Behind the headlines: Symptoms, screening and PSA – should I have a test?
With recent announcements from Stephen Fry and Bill Turnbull about their prostate cancer, our Specialist Nurses have been taking a lot of calls from men wanting to find out about the symptoms of prostate cancer, screening and the PSA test.
The PSA test was also in the media spotlight again after results from a large prostate cancer trial, the 'CAP' trial were released.
So what should men do if they are worried about prostate cancer? Who should have a PSA test? Our Specialist Nurse, Ali Rooke sets out the facts.
What is prostate cancer?
Prostate cancer can develop when cells in the prostate start to grow in an uncontrolled way. Prostate cancer often grows slowly and may never cause any problems or shorten a man’s life. But some prostate cancers grow more quickly and need treatment to stop them spreading.
Are there any symptoms of prostate cancer?
Most men with early prostate cancer don’t have any signs or symptoms. Some men with early prostate cancer have urinary symptoms but often, these symptoms indicate another common prostate problem called an enlarged prostate.
Because of this, it is very important to consider if you are at higher than normal risk of prostate cancer. Prostate cancer is most common in men over 50, and you are at higher risk of prostate cancer if you are a black man or have a family history of the disease.
If prostate cancer breaks out of the prostate or spreads to other parts of the body (advanced prostate cancer), it can cause other symptoms.
How can I find out if I have prostate cancer?
If you are worried about prostate cancer, you should speak to your GP, especially if you are at an increased risk of prostate cancer. They should ask you about this and consider it when deciding what steps to take.
There are a number of tests and checks doctors use to see if you have prostate cancer or another prostate problem. These include the PSA test; the digital rectal examination (DRE) which is a physical examination to check if your prostate feels normal; prostate biopsy and scans.
What is the PSA test?
The PSA test is a blood test that can help diagnose prostate problems, including prostate cancer.
The test measures the amount of prostate specific antigen (PSA) in your blood. PSA is a protein produced by normal cells in the prostate and also by prostate cancer cells.
It’s normal to have a small amount of PSA in your blood, and the amount rises as you get older and your prostate gets bigger. A raised PSA level may suggest you have a problem with your prostate, but not necessarily cancer.
I’ve heard that the PSA test is an unreliable test for prostate cancer. Is this true?
A PSA test alone can’t diagnose prostate cancer and there are advantages and disadvantages to having a PSA test. You’ll need to talk to your GP or practice nurse about these before deciding whether to have a test.
If I have symptoms that could mean I have prostate cancer, should I have a PSA test?
It’s a good idea to get any symptoms checked out by your GP so they can find out what’s causing them and make sure you get the right treatment if you need it. If they think there is a risk they may suggest you have some of the tests listed above, which could include the PSA test.
If I have no symptoms, can I have a PSA test?
Men who have a higher than normal risk of prostate cancer should speak to their GP to discuss the pros and cons of the PSA test so that they can decide if it’s right for them.
You have the right to be given a PSA test if you’re over 50 and you’ve talked through the advantages and disadvantages with your GP or practice nurse.
If you’re over 45 and have a higher risk of prostate cancer, for example if you’re black or you have a family history of the disease, you might want to talk to your GP about having a PSA test.
It’s important to think about whether the PSA test is right for you before you decide whether or not to have one.
Your GP or practice nurse may not recommend the PSA test if you don’t have any symptoms, and you have other serious health problems that mean you might not be fit enough for treatment for prostate cancer, or if treatment for prostate cancer wouldn’t help you to live longer.
I asked for a test and my GP refused. What can I do?
As we said above, you have the right to be given a PSA test if you’re over 50 and you’ve talked through the advantages and disadvantages with your GP or practice nurse.
Men at higher than average risk of prostate cancer may want to talk their doctor about the PSA test from the age of 45.
If this describes you and you have been refused a PSA test, you should ask your GP again and explain that you are entitled to a PSA test under the NHS Prostate Cancer Risk Management Programme. You might also like to print and show them a copy of our information for GPs.
If they still say no, try speaking to another GP or practice nurse and 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.
I’ve been given a lot of information about the PSA test and I’m still confused. Can anyone help me?
If this is the case for you and you are worried, you should speak to your GP or call our Specialist Nurses on 0800 074 8383. You can leave a message requesting a call back if the lines are busy. There are other ways to contact the Specialist Nurses too including by email and via our Live Chat.
Is there a screening programme for prostate cancer in the UK?
No. There’s currently no single test that can be used as part of a screening programme that will accurately detect prostate cancer. Right now, the PSA test is the best first step we have to indicate if there might be a problem with the prostate in men who do not have symptoms. But it isn’t accurate enough to be used alone as a screening tool for prostate cancer.
One of the main reasons the PSA test is not use as a basis for screening is the potential for this to lead to men being treated unnecessarily, risking life-changing side effects such as incontinence and erection problems. To save one life from prostate cancer, over 500 men would need to be screened. Of these, 27 men would have unnecessary treatments. Screening all UK men with the PSA test would also lead to many men having unnecessary biopsies which, for up to 3 in 50 men (6 per cent), can cause a serious infection (such as sepsis) that can lead to hospitalisation. Also, a high PSA reading doesn’t necessarily mean that a man has prostate cancer. Many men receive ‘false positive’ or ‘false negative’ results, which can cause unnecessary anxiety or false reassurance.
Are you doing anything about the fact that there is no screening programme for prostate cancer?
Yes. Improving diagnosis is one of our top research priorities. In 2016 we kick started plans to improve diagnosis, launching a research pot worth millions to help develop tests which could be used as part of a national screening programme. We believe better blood tests that are in development, combined with more advanced scanning should be the basis for such a programme. We’re working to make that happen in the next five years.
But to achieve these aims, we need to increase our investment in research. We’re calling for people to sign up to a March for Men this summer to help raise the funds we desperately need to stop prostate cancer being a killer.