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Making a decision - should I have a PSA test?

This page is for men who are thinking about having a PSA test. The information comes from our booklet PSA and beyond: a guide for men concerned about prostate cancer. You can download a PDF of the booklet or order a copy free from our publications page.

• Should I have a PSA test?
• What are the advantages and disadvantages?
• Questions to think about
• Questions to ask your GP
• Why is there no screening programme?
• Read our PSA policy statement

Should I have a PSA test?

It can be difficult to decide whether or not to have a PSA test. Before you make a decision, find out as much as you can about the test and what the results can and cannot tell you. You can discuss the test with your GP and ask them any questions you may have. You can also speak to a Prostate Cancer Charity Support & Information Specialist nurse by calling our confidential Helpline.

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What are the advantages and disadvantages?

Some of the advantages and disadvantages of the test are listed below^1,2,3,4

Advantages

• A PSA test may pick up a significant prostate cancer before you get any symptoms.
• A PSA test may be used for monitoring men who have a high risk of developing. prostate cancer, for example men with a strong family history.
• A PSA test may pick up a high risk cancer at an early stage when treatment may prevent the cancer from becoming more advanced.
• A normal PSA test result may reassure you.
• Repeat PSA tests can identify changes to your PSA level that may show that there is a problem with your prostate
• A PSA test may pick up a non-cancerous prostate problem such as BPH or prostatitis which can be treated and may relieve you of any symptoms.

Disadvantages

• Around two thirds of men with a raised PSA do not have prostate cancer ⁵
• PSA tests will not pick up all prostate cancers. Some men with prostate cancer have a normal PSA level.
• A PSA test cannot tell you whether a prostate cancer is likely to be fast or slow growing. A slow growing cancer may not cause any symptoms or shorten your life.
• A normal result does not mean that you will not get prostate cancer in the future.
• If your PSA is raised, you may need further tests and treatment that carry their own risks and side effects.
• Treatment for prostate cancer may cause side effects which can affect your quality of life.

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Questions to think about

You may want to think about your risk of prostate cancer. How would you feel about being diagnosed with prostate cancer? How do you feel about treatment and possible side effects? How do you feel about your general health? What are your personal preferences?

Try asking yourself the following questions:

• If you are concerned about prostate cancer, would you rather know that you have cancer, or not know but continue to worry about it?
• If the result of your PSA test was normal, would this reassure you?
• If your PSA was high, what would you do?
• If you were diagnosed with early, slow growing prostate cancer, would you want to have treatment that may cause side effects?

Speak to your GP about any concerns before making a decision. You can also speak to a Prostate Cancer Charity specialist nurse by calling our free and confidential Helpline on 0800 074 8383.

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Questions to ask your GP

• Do I have an increased risk of developing prostate cancer?
• Would you recommend that I have a PSA test?
• How long will I have to wait for the results?
• If I have a PSA test and the result is normal, will I need to have regular tests in the future?
• Do I need a DRE?

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Why is there no prostate cancer screening programme for all men?

The PSA test alone is not able to diagnose prostate cancer and is a relatively unreliable screening tool. Screening men for prostate cancer would involve measuring the PSA level of all men in the ‘at risk’ age group (over 50 years of age). A large number of men who have prostate cancer will go through life unaware of their condition because the cancer is slow growing and may not cause any troublesome symptoms or shorten their life. ^6,7

Since current treatments may cause unpleasant side effects such as erectile dysfunction and incontinence, screening could lead to a large number of men having worse effects from the treatment than they would have had from the disease. However, there is concern that early diagnosis may be vital for those men with higher risk or more advanced disease but have no symptoms.

There is currently no screening programme for prostate cancer in the UK. The Department of Health has set up a ‘Prostate Cancer Risk Management Programme’ to help men decide whether to have a PSA test or not. If you are concerned about prostate cancer, you can ask for information about the advantages and disadvantages of the PSA test and prostate cancer treatment. If you then decide that you want a PSA test you can ask your GP for one. You are entitled to have a PSA test if you are a man aged over 50 or a younger man with an increased risk of prostate cancer. Your GP can give you more information about the programme or you can call our free and confidential Helpline on 0800 074 8383.

You can find out more about what the Prostate Cancer Charity thinks about screening for prostate cancer by reading our policy position.

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References used in the production of this page.

1 Stamey TA et al. The prostate specific antigen era in the United States is over for prostate cancer: what happened in the last 20 years? J Urol. 2004; 172: 1297-301.

2 Draisma G et al. Lead times and overdetection due to prostate-specific antigen screening: estimates from the European Randomized Study of Screening for Prostate Cancer. J Natl Cancer Inst 2003; 95(12): 868-878.

3 Yao SL, Lu-Yao G. Understanding and appreciating overdiagnosis in the PSA era. J Natl Cancer Inst. 2002; 94: 958-960.

4 Etzioni R et al. Overdiagnosis due to prostate-specific antigen screening: lessons from US prostate cancer incidence trends. J Natl Cancer Inst. 2002; 94: 981-990.

5 Selley S, Donovan J, Faulkner A, Coast J, Gillatt D. Diagnosis, management and screening of early localised prostate cancer. Health Technol Assess 1997;1(2):i, 1-i,96.

6 Draisma G et al. Lead times and overdetection due to prostate-specific antigen screening: estimates from the European Randomized Study of Screening for Prostate Cancer. J Natl Cancer Inst 2003; 95(12): 868-878.

7 Yao SL, Lu-Yao G. Understanding and appreciating overdiagnosis in the PSA era. J Natl Cancer Inst. 2002; 94: 958-960.