Q&A: Answering your questions on the PSA blood test

The earlier you find it, the easier it is to treat. With prostate cancer, it’s not about luck or fate. It’s about understanding your risk and knowing what you can do about it. 

If you’re concerned about prostate cancer, you have a right to ask your GP for a PSA blood test. But there are pros and cons to having one, so it’s important to consider all the options and make the choice that’s right for you. 

We’ve received lots of questions from men about the PSA blood test. How often should I have one? How accurate will it be? What should I do if my GP says no?  

So we asked our Risk Information Officer, Liam O’Reilly, to help answer some of your latest questions and help you understand the options in front of you. 

Before you do anything else, it’s important to understand your risk of prostate cancer. You can check your risk in 30 seconds, using our simple online Risk Checker.  

You can also speak to your GP or primary care nurse about your risk and the option of having a PSA blood test. There are advantages and disadvantages to having a test, so it’s important to consider these carefully before deciding if it’s the right choice for you.  

If you decide to have a test, your GP can also help you understand the results afterwards. And if you need to have further tests, they can refer you straight to a urologist at your local hospital.  

The PSA blood test is available for free on the NHS and is offered by private healthcare providers too. You can also buy PSA test kits to use at home, but we don’t recommend using them. Last year a BBC report found they can give unreliable results. And if you have a raised PSA level, you’ll need to speak to your GP anyway, to discuss what the results might mean for you and whether you need further tests. 

Occasionally, you might find PSA tests are also available at events in your local community. If you’re thinking about having a test at one of these events, make sure there are trained health professionals on hand. They’ll be able to give you unbiased information and help you decide if having a test is right for you.  

The digital rectal exam (DRE) is no longer a standard part of the way prostate cancer is diagnosed in the UK. This is because, during the exam, your doctor or nurse can only feel the back of the prostate – but cancer sometimes grows in other parts of the prostate, or it might be too small to pick up by touch.  

The best first test for prostate cancer is the PSA blood test. On its own, it can’t tell you whether or not you have prostate cancer. But it can tell you if you might benefit from having further tests, like an MRI scan.  

You might be offered a DRE if you have symptoms, because it could might diagnose other prostate problems that aren’t related to cancer. It isn’t usually painful and it doesn’t take long. And ou can ask to have someone in the room with you for support. 

Whether you have symptoms or not, you don’t have to have a DRE if you don’t want to. You can have a PSA blood test on its own. 

The PSA blood test is good at measuring the level of a protein called prostate-specific antigen (PSA) that’s in your blood. A raised PSA level could be a sign of prostate cancer, but it’s more likely to be something else. 

If you have a raised PSA level and are experiencing changes to the way you wee, it’s more likely to be a different kind of prostate problem. As you get older, your prostate tends to get bigger, which releases more PSA into the blood – and it’s very common for men over the age of 50 to have an enlarged prostate. This is sometimes called Benign Prostatic Hyperplasia (BPH) or Benign Prostatic Enlargement (BPE).  

There are several other things that can temporarily affect your PSA level. For example, you should avoid doing vigorous exercise, having sex or masturbating for 48 hours before a PSA blood test. Urine infections and some medicines can also affect your PSA level, among other things. It’s a good idea to talk to your GP and discuss the best time for you to have a PSA blood test.

Some men decide to have an annual test. However, we know prostate cancer usually grows slowly and – if you’re undiagnosed and have no symptoms – there’s currently no evidence to suggest you should have a test more frequently than this. 

Before you make any decisions about whether to have a PSA test, it’s important to speak to a healthcare professional. They can help you assess your risk factors – like your age, ethnicity, whether you have a family history of the disease, your general health and any previous PSA test results. They can also talk you through the advantages and disadvantages of having further tests.  

The PSA blood test is the best first test for prostate cancer. However, we know it isn’t right for everyone.  

If your GP has refused to give you a PSA blood test, ask them why – there might be a good reason for it. Your GP might advise you not to have one if your general health means you wouldn’t be fit enough to have prostate cancer treatment, or if treatment wouldn’t help you live longer. For some men, the side effects of treatment could be more harmful than the cancer itself.  

If you still want to have a PSA blood test, you could choose to get a second opinion from another doctor or nurse at the surgery.  

Many people contact our Risk Information Service after speaking to a receptionist at their GP surgery. A receptionist may not be able to book you in for a PSA blood test until you’ve spoken to a doctor or nurse at the surgery, but that doesn’t necessarily mean you can’t get one. You’ll just have to discuss the advantages and disadvantages with your GP or a nurse first.

If you’re thinking about having a PSA blood test, it’s important to consider your risk of prostate cancer. Along with your age and ethnicity, your family history is one of the three main risk factors. 

If your dad or brother has had prostate cancer, you’re about two-and-a-half times more likely to get it than a man who has no family history of the disease.

If you have a family history of prostate cancer, you might choose to speak to your GP a few years earlier than other men – from around the age of 45. Make sure your GP is aware that you have a family history because it might not be on your medical records. It’s important for the GP to know about it, so they can help you understand your risk. 

Your father and brother are sometimes referred to as ‘first-degree’ relatives. Health professionals might call your uncle, grandfather or cousins ‘second-degree’ relatives. If you have a second-degree relative who’s had prostate cancer, you might also be at higher risk. However, the evidence isn’t as clear for second-degree relatives as it is for first-degree relatives.