The PSA test

The PSA test is a blood test that measures the amount of prostate specific antigen (PSA) in your blood. PSA is a protein produced by the prostate. It is normal for all men to have a small amount of PSA in their blood, and this amount rises as you get older. But a raised PSA level may suggest you have a problem with your prostate, including:

A raised PSA level does not necessarily mean you have prostate cancer. Other things can also cause your PSA level to rise. If you have a raised PSA level, there are other tests your GP can do to find out what’s causing it.

Who can have a PSA test?

You have the right to have a PSA test if you’re over 50 and you’ve talked through the pros and cons with your GP or practice nurse. If you’re under 50 but have a higher risk of prostate cancer, you might want to talk to your GP about having a PSA test.

Your GP may not recommend the PSA test if you have other serious health problems which might cause you more problems than prostate cancer would. 

Sometimes men are offered a PSA test as part of a general check-up. You should still think about whether a PSA test is right for you before you agree to have one.

The PSA test and prostate cancer

A raised PSA level can be a sign of prostate cancer. But around three quarters of men (76 per cent) with a raised PSA level don’t have prostate cancer.

And some men with a normal PSA level do have prostate cancer. 1 in 50 men (two per cent) with fast-growing prostate cancer have a normal PSA level.

Having a PSA test

You can have a PSA test at your GP surgery. It’s up to you whether or not you have a PSA test. It’s important that you think through whether the PSA test is right for you.

Your GP should talk to you about the pros and cons  of the PSA test before you decide to have one. They will also discuss your risk of prostate cancer, ask you about any symptoms you might have, and any other health problems.

If you decide you want a PSA test, your GP will take a sample of blood which is sent to a laboratory to be tested. The amount of PSA in your blood is measured in nanograms (a billionth of a gram) per millilitre of blood (ng/ml).

Your GP may also do a digital rectal examination, and a urine test to rule out a urine infection.

What if my GP won’t give me a PSA test?

If you’re over 50 and have discussed the pros and cons of the PSA test with your GP and decide that you want to have one, they should give you a test. But we know that some men have trouble getting the test. There are things that you can do if your GP won’t give you a test.

  • Explain that you are entitled to a PSA test under the Prostate Cancer Risk Management Programme.
  • If they still say no, try speaking to another GP or practice nurse.
  • If they also say no, speak to the practice manager at your GP surgery.
  • Your GP surgery should have information about its complaints procedure. You can follow this procedure, or write to the GP or practice manager explaining your complaint.

If you still have trouble getting a PSA test, you could make a complaint through the NHS complaints procedure.

  • If you live in England, you can complain to NHS England. NHS Choices has more information.
  • If you live in Scotland, you can make a complaint to your local health board. Get more information from NHS National Services Scotland.
  • If you live in Wales, you can make a complaint to your local health board. Health in Wales has more information.

If you live in Northern Ireland, you can make a complaint to the health and social care board. Get more information from nidirect.

You can get advice and support about making a complaint from your local Citizens Advice Bureau.

What could affect my PSA level?

PSA is produced by healthy cells in the prostate, so it’s normal for all men to have a small amount of PSA in their blood. There are other things that can raise your PSA level.

  • A urine infection - you will have treatment for any infection, and will need to wait around four to six weeks until the infection has cleared up before you have a PSA test.  
  • Vigorous exercise – especially cycling – in the 48 hours before a PSA test.
  • Ejaculation in the 48 hours before a PSA test.
  • Anal sex and prostate stimulation – if you are gay, bisexual or a man who has sex with men, being the receptive partner during anal sex might raise your PSA level. Having your prostate stimulated during sex might also raise your PSA level. It might be worth avoiding this for a week before a PSA test.
  • A DRE before a PSA test might raise your PSA level a small amount.
  • A prostate biopsy in the six weeks before a PSA test.
  • Other investigations or operations on your bladder or prostate, or a catheter. You may need to wait up to six weeks after these procedures before having a PSA test.

You should also let your GP know if you’re taking any prescription or over-the-counter medicines as some might affect your PSA level. For example, 5-alpha-reductase inhibitors to treat an enlarged prostate, such as finasteride (Proscar®) or dutasteride (Avodart®), can reduce your PSA level.

What will the test results tell me?

A PSA test alone can’t tell you whether you have prostate cancer, because other things can affect your PSA level. It’s normal to have a small amount of PSA in your blood, and the amount rises as you get older. The prostate gland gets bigger with age, and may produce more PSA.

The following figures are a very rough guide to ‘normal’ PSA levels, depending on your age.

A ‘normal’ PSA level is less than:

  • 3 ng/ml for men aged 50-59
  • 4 ng/ml for men aged 60-69
  • 5 ng/ml for men aged 70 and over.

This is just a guide – different GP surgeries might use slightly different figures. For example, in some places, a PSA level of less than 7 ng/ml might be seen as normal for men aged 70-75. Speak to your GP about what your results mean.

A high PSA level for your age can be a sign of prostate cancer. But it can also be a sign of other prostate problems such as an enlarged prostate or prostatitis.

If your test results are normal for your age, then you may not need any further tests. Or you may need another PSA test in the future.

A very high PSA level (for example in the hundreds or thousands) normally means that a man has prostate cancer. But if your PSA level is only slightly high for your age, then you will need other tests to help find out if there is a problem.

Your GP will look at several factors together with your PSA level to help you agree on the next step. These include:

  • the results of a DRE
  • whether you are at higher risk of prostate cancer
  • any other health problems or things that may have affected the results
  • whether you’ve had a prostate biopsy in the past.

Your GP should discuss all this with you. They may also do another PSA test, especially if your PSA is only slightly raised.

Your GP will make an appointment for you to see a specialist at the hospital if they think you need more tests to work out whether you have a prostate problem. You can also ask your GP to refer you to a specialist.

Regular PSA tests

After some men have had their first PSA test they might want to have tests every few years, particularly if they are more at risk of prostate cancer. This might be a good way to spot any changes in your PSA level which might suggest prostate cancer. But we need more research to show how often you might need a test. You could discuss this with your GP, or call our Specialist Nurses.

There is some research that suggests that if you have a PSA test in your 40s, it might be possible to predict how likely you are to get fast-growing prostate cancer later in life. However, we don’t yet know exactly what PSA level would show this, or how often you should have more tests.

What are the advantages and disadvantages of the PSA test?

It’s important you think through the advantages and disadvantages of the PSA test. Having a PSA test is a personal decision – what might be an advantage for one man may not be for another.

Advantages

  • A PSA test can help pick up prostate cancer before you have any symptoms.
  • A PSA test may help to pick up a fast-growing cancer at an early stage when treatment may stop the cancer spreading and causing problems.
  • Slow-growing prostate cancer might not need treatment. You might be able to have regular check-ups, including PSA tests, to keep an eye on your cancer. This can avoid or delay the side effects of treatment.
  • Having regular PSA tests could be helpful for men who are more at risk of prostate cancer. This can help spot any changes in your PSA level, which might be a sign of prostate cancer. But we need more research to show how often you might need a test.

  Disadvantages

  • You might have a raised PSA level, even if you don’t have prostate cancer. Around three quarters of men (76 per cent) with a raised PSA level don’t have prostate cancer.
  • If your PSA level is raised you may need more tests, including a biopsy. The biopsy has some risks, such as pain, infection and blood in the urine and semen. Up to 3 in 50 men (six per cent) may get a serious infection after a biopsy.
  • The PSA test can miss prostate cancer. 1 in 50 men (two per cent) with fast-growing prostate cancer have a normal PSA level. 
  • You might be diagnosed with a slow-growing prostate cancer which would never have caused you any problems or shortened your life.But being diagnosed with cancer could make you worry, and you might decide to have treatment that you didn’t need.
  • Treatments for prostate cancer have side effects which can affect your daily life. These include urinary and bowel problems, and problems getting and keeping an erection.

Should I have a PSA test?

Before you decide whether to have the test, try asking yourself these questions, or discuss them with your GP.

  • Are you more at risk of prostate cancer?
  • If the result of your PSA test was normal, would this reassure you?
  • If your PSA level was high, what would you do?
  • If you were diagnosed with slow-growing prostate cancer that might not cause you any problems in your lifetime, would you want to have treatment that may cause side effects that affect your daily life? 

It can be difficult to decide whether or not to have a PSA test. It might help to talk it over with your partner, family or friends. You could also talk to your GP or call our Specialist Nurses.

You might also find a decision aid helpful.  Decision aids help people make difficult decisions about their healthcare. The NHS has produced a decision aid to help men decide whether to have a PSA test, and help them talk to their GP about it.

Why isn’t there a prostate cancer screening programme?

Screening programmes aim to spot the early signs of cancers in people who don’t have any symptoms. By finding cancer early, it could be treated in time to cure it. In the UK there are screening programmes for breast, cervical and bowel cancer.

There is currently no screening programme for prostate cancer. One reason for this is that the PSA test isn’t good enough at finding prostate cancer to be used as part of a screening programme.

It’s important that the benefits of a screening programme outweigh any disadvantages. But it’s not clear that screening with the PSA test would have more benefits than disadvantages.

Some studies have found that screening with the PSA test could mean fewer men die from prostate cancer. But it would also mean that a large number of men would be diagnosed with a slow-growing cancer that wouldn’t have caused any symptoms or shortened their life. And a large number of these men would have treatment they didn’t need which could cause side effects. Other studies have found that screening doesn’t reduce the number of deaths from prostate cancer.

Although there's no screening programme, many men want a PSA test. So the Prostate Cancer Risk Management Programme was set up. This programme gives men over 50 who want a PSA test the right to have one on the NHS - as long as they have talked through the pros and cons with their GP.

Questions to ask your GP or practice nurse

Am I at risk of prostate cancer?

What are the advantages and diadvantages of having a PSA test?

How long will I have to wait for the results?

If I have a PSA test and the result is normal, will I need to have regular tests in the future?

Will I need a DRE?

Questions to ask your hospital specialist

Do I need a biopsy?

Will I have an MRI scan before having a biopsy?

What are the risks and side effects of a biopsy?

How soon will I get the results?

Will I need any other tests?

What support can I get?

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Reviewers

  • James Catto, Professor of Urology, University of Sheffield
  • Mr Vincent J Gnanapragasam, University Lecturer in Uro-oncology & Honorary Consultant Urological Surgeon, University of Cambridge
  • Mike James, Consultant Urologist, Chesterfield Hospital, Derbyshire
  • Lyn Kirkwood, CNS Urology, Continence and Stoma, Weston General Hospital, Weston-super-Mare
  • Chris Parker, Consultant Clinical Oncologist and Honorary Reader, Royal Marsden Hospital and Institute of Cancer Research
  • James Phillips, GP Principal, Maclean Medical Practice, Glasgow
  • Jonathan Rees, GP with a special interest in Urology and Men's Health, Backwell and Nailsea Medical Group, Bristol
  • Bruce Turner, Uro-oncology Nurse Practioner, Homerton Univeristy Hospital NHS Foundation Trust and Bart's Health NHS Trust, London
  • Karen Wilkinson, Urology Nurse Specialist, Barts Health NHS Trust, London
  • Prostate Cancer UK Volunteers
  • Prostate Cancer UK Specialist Nurses

Reviewers of The PSA test: A quick guide

  • Simon Bott, Consultant Urologist, Frimley Park Hospital, Frimley, Surrey
  • Mike James, Consultant Urologist, Chesterfield Hospital, Derbyshire
  • Lyn Kirkwood, CNS Urology, Continence and Stoma, Weston General Hospital, Weston- Super-Mare
  • Dr James Phillips, GP Principal, Maclean Medical Practice, Glasgow
  • Jonathan Rees, GP with a special interest in Urology and Men's Health, Backwell and Nailsea Medical Group, Bristol
  • Bruce Turner, Uro-oncology Nurse Practioner, Homerton Univeristy Hospital NHS Foundation Trust and Bart's Health NHS Trust, London
  • Karen Wilkinson, Urology Nurse Specialist, Barts Health NHS Trust, London
  • Prostate Cancer UK Volunteers
  • Prostate Cancer UK Specialist Nurses
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References

References used to produce Understanding the PSA test: A guide for men concerned about prostate cancer

The PSA test in brief

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Popiolek M, Rider JR, Andrén O, Andersson S-O, Holmberg L, Adami H-O, et al. Natural History of Early, Localized Prostate Cancer: A Final Report from Three Decades of Follow-up. Eur Urol. 2013;63(3):428–35

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Prostate cancer incidence statistics: By Age. Cancer Research UK. 2010. Available from: http://www.cancerresearchuk.org/cancer-info/cancerstats/types/prostate/incidence/#age

Castro E, Eeles R. The role of BRCA1 and BRCA2 in prostate cancer. Asian J Androl. 2012;14(3):409–14.

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Having a PSA test

Ilic D, Neuberger MM, Djulbegovic M, Dahm P. Screening for prostate cancer. In: The Cochrane Collaboration, Ilic D, editors. Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd; 2013

Burford D, Austoker J, Kirby M. Advising men about the PSA test for prostate cancer. Prostate Cancer Risk Management Programme; 2009. Available from: http://www.cancerscreening.nhs.uk/prostate/prostate-summary-sheet.pdf

What could affect my PSA level?

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What will the test results tell me?

Burford DC, Kirby M, Austoker J. Prostate Cancer Risk Management Programme. Information for primary care; PSA testing in asymptomatic men. Evidence document January 2010. Cancer Research UK. 2010; Available from: http://scotland.gov.uk/Resource/Doc/1094/0088915.pdf

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Regular PSA tests

Burford DC, Kirby M, Austoker J. Prostate Cancer Risk Management Programme. Information for primary care; PSA testing in asymptomatic men. Evidence document January 2010. Cancer Research UK. 2010; Available from: http://scotland.gov.uk/Resource/Doc/1094/0088915.pdf

D’Amico AV, Renshaw AA, Sussman B, Chen M-H. Pretreatment PSA velocity and risk of death from prostate cancer following external beam radiation therapy. JAMA. 2005;294(4):440–7.

D’Amico AV, Chen M-H, Roehl KA, Catalona WJ. Preoperative PSA velocity and the risk of death from prostate cancer after radical prostatectomy. N Engl J Med. 2004;351(2):125–35.

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Loeb S, Carter HB, Schaeffer EM, Kettermann A, Ferrucci L, Metter EJ. Distribution of PSA Velocity by Total PSA Levels: Data From the Baltimore Longitudinal Study of Aging. Urology. 2011;77(1):143–7.

Vickers AJ, Ulmert D, Sjoberg DD, Bennette CJ, Bjork T, Gerdtsson A, et al. Strategy for detection of prostate cancer based on relation between prostate specific antigen at age 40-55 and long term risk of metastasis: case-control study. BMJ. 2013;346:f2023.

Ørsted DD, Nordestgaard BG, Jensen GB, Schnohr P, Bojesen SE. Prostate-Specific Antigen and Long-Term Prediction of Prostate Cancer Incidence and Mortality in the General Population. Eur Urol. 2012;61(5):865–74.

Loeb S, Carter HB, Catalona WJ, Moul JW, Schroder FH. Baseline Prostate-Specific Antigen Testing at a Young Age. Eur Urol. 2012;61(1):1–7.

The digital rectal examination (DRE)

Burford DC, Kirby M, Austoker J. Prostate Cancer Risk Management Programme. Information for primary care; PSA testing in asymptomatic men. Evidence document January 2010. Cancer Research UK. 2010; Available from: http://scotland.gov.uk/Resource/Doc/1094/0088915.pdf

Seeing a specialist

Haffner J, Lemaitre L, Puech P, Haber G-P, Leroy X, Jones JS, et al. Role of magnetic resonance imaging before initial biopsy: comparison of magnetic resonance imaging-targeted and systematic biopsy for significant prostate cancer detection. BJU Int. 2011;108(8b):E171–E178.

Yacoub JH, Verma S, Moulton JS, Eggener S, Oto A. Imaging-guided Prostate Biopsy: Conventional and Emerging Techniques. RadioGraphics. 2012;32(3):819–37.

Kirkham APS, Emberton M, Allen C. How good is MRI at detecting and characterising cancer within the prostate? Eur Urol. 2006;50(6):1163–1174; discussion 1175.

National Institute for Health and Care Excellence. Prostate Cancer: diagnosis and treatment. Full guidleine. 2014

Prostate Cancer Risk Management Programme. Undertaking a transrectal ultrasound guided biopsy of the prostate. 2006. Available from www.cancerscreening.nhs.uk

Loeb S, Vellekoop A, Ahmed HU, Catto J, Emberton M, Nam R, et al. Systematic Review of Complications of Prostate Biopsy. Eur Urol. 2013;64(6):876–92.

If I am diagnosed with prostate cancer, what are my options?

National Institute for Health and Care Excellence. Prostate Cancer: Diagnosis and treatment. 2014. Clinical Guideline. Full guideline.

Burford DC, Kirby M, Austoker J. Prostate Cancer Risk Management Programme. Information for primary care; PSA testing in asymptomatic men. Evidence document January 2010. Cancer Research UK. 2010; Available from: http://scotland.gov.uk/Resource/Doc/1094/0088915.pdf

Albertsen PC, Hanley JA, Fine J. 20-Year Outcomes Following Conservative Management of Clinically Localized Prostate Cancer. JAMA. 2005;293(17):2095-2101.

Should I have a PSA test?

Schröder FH, Hugosson J, Roobol MJ. Screening and Prostate-Cancer Mortality in a Randomized European Study. N Engl J Med. 2009;360:1320-8.

Rosario DJ, Lane JA, Metcalfe C, et al. Short term outcomes of prostate biopsy in men tested for cancer by prostate specific antigen: prospective evaluation within ProtecT study. BMJ 2012;344:d7894 doi: 10.1136/bmj.d7894

Loeb S, Vellekoop A, Ahmed HU, Catto J, Emberton M, Nam R, Rosario DJ, Scattoni V, Lotan Y. Systematic review of complications of prostate biopsy. Eur Urol 2013;64(6): 876-892.

Thompson IM, Pauler DK, Goodman PJ, Tangen CM, Lucia MS, Parnes HL, et al. Prevalence of prostate cancer among men with a prostate-specific antigen level < or =4.0 ng per milliliter. N Engl J Med. 2004;350(22):2239–46.

Burford DC, Kirby M, Austoker J. Prostate Cancer Risk Management Programme. Information for primary care; PSA testing in asymptomatic men. Evidence document January 2010. Cancer Research UK. 2010; Available from: http://scotland.gov.uk/Resource/Doc/1094/0088915.pdf

Ilic D, Neuberger MM, Djulbegovic M, Dahm P. Screening for prostate cancer. Cochrane Database of Systematic Reviews. 2013, Issue 1. Art. No.: CD004720. DOI: 10.1002/14651858.CD004720.pub3.

National Institute for Health and Care Excellence. Prostate Cancer: Diagnosis and treatment. 2014. Clinical Guideline. Full guideline.

Ilic D, Neuberger MM, Djulbegovic M, Dahm P. Screening for prostate cancer. In: The Cochrane Collaboration, Ilic D, editors. Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd; 2013

Burford D, Austoker J, Kirby M. Advising men about the PSA test for prostate cancer. Prostate Cancer Risk Management Programme; 2009. Available from: http://www.cancerscreening.nhs.uk/prostate/prostate-summary-sheet.pdf

Schröder FH, Hugosson J, Roobol MJ, Tammela TLJ, Ciatto S, Nelen V, et al. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med. 2009;360(13):1320–8.

Thompson IM, Pauler DK, Goodman PJ, Tangen CM, Lucia MS, Parnes HL, et al. Prevalence of prostate cancer among men with a prostate-specific antigen level < or =4.0 ng per milliliter. N Engl J Med. 2004;350(22):2239–46.

Prostate cancer incidence statistics: By Age. Cancer Research UK. 2010. Available from: http://www.cancerresearchuk.org/cancer-info/cancerstats/types/prostate/incidence/#age

Working out the risk of prostate cancer in Black men. Prostate Cancer UK. 2013. Available from: /we-can-help/african-caribbean-communities/1-in-4-stat-explained

Johns L e., Houlston R s. A systematic review and meta-analysis of familial prostate cancer risk. BJU Int. 2003;91(9):789–94.

National Institute for Health and Care Excellence. Prostate Cancer: diagnosis and treatment. NICE full guideline. 2014.

What is the prostate?

Roehrborn CG. BPH progression: concept and key learning from MTOPS, ALTESS, COMBAT, and ALF-ONE. BJU Int. 2008;101 Suppl 3:17–21.

What changes should I look out for?

Burford DC, Kirby M, Austoker J. Prostate Cancer Risk Management Programme. Information for primary care; PSA testing in asymptomatic men. Evidence document January 2010. Cancer Research UK. 2010; Available from: http://scotland.gov.uk/Resource/Doc/1094/0088915.pdf

Collin SM, Metcalfe C, Donovan J, Lane JA, Davis M, Neal D, et al. Associations of lower urinary tract symptoms with prostate-specific antigen levels, and screen-detected localized and advanced prostate cancer: a case-control study nested within the UK population-based ProtecT (Prostate testing for cancer and Treatment) study. BJU Int. 2008;102(10):1400-6

Lower urinary tract symptoms. The management of lower urinary tract symptoms in men. NICE clinical guideline 97. National Institute for Health and Care Excellence; 2010.

Popiolek M, Rider JR, Andrén O, Andersson S-O, Holmberg L, Adami H-O, et al. Natural History of Early, Localized Prostate Cancer: A Final Report from Three Decades of Follow-up. Eur Urol. 2013;63(3):428–35.

Crawford ED. Understanding the Epidemiology, Natural History, and Key Pathways Involved in Prostate Cancer. Urology. 2009;73(5):S4–S10.

Gacci M, Eardley I, Giuliano F, Hatzichristou D, Kaplan SA, Maggi M, et al. Critical Analysis of the Relationship Between Sexual Dysfunctions and Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia. Eur Urol. 2011;60(4):809–25.

Kirby M, Chapple C, Jackson G, Eardley I, Edwards D, Hackett G, et al. Erectile dysfunction and lower urinary tract symptoms: a consensus on the importance of co-diagnosis. Int J Clin Pract. 2013;67(7):606–18.

Rosen R, Altwein J, Boyle P, Kirby RS, Lukacs B, Meuleman E, et al. LowerUrinaryTractSymptomsandMaleSexualDysfunction: TheMultinational Survey of theAgingMale (MSAM-7). European Urology. 2003;44:637–649.

What is an enlarged prostate?

Lower urinary tract symptoms. The management of lower urinary tract symptoms in men. NICE clinical guideline 97. National Institute for Health and Care Excellence; 2010.

What is prostatitis?

McNaughton-Collins M, Joyce G, Wise M, Pontari M. Prostatitis. Urologic Diseases in America US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Washington, US: Government Publishing Office; 2007.

Thakkinstian A, Attia J, Anothaisintawee T, Nickel JC. α-blockers, antibiotics and anti-inflammatories have a role in the management of chronic prostatitis/chronic pelvic pain syndrome: antibiotics, anti-inflammatories and α-blockers in cp/cpps. BJU Int. 2012;110(7):1014–22.

Clearinghouse TNNK and UDI. Prostatitis: Disorders of the Prostate.. Available from: http://kidney.niddk.nih.gov/KUDiseases/pubs/prostatitis/index.aspx#types

What is prostate cancer?

Cancer Research UK. Cancer incidence for common cancers: Twenty most common cancers. 2010. Available from: http://www.cancerresearchuk.org/cancer-info/cancerstats/incidence/commoncancers/#Twenty

Cancer Research UK. Prostate cancer incidence statistics: Lifetime risk. [Internet]. 2010. Available from: http://www.cancerresearchuk.org/cancer-info/cancerstats/types/prostate/incidence/#Lifetime

Burford DC, Kirby M, Austoker J. Prostate Cancer Risk Management Programme. Information for primary care; PSA testing in asymptomatic men. Evidence document January 2010. Cancer Research UK. 2010; Available from: http://scotland.gov.uk/Resource/Doc/1094/0088915.pdf

Popiolek M, Rider JR, Andrén O, Andersson S-O, Holmberg L, Adami H-O, et al. Natural History of Early, Localized Prostate Cancer: A Final Report from Three Decades of Follow-up. Eur Urol. 2013;63(3):428–35

Crawford ED. Understanding the Epidemiology, Natural History, and Key Pathways Involved in Prostate Cancer. Urology. 2009;73(5):S4–S10.

National Institute for Health and Care Excellence. Prostate Cancer: diagnosis and treatment. Full guidleine. 2014.

Prostate cancer incidence statistics: By Age. Cancer Research UK. 2010. Available from: http://www.cancerresearchuk.org/cancer-info/cancerstats/types/prostate/incidence/#age

Castro E, Eeles R. The role of BRCA1 and BRCA2 in prostate cancer. Asian J Androl. 2012;14(3):409–14.

Dianat SS, Margreiter M, Eckersberger E, Finkelstein J, Kuehas F, Herwig R, et al. Gene polymorphisms and prostate cancer: the evidence. BJU Int. 2009;104(11):1560–72.

Johns L e., Houlston R s. A systematic review and meta-analysis of familial prostate cancer risk. BJU Int. 2003;91(9):789–94

McPherson K, Steel CM, Dixon JM. 5 Breast cancer—epidemiology, risk factors, and genetics. ABC Breast Dis. 2006;572:24.

Edwards SM, Kote-Jarai Z, Meitz J, Hamoudi R, Hope Q, Osin P, et al. Two percent of men with early-onset prostate cancer harbor germline mutations in the BRCA2 gene. Am J Hum Genet. 2003;72(1):1–12.

Thompson D, Easton DF. Cancer incidence in BRCA1 mutation carriers. J Natl Cancer Inst. 2002;94(18):1358–65.

Mitra AV, Bancroft EK, Barbachano Y, Page EC, Foster CS, Jameson C, et al. Targeted prostate cancer screening in men with mutations in BRCA1 and BRCA2 detects aggressive prostate cancer: preliminary analysis of the results of the IMPACT study: targeted prostate cancer screening. BJU Int. 2011;107(1):28–39.

Leongamornlert D, Mahmud N, Tymrakiewicz M, Saunders E, Dadaev T, Castro E, et al. Germline BRCA1 mutations increase prostate cancer risk. Br J Cancer. 2012;106(10):1697–701.

Kote-Jarai Z, Leongamornlert D, Saunders E, Tymrakiewicz M, Castro E, Mahmud N, et al. BRCA2 is a moderate penetrance gene contributing to young-onset prostate cancer: implications for genetic testing in prostate cancer patients. Br J Cancer. 2011;105(8):1230–4.

Thompson D, Easton D. Variation in cancer risks, by mutation position, in BRCA2 mutation carriers. Am J Hum Genet. 2001;68(2):410–9.

Consortium BCL. Cancer risks in BRCA2 mutation carriers. J Natl Cancer Inst. 1999;91(15):1310–6.

Kote-Jarai Z, Saunders EJ, Leongamornlert DA, Tymrakiewicz M, Dadaev T, Jugurnauth-Little S, et al. Fine-mapping identifies multiple prostate cancer risk loci at 5p15, one of which associates with TERT expression. Hum Mol Genet. 2013;22(12):2520–8.

Eeles RA, Olama AAA, Benlloch S, Saunders EJ, Leongamornlert DA, Tymrakiewicz M, et al. Identification of 23 new prostate cancer susceptibility loci using the iCOGS custom genotyping array. Nat Genet. 2013;45(4):385–91.

Amin Al Olama A, Kote-Jarai Z, Schumacher FR, Wiklund F, Berndt SI, Benlloch S, et al. A meta-analysis of genome-wide association studies to identify prostate cancer susceptibility loci associated with aggressive and non-aggressive disease. Hum Mol Genet. 2013;22(2):408–15.

Nakagawa H. Prostate cancer genomics by high-throughput technologies: genome-wide association study and sequencing analysis. Endocr Relat Cancer. 2013;20(4):R171–R181.

Xu J, Kibel AS, Hu JJ, Turner AR, Pruett K, Zheng SL, et al. Prostate cancer risk associated loci in African Americans. Cancer Epidemiol Biomarkers Prev. 2009;18(7):2145–9.

Hooker S, Hernandez W, Chen H, Robbins C, Torres JB, Ahaghotu C, et al. Replication of prostate cancer risk loci on 8q24, 11q13, 17q12, 19q33, and Xp11 in African Americans. The Prostate. 2010;70(3):270-5

Wang Y, Ray AM, Johnson EK, Zuhlke KA, Cooney KA, Lange EM. Evidence for an association between prostate cancer and chromosome 8q24 and 10q11 genetic variants in African American men: the Flint Men’s Health Study. The Prostate. 2011;71(3):225–31.

Lavender NA, Benford ML, VanCleave TT, Brock GN, Kittles RA, Moore JH, et al. Examination of polymorphic glutathione S-transferase (GST) genes, tobacco smoking and prostate cancer risk among Men of African Descent: A case-control study. BMC Cancer. 2009;9(1):397.

Mason TE, Ricks-Santi L, Chen W, Apprey V, Joykutty J, Ahaghotu C, et al. Association of CD14 variant with prostate cancer in African American men. The Prostate. 2010;70(3):262-9

Kheirandish P, Chinegwundoh F. Ethnic differences in prostate cancer. Br J Cancer. 2011;105(4):481–5.

Rebbeck TR, Devesa SS, Chang B-L, Bunker CH, Cheng I, Cooney K, et al. Global Patterns of Prostate Cancer Incidence, Aggressiveness, and Mortality in Men of African Descent. Prostate Cancer. 2013;2013:1–12.

Working out the risk of prostate cancer in Black men. Prostate Cancer UK. 2013. Available from: /we-can-help/african-caribbean-communities/1-in-4-stat-explained

Ho T, Gerber L, Aronson WJ, Terris MK, Presti JC, Kane CJ, et al. Obesity, Prostate-Specific Antigen Nadir, and Biochemical Recurrence After Radical Prostatectomy: Biology or Technique? Results from the SEARCH Database. Eur Urol. 2012;62(5):910–6.

Cao Y, Ma J. Body Mass Index, Prostate Cancer-Specific Mortality, and Biochemical Recurrence: a Systematic Review and Meta-analysis. Cancer Prev Res (Phila Pa). 2011;4(4):486–501.

Discacciati A, Orsini N, Wolk A. Body mass index and incidence of localized and advanced prostate cancer--a dose-response meta-analysis of prospective studies. Ann Oncol. 2012;23(7):1665–71.

Häggström C, Stocks T, Ulmert D, Bjørge T, Ulmer H, Hallmans G, et al. Prospective study on metabolic factors and risk of prostate cancer: Metabolic Factors and Prostate Cancer. Cancer. 2012;118(24):6199–206.

Orsini N, Bellocco R, Bottai M, Pagano M, Andersson S-O, Johansson J-E, et al. A prospective study of lifetime physical activity and prostate cancer incidence and mortality. Br J Cancer. 2009;101(11):1932–8.

World Cancer Research Fund, American Institute for Cancer Research. Food, nutrition, physical activity, and the prevention of cancer: a global perspective. Washington, DC: WCRF/AICR; 2007.

Ma RW-L, Chapman K. A systematic review of the effect of diet in prostate cancer prevention and treatment. J Hum Nutr Diet. 2009;22(3):187–99.

Allen NE, Key TJ, Appleby PN, Travis RC, Roddam AW, Tjønneland A, et al. Animal foods, protein, calcium and prostate cancer risk: the European Prospective Investigation into Cancer and Nutrition. Br J Cancer. 2008;98(9):1574–81.

Giovannucci E, Liu Y, Platz EA, Stampfer MJ, Willett WC. Risk factors for prostate cancer incidence and progression in the health professionals follow-up study. Int J Cancer. 2007;121(7):1571–8.

Gao X, LaValley MP, Tucker KL. Prospective Studies of Dairy Product and Calcium Intakes and Prostate Cancer Risk: A Meta-Analysis. JNCI J Natl Cancer Inst. 2005;97(23):1768–77.

Having a PSA test

Ilic D, Neuberger MM, Djulbegovic M, Dahm P. Screening for prostate cancer. In: The Cochrane Collaboration, Ilic D, editors. Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd; 2013

Burford D, Austoker J, Kirby M. Advising men about the PSA test for prostate cancer. Prostate Cancer Risk Management Programme; 2009. Available from: http://www.cancerscreening.nhs.uk/prostate/prostate-summary-sheet.pdf

What could affect my PSA level?

Price CP, Allard J, Davies G, Dawnay A, Duffy MJ, France M, et al. Pre-and post-analytical factors that may influence use of serum prostate specific antigen and its isoforms in a screening programme for prostate cancer. Ann Clin Biochem. 2001;38(3):188–216.

Burford DC, Kirby M, Austoker J. Prostate Cancer Risk Management Programme. Information for primary care; PSA testing in asymptomatic men. Evidence document January 2010. Cancer Research UK. 2010; Available from: http://scotland.gov.uk/Resource/Doc/1094/0088915.pdf

Perlman G, Drescher J. Introduction: What Gay Men (and Those Near and Dear to Them) Need to Know About Prostate Cancer. J Gay Lesbian Psychother. 2005;9(1-2):1–7.

Klein LT, Lowe FC. The effects of prostatic manipulation on prostate-specific antigen levels. Urol Clin North Am. 1997;24(2):293–7.

Santillo V., Lowe C. Prostate cancer and the gay male. A gay man’s guide to prostate cancer. Binghamton, NY: The Haworth Medical Press; 2005. p. 29–41.

Tarhan F, Orçun A, Küçükercan I, Camursoy N, Kuyumcuoğlu U. Effect of prostatic massage on serum complexed prostate-specific antigen levels. Urology. 2005;66(6):1234–8.

What will the test results tell me?

Burford DC, Kirby M, Austoker J. Prostate Cancer Risk Management Programme. Information for primary care; PSA testing in asymptomatic men. Evidence document January 2010. Cancer Research UK. 2010; Available from: http://scotland.gov.uk/Resource/Doc/1094/0088915.pdf

The British Association of Urological Surgeons. PSA measurements. Frequently-asked questions. March 2014

Prostate Cancer: Diagnosis and treatment. National Institute for Health and Care Excellence. 2014. Clinical Guideline. Full guideline.

Albertsen PC, Hanley JA, Fine J. 20-Year Outcomes Following Conservative Management of Clinically Localized Prostate Cancer. JAMA. 2005;293(17):2095-2101.

Regular PSA tests

Burford DC, Kirby M, Austoker J. Prostate Cancer Risk Management Programme. Information for primary care; PSA testing in asymptomatic men. Evidence document January 2010. Cancer Research UK. 2010; Available from: http://scotland.gov.uk/Resource/Doc/1094/0088915.pdf

D’Amico AV, Renshaw AA, Sussman B, Chen M-H. Pretreatment PSA velocity and risk of death from prostate cancer following external beam radiation therapy. JAMA. 2005;294(4):440–7.

D’Amico AV, Chen M-H, Roehl KA, Catalona WJ. Preoperative PSA velocity and the risk of death from prostate cancer after radical prostatectomy. N Engl J Med. 2004;351(2):125–35.

Carter HB, Ferrucci L, Kettermann A, Landis P, Wright EJ, Epstein JI, et al. Detection of Life-Threatening Prostate Cancer With Prostate-Specific Antigen Velocity During a Window of Curability. JNCI J Natl Cancer Inst. 2006;98(21):1521–7.

Loeb S, Carter HB, Schaeffer EM, Kettermann A, Ferrucci L, Metter EJ. Distribution of PSA Velocity by Total PSA Levels: Data From the Baltimore Longitudinal Study of Aging. Urology. 2011;77(1):143–7.

Vickers AJ, Ulmert D, Sjoberg DD, Bennette CJ, Bjork T, Gerdtsson A, et al. Strategy for detection of prostate cancer based on relation between prostate specific antigen at age 40-55 and long term risk of metastasis: case-control study. BMJ. 2013;346:f2023.

Ørsted DD, Nordestgaard BG, Jensen GB, Schnohr P, Bojesen SE. Prostate-Specific Antigen and Long-Term Prediction of Prostate Cancer Incidence and Mortality in the General Population. Eur Urol. 2012;61(5):865–74.

Loeb S, Carter HB, Catalona WJ, Moul JW, Schroder FH. Baseline Prostate-Specific Antigen Testing at a Young Age. Eur Urol. 2012;61(1):1–7.

The digital rectal examination (DRE)

Burford DC, Kirby M, Austoker J. Prostate Cancer Risk Management Programme. Information for primary care; PSA testing in asymptomatic men. Evidence document January 2010. Cancer Research UK. 2010; Available from: http://scotland.gov.uk/Resource/Doc/1094/0088915.pdf

Seeing a specialist

Haffner J, Lemaitre L, Puech P, Haber G-P, Leroy X, Jones JS, et al. Role of magnetic resonance imaging before initial biopsy: comparison of magnetic resonance imaging-targeted and systematic biopsy for significant prostate cancer detection. BJU Int. 2011;108(8b):E171–E178.

Yacoub JH, Verma S, Moulton JS, Eggener S, Oto A. Imaging-guided Prostate Biopsy: Conventional and Emerging Techniques. RadioGraphics. 2012;32(3):819–37.

Kirkham APS, Emberton M, Allen C. How good is MRI at detecting and characterising cancer within the prostate? Eur Urol. 2006;50(6):1163–1174; discussion 1175.

National Institute for Health and Care Excellence. Prostate Cancer: diagnosis and treatment. Full guidleine. 2014

Prostate Cancer Risk Management Programme. Undertaking a transrectal ultrasound guided biopsy of the prostate. 2006. Available from www.cancerscreening.nhs.uk

Loeb S, Vellekoop A, Ahmed HU, Catto J, Emberton M, Nam R, et al. Systematic Review of Complications of Prostate Biopsy. Eur Urol. 2013;64(6):876–92.

If I am diagnosed with prostate cancer, what are my options?

National Institute for Health and Care Excellence. Prostate Cancer: Diagnosis and treatment. 2014. Clinical Guideline. Full guideline.

Burford DC, Kirby M, Austoker J. Prostate Cancer Risk Management Programme. Information for primary care; PSA testing in asymptomatic men. Evidence document January 2010. Cancer Research UK. 2010; Available from: http://scotland.gov.uk/Resource/Doc/1094/0088915.pdf

Albertsen PC, Hanley JA, Fine J. 20-Year Outcomes Following Conservative Management of Clinically Localized Prostate Cancer. JAMA. 2005;293(17):2095-2101.

Should I have a PSA test?

Schröder FH, Hugosson J, Roobol MJ. Screening and Prostate-Cancer Mortality in a Randomized European Study. N Engl J Med. 2009;360:1320-8.

Rosario DJ, Lane JA, Metcalfe C, et al. Short term outcomes of prostate biopsy in men tested for cancer by prostate specific antigen: prospective evaluation within ProtecT study. BMJ 2012;344:d7894 doi: 10.1136/bmj.d7894

Loeb S, Vellekoop A, Ahmed HU, Catto J, Emberton M, Nam R, Rosario DJ, Scattoni V, Lotan Y. Systematic review of complications of prostate biopsy. Eur Urol 2013;64(6): 876-892.

Thompson IM, Pauler DK, Goodman PJ, Tangen CM, Lucia MS, Parnes HL, et al. Prevalence of prostate cancer among men with a prostate-specific antigen level < or =4.0 ng per milliliter. N Engl J Med. 2004;350(22):2239–46.

Burford DC, Kirby M, Austoker J. Prostate Cancer Risk Management Programme. Information for primary care; PSA testing in asymptomatic men. Evidence document January 2010. Cancer Research UK. 2010; Available from: http://scotland.gov.uk/Resource/Doc/1094/0088915.pdf

Ilic D, Neuberger MM, Djulbegovic M, Dahm P. Screening for prostate cancer. Cochrane Database of Systematic Reviews. 2013, Issue 1. Art. No.: CD004720. DOI: 10.1002/14651858.CD004720.pub3.

National Institute for Health and Care Excellence. Prostate Cancer: Diagnosis and treatment. 2014. Clinical Guideline. Full guideline.

Why isn't there a screening programme for prostate cancer?

Ilic D, Neuberger MM, Djulbegovic M, Dahm P. Screening for prostate cancer. In: The Cochrane Collaboration, Ilic D, editors. Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd; 2013. Available from: http://doi.wiley.com/10.1002/14651858.CD004720.pub3

About the Prostate Cancer Risk Management Programme.htm Available from: http://www.cancerscreening.nhs.uk/prostate/about-pcrm.html

Schröder FH, Hugosson J, Roobol MJ, Tammela TLJ, Ciatto S, Nelen V, et al. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med. 2009 Mar 26;360(13):1320–8

References used to produce The PSA test and prostate cancer: A quick guide

Cancer Research UK. Prostate cancer incidence statistics: Lifetime risk. 2010. Available from: http://www.cancerresearchuk.org/cancer-info/cancerstats/types/prostate/incidence/#Lifetime

Ilic D, Neuberger MM, Djulbegovic M, Dahm P. Screening for prostate cancer. In: The Cochrane Collaboration, Ilic D, editors. Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd; 2013

Burford D, Austoker J, Kirby M. Advising men about the PSA test for prostate cancer. Prostate Cancer Risk Management Programme; 2009. Available from: http://www.cancerscreening.nhs.uk/prostate/

Cancer Research UK. Cancer incidence for common cancers: Twenty most common cancers. 2010. Available from: http://www.cancerresearchuk.org/cancer-info/cancerstats/incidence/commoncancers/#Twenty

Prostate cancer incidence statistics: By Age. Cancer Research UK. 2010. Available from: http://www.cancerresearchuk.org/cancer-info/cancerstats/types/prostate/incidence/#age

Working out the risk of prostate cancer in Black men. Prostate Cancer UK. 2013. Available from: /we-can-help/african-caribbean-communities/1-in-4-stat-explained

Johns LE, Houlston RS. A systematic review and meta-analysis of familial prostate cancer risk. BJUI. 2003;91(9):789-794.

Popiolek M, et al. Natural History of Early, Localized Prostate Cancer: A Final Report from Three Decades of Follow-up. Eur Urol. 2013;63(3):428–435

Crawford E D. Understanding the Epidemiology, Natural History and Key Pathways Involved in Prostate Cancer. 2009 Urology; 73:5A

Prostate Cancer Risk Management Programme information for primary care; PSA testing in asymptomatic men. Evidence document January 2010.

Colin SM, Metcalfe C, Donovan J, Lane JA, Davis M, Neal D, Hamdy F, Martin RM. Associations of lower urinary tract symptoms with prostate-specific antigen levels, and screen detected localized and advanced prostate cancer: a case-control study nested within the UK based population ProtecT (Prostate testing for cancer and Treatment) study. BJU Int, 2008, 102 (10):1400-140

Prostate Cancer: Diagnosis and treatment. National Institute for Health and Care Excellence. 2014. Clinical Guideline. Full guideline.

Albertsen PC, Hanley JA, Fine J. 20-Year Outcomes Following Conservative Management of Clinically Localized Prostate Cancer. JAMA. 2005;293(17):2095-2101.

D’Amico et al. Pretreatment PSA velocity and risk of death from prostate cancer following external beam radiotherapy. JAMA 2005: 294 (4)

D’Amico et al. Preoperative PSA velocity and risk of death from prostate cancer after radical prostatectomy. N Engl J Med. 2004: 351 (2)

Carter HB et al. Detection of life-threatening prostate cancer with prostate-specific antigen velocity during a window of curability. J Nat Cancer Inst 2006;98: 1521-1527

Loeb, Carter et al. Distribution of PSA velocity total PSA levels: data from the Baltimore study of aging. Urology 2011; 77 (1)

Schröder FH, Hugosson J, Roobol MJ. Screening and Prostate-Cancer Mortality in a Randomized European Study. N Engl J Med. 2009;360:1320-8.

Rosario DJ, Lane JA, Metcalfe C, et al. Short term outcomes of prostate biopsy in men tested for cancer by prostate specific antigen: prospective evaluation within ProtecT study. BMJ 2012;344:d7894 doi: 10.1136/bmj.d7894

Loeb S, Vellekoop A, Ahmed HU, Catto J, Emberton M, Nam R, Rosario DJ, Scattoni V, Lotan Y. Systematic review of complications of prostate biopsy. Eur Urol 2013;64(6): 876-892.

Thompson IM, Pauler DK, Goodman PJ, Tangen CM, Lucia MS, Parnes HL, et al. Prevalence of prostate cancer among men with a prostate-specific antigen level < or =4.0 ng per milliliter. N Engl J Med. 2004;350(22):2239–46.