Consensus on PSA testing

Guideline 1: In the future, health professionals should look at a man’s PSA level alongside other known risk factors as part of a risk assessment tool, when one becomes available.

We are currently working to develop a simple and reliable risk assessment tool, which will show whether a man is at risk of getting prostate cancer. This will help health professionals to support men at risk and talk to them about possible further tests.

• About the risk assessment tool
  

Guideline 2: GPs and practice nurses should know what may increase a man’s risk of getting prostate cancer.

• About your risk of prostate cancer

Guideline 3: GPs and practice nurses should be prepared to start conversations about the pros and cons of the PSA test with men who have a higher risk of getting prostate cancer.

• About the PSA test, including the pros and cons

Guideline 4: The government and health organisations, with help from health professionals and charities, should make sure men know about their risk of prostate cancer, and about general prostate health.

Guideline 5: All men should be able to have a PSA test if they’re over 50. Men who have a higher risk of prostate cancer should be able to have a PSA test if they’re over 45.

The Prostate Cancer Risk Management Programme guidance, from Public Health England, states that "The PSA test is available free to any man aged 50 or over who requests it, after careful consideration of the implications".

Guideline 6: If a man is thinking about having a PSA test, his GP or practice nurse should talk to him about the pros and cons. This should help the man decide whether or not to have a PSA test.  

• About the PSA test, including the pros and cons

Guideline 7: If a man has no symptoms of a prostate problem and is clearly likely to live for less than 10 more years, his GP or practice nurse should advise him not to have a PSA test.

This is because a man in this situation is unlikely to benefit from having the test. Early prostate cancer doesn’t usually cause any symptoms. It often grows slowly and has a low risk of spreading. So it may never cause any problems in a man’s lifetime or affect how long they live. 

• About prostate cancer

Guideline 8: If a man decides to have a PSA test, his GP should offer him a digital rectal examination (DRE) as well, even if he has no symptoms of a prostate problem.

• About the digital rectal examination (DRE)

Guideline 9: Even if a man has no symptoms of a prostate problem, he should be referred to a specialist at the hospital for more tests if:

• he has a higher risk of prostate cancer, and
• he is aged between 45 and 49 years, and
• his PSA level is higher than 2.5 ng/ml.

Guideline 10: When deciding whether to refer a man to a specialist at the hospital, GPs and practice nurses should look at the man’s previous PSA test results. They should look at any rise in the man’s PSA level, even if their PSA level is still ‘normal’ for their age.

A ‘normal’ PSA level is less than 3ng/ml for men aged 50-69.

Guideline 11: Men with a ‘normal’ PSA level should be able to have another PSA test in the future, even if they still have no symptoms of a prostate problem. 

This is known as repeat testing. Men should discuss how often to have a PSA test with their GP or practice nurse. This will depend on that man’s risk of getting prostate cancer. 

Guideline 12: Men over the age of 40 who have no symptoms of a prostate problem should think about having a PSA test to help work out their risk of getting prostate cancer later in life. 

This is known as a ‘baseline’ PSA test. If a man aged between 40 and 49 years has a PSA level higher than 0.7ng/ml, this may mean he has a higher risk of getting prostate cancer. He and his GP or practice nurse should talk about having regular PSA tests in the future. This might be a good way to spot any changes in the man’s PSA level that might suggest prostate cancer. 

• More about 'baseline' PSA testing

Guideline 13: The PSA test (with or without a digital rectal examination) should not be used in a national screening programme for men in the UK.

• About why we don’t have a national screening programme using the PSA test in the UK

The PSA test is a blood test that measures the amount of prostate specific antigen (PSA) in your blood. PSA is a protein made by the prostate. A high PSA level can be a sign of a prostate problem, such as prostate cancer.

The NHS Prostate Cancer Risk Management Programme (PCRMP) provides GPs and practice nurses with information to help any man aged over 50 who asks about prostate cancer and the PSA test. But GPs have told us they want more information about when and how often men who want a PSA test should have one. So we’ve worked with over 300 health professionals across the UK to produce new guidelines to help them. The guidelines are called the ‘Consensus statements on PSA testing in asymptomatic men in the UK’.

If you find it difficult talking to your GP or practice nurse about the PSA test, or you’re having trouble getting the test, it may help to show them this information. If you’ve got any questions about the PSA test you can read more about what’s involved or speak to our Specialist Nurses.

What are the guidelines for and how were they produced?

The 'Consensus statements on PSA testing in asymptomatic men in the UK' are a set of recommendations for health professionals. It contains a list of guidelines to help them better support men to decide whether or not to have a PSA test and when and how often this should happen.

Usually, experts look at the results of medical research to help them produce guidelines. But there haven’t been enough studies about the PSA test to give us all the answers. So until more results from research are available, we needed to get agreement from a large group of health professionals in order to write guidelines to fill some of the gaps. We asked more than 300 health professionals to tell us whether they agreed or disagreed with each guideline. We then made changes to the guidelines until the majority of the health professionals agreed with them. A smaller group of experts then met to talk about the guidelines and helped us produce the final version.

The consensus statements have been endorsed by the British Association of Urological Nurses (BAUN), the British Association of Urological Surgeons (BAUS) and the Primary Care Urology Society (PCUS).

We also spoke with men, including some men with prostate cancer and their partners, to find out what they thought about the guidelines, and whether they would help to support men.

This project was funded through charitable funds which were not provided by the pharmaceutical industry or any medical device or treatment company.

What else are we working on to improve the future of diagnosis?

We’re working to make sure that the training, equipment and expertise are in place to offer men an accurate and reliable multiparametric MRI (mpMRI) scan before a biopsy by healthcare systems UK-wide, in anticipation of the PROMIS trial results being published later this year.

We are also currently working to develop a simple and reliable risk assessment tool, which will show whether a man is at risk of getting prostate cancer. This will help health professionals to support men at risk and talk to them about possible further tests.

You can also read about our research into prostate cancer diagnosis.