Should you have the PSA test to detect prostate cancer

All men over 40 years of age should have a digital rectal examination (DRE) during their annual physical examination to detect prostate enlargement and cancer. Younger men should also be tested regularly if they have family members who suffer from prostate cancer. Your doctor may wish to also do a laboratory test (PSA antigen test) and a prostatic biopsy if a lump is present or the prostate is enlarged.

Prostate-specific antigen test (PSAT)

Prostate-specific antigen (PSA) is released into a man’s blood by his prostate gland. A PSA test measures the amount of PSA in the blood; a healthy man has low amounts of PSA in his blood.

Who should have the PSAT?

Doctors’ recommendations for the PSAT vary. Some encourage annual screening for men over 50 years of age and some advise men who have a family history of the disease to begin screening at the age of 40 or 45. Others caution against routine screening. However, they all agree that men should be informed about the potential risks and benefits of the PSAT before being tested.

Your doctor may want you to have the PSAT to:

• • Check if cancer may be present when results from other tests, such as a digital rectal examination, are not normal. A PSA test does not diagnose cancer, but it can be used together with other tests to determine if cancer is present.

• • Watch your prostate cancer and see if the treatment is working. If PSA levels increase, the cancer may be growing or spreading. PSA is usually not present in a man who has had his prostate gland removed. A PSA level that rises after prostate removal may mean the cancer has returned or has spread.

• • Check men for prostate cancer. A man’s PSA level alone does not give doctors enough information to distinguish between benign prostate conditions and cancer; the doctor will take the result of the PSA test into account when deciding whether to check for additional signs of prostate cancer. Since other common medical conditions, such as prostatitis, can cause high PSA levels, a prostate biopsy is needed to confirm a diagnosis of cancer.

Some limitations of the PSAT

• • When used in screening, the PSA test can detect small tumours. However, finding a small tumour does not necessarily reduce a man’s chances of dying from prostate cancer. PSA testing may identify very slow-growing tumours that are unlikely to threaten a man’s life. Also, PSA testing may not help a man with a fast-growing or aggressive cancer that has already spread to other parts of his body before being detected.

• • False-positive test results occur when the PSA level is elevated but no cancer is actually present. False positives may lead to additional medical procedures that have potential risks and significant financial costs and can create anxiety for the man involved and his family. Most men with an elevated PSA test result do not have cancer; only 25 to 35 per cent of men who have a biopsy due to an elevated PSA level actually have prostate cancer.

• • False-negative test results occur when the PSA level is normal, even though prostate cancer is actually present. Most prostate cancers are slow-growing and may exist for decades before they are large enough to cause symptoms. Subsequent PSA tests may indicate a problem before the disease progresses significantly.

Our Employee Wellbeing Programme (EAP) is available 24 hours a day if you want to know more about the PSA test for prostate cancer.