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The PSA test

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What is 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 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 slightly 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.

You can have a PSA test at your GP surgery. You will need to discuss it with your GP first. At some GP surgeries you can discuss the test with a practice nurse, and they can do a test if you decide you want one.

Who can have a PSA test?

You have the right to a prostate specific antigen (PSA) test if you’re over 50 and you’ve thought carefully about the advantages and disadvantages. 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 it, 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. There are a number of things you might want to think about.

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. But if you have symptoms of a possible prostate problem, your GP may arrange for you to see a specialist at the hospital.

Some men are offered a PSA test as part of a general check-up. You should still think about the advantages and disadvantages of the test and whether it is right for you before agreeing to have one.

What if my doctor doesn't want to do a PSA test?

We know that some men having trouble getting a PSA test. There are a number of things you can do if you can't get a PSA test.

What can the PSA test tell me?

A raised PSA level can be a sign of a problem with your prostate. This could be:

Other things can also cause men's PSA levels to rise. If you have a raised PSA level, your GP might do other tests to find out what’s causing it, or they may refer you to see a specialist at the hospital.

The PSA test and prostate cancer

A raised PSA level can be a sign of prostate cancer. But many men with raised PSA levels don’t have prostate cancer. And some men with a normal PSA level do have prostate cancer.

You may be more likely to get prostate cancer if:

  • you are aged 50 or over, or
  • your father or brother has had it, or
  • you are black.

To decide whether you need to see a specialist, your GP will look at more than just your PSA level. They will also look at your risk of prostate cancer and whether you've had a prostate biopsy in the past. They may also do a digital rectal examination (DRE) to check if your prostate feels normal.

Having a PSA test

You can have a PSA test at your GP surgery. Your GP or practice nurse might talk to you about having a PSA test if you have symptoms such as problems urinating, if you’re worried about prostate problems, or if you’re at higher risk of getting prostate cancer.

Your GP or practice nurse should talk to you about the advantages and disadvantages of the PSA test before you decide to have one. They will also discuss your own risk of getting prostate cancer, and ask about any symptoms you might have.

Your GP or practice nurse will also talk to you about your general health and any other health problems. They might recommend not having a 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.

If you decide you want a PSA test, your GP or practice nurse will take a sample of your blood and send it 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 (DRE), also known as a physical prostate exam, and a urine test to rule out a urine infection.

What could affect my PSA level?

Prostate specific antigen (PSA) is produced by healthy cells in the prostate, so it’s normal to have a small amount of PSA in your blood. The amount rises as you get older and your prostate gets bigger. Prostate problems, such as an enlarged prostate or prostatitis, can cause your PSA level to rise – but lots of other things can affect your PSA level too.

A urine infection – You may have a test for a urine infection as this can raise your PSA level. If you have an infection, you’ll be given treatment for this. You’ll need to wait until the infection has gone – around six weeks – before you have a PSA test.

Vigorous exercise – You might be asked not to do any vigorous exercise, especially cycling, in the 48 hours before a PSA test.

Ejaculation – You may be asked to avoid any sexual activity that leads to ejaculation in the 48 hours before a PSA test.

Anal sex and prostate stimulation – Receiving anal sex might raise your PSA level for a while. 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.

Digital rectal examination (DRE) – Having a DRE just before a PSA test might raise your PSA level a small amount. Your doctor might avoid testing your PSA for a week if you’ve just had a DRE.

Prostate biopsy – If you’ve had a prostate biopsy in the six weeks before a PSA test, this could raise your PSA level.

Medicines – Let your GP or practice nurse know if you’re taking any prescription or over-the-counter medicines, as some can affect men's PSA levels. For example, 5-alpha-reductase inhibitors such as finasteride (Proscar®) or dutasteride (Avodart®), which can be used to treat an enlarged prostate, can reduce your PSA level and give a false test result.

Other tests or surgery – If you have a catheter or have had any tests or surgery on your bladder or prostate, you may need to wait up to six weeks before having a PSA test.

What will the test results tell me?

Lots of things can affect your PSA level, so a PSA test alone can’t usually tell you if you have prostate cancer. Your GP will look at the following things to decide whether you need to see a specialist at the hospital:

If your doctor thinks your PSA level is higher than it should be for your own situation, they might  decide you need to see a specialist at the hospital. For example, they  might make an appointment for you to see a specialist if your PSA level is 3 ng/ml or higher. But this is just a guide and slightly higher levels may be normal in older men.

Your GP might decide you don’t need to see a specialist if there are other reasons why your PSA level is raised. In this case, they might suggest having another PSA test in the future to see if your PSA level changes. Your GP might decide to refer you to a specialist if your PSA level is lower than 3 ng/ml but you have a higher risk of prostate cancer for other reasons, such as your family history.

Your GP should discuss all of this with you to help you decide what to do next.

Advantages and disadvantages of the PSA test

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

Advantages

  • It can help pick up prostate cancer before you have any symptoms.
  • It may help to pick up a fast-growing cancer at an early stage when treatment may stop the cancer spreading and causing problems.
  • 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.

Disadvantages

  • You might have a raised PSA level, even if you don’t have prostate cancer. Many men with a raised PSA level don’t have prostate cancer.
  • The PSA test can miss prostate cancer. 1 in 7 men (15 per cent) with a normal PSA level may have prostate cancer, and 1 in 50 men (two per cent) with a normal PSA may have a fast-growing prostate cancer.
  • If your PSA level is raised you may need more tests, including a biopsy. The biopsy can cause side effects, such as pain, infection and blood in the urine and semen.
  • 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 that can affect your daily life, including urinary, bowel, and erection problems.

Should I have a PSA test?

It can be difficult to decide whether or not to have a PSA test. Before you decide, try asking yourself the following questions, or discuss them with your GP or practice nurse.

  • Am I at higher risk of prostate cancer?
  • If my PSA level was normal, would this reassure me?
  • If my PSA level was raised, what would I do?
  • If I was diagnosed with slow-growing prostate cancer that might never cause any problems, would I want treatment that could cause side effects?

It might help to talk this over with your partner, family or friends. If you want to discuss the test, call our Specialist Nurses. They can help you understand your own risk of prostate cancer and talk you through the advantages and disadvantages of the test.

Regular PSA tests

After some men have had their first PSA test they might want to have regular tests every few years, particularly if they are at higher risk of prostate cancer. This might be a good way to spot any changes in your PSA level that 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 practice nurse, or call our Specialist Nurses.

Having a baseline PSA test

A baseline prostate specific antigen (PSA) test involves having a PSA test while your risk of getting prostate cancer is still low – for example when you are in your 40s. The aim of a baseline PSA test is not to help diagnose prostate cancer, but to help work out your risk of getting prostate cancer in the future.

There is some research suggesting that your PSA level in your 40s could be used to predict how likely you are to get prostate cancer, or fast-growing (aggressive) prostate cancer, in the future. If a man’s PSA level in his 40s is slightly higher than most men the same age, he might have a higher risk of getting prostate cancer in the future.

If the test suggests you're at higher risk, you and your doctor may decide to do regular PSA tests. This might be a good way to spot any changes in your PSA level that might suggest prostate cancer.

However, we don’t yet know exactly what PSA level in your 40s would show an increased risk of prostate cancer, or how often you should have more tests. Because of this, baseline testing isn’t very common in the UK. For more information about baseline testing, speak to your GP.

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

You have the right to 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’ve talked about it with your GP or practice nurse, and decided that you want to have one, they should give you a PSA test. But we know that some men have trouble getting the test. There are things you can do if your GP or practice nurse won’t give you a test.

Explain that you are entitled to a PSA test under the NHS Prostate Cancer Risk Management Programme. It might help to take this booklet along with you. 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.
  • 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. The NHS website 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.

Make sure you include the following information in your complaint:

  • your name
  • your contact details – such as your home address, telephone number or email address
  • a clear description of your complaint – including what happened, where and when
  • details of any relevant conversations, letters or emails you’ve had.

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

If your GP or practice nurse won’t give you a PSA test and you’re not sure whether to make a complaint, get in touch with our Specialist Nurses. They can help you understand your risk of prostate cancer so that you can decide what to do next.

Why isn’t there a prostate cancer screening programme?

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

There is currently no screening programme for prostate cancer in the UK. 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 – the list of disadvantages on this page explains why.

It’s important that the benefits of a screening programme outweigh any disadvantages. But it isn’t 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:

  • many men would have a biopsy, which could cause side effects
  • a large number of men would be diagnosed with a slow-growing cancer that wouldn’t have caused any symptoms or shortened their life
  • a large number of these men would have treatment they didn’t need, which could cause side effects.

Other studies have found that screening may not reduce the number of deaths from prostate cancer.

Although there’s no screening programme for prostate cancer, the Prostate Cancer Risk Management Programme gives men over 50 the right to have a PSA test on the NHS – as long as they’ve talked through the advantages and disadvantages with their GP or practice nurse.

Questions to ask your doctor or nurse

  • Am I at risk of prostate cancer?
  • What are the advantages and disadvantages of having a PSA test?
  • Will I need a DRE?
  • How long will I have to wait for my PSA test results?
  • If I have a PSA test and the result is normal, will I need to have regular PSA tests in the future?
  • If I have a PSA test and my PSA is raised, what will happen?
  • Should I have regular PSA tests?

References

Updated November 2016 | Due for Review: November 2018

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