Association (BMA)
ISBN:1-898205-87-6

Cancer Research UK web-site:
http://www.cancerresearchuk.org
http://www.cancerhelp.org.uk
Helpline: 0800 226237

This information sheet was prepared by Jo Brett, Dr Eila Watson, Colleen Bukach, and Dr Joan Austoker,
Cancer Research UK Primary Care Education Research Group, University of Oxford.
The information sheet is based on information initially prepared by Dr Graham Easton.