What is the prostate?
The prostate is a gland that makes semen which is the fluid that sperm travel in. It sits underneath the bladder and surrounds the urethra (the tube that carries wee). It is usually about the size of a walnut and grows as you age.
Can you tell me a bit about prostate cancer?
Prostate cancer can develop when cells in the prostate start to grow in an uncontrolled way.
Some prostate cancer grows so slowly that they cause no problems and don’t affect how long you live.
But some prostate cancer grows quickly and can spread. This is more likely to cause problems and needs treatment.
Am I at RISK?
Prostate cancer mainly affects men over 50, and your risk increases with age.
It is the most common cancer in men. In the UK, about 1 in 8 men will get prostate cancer in their lifetime.
The risk is even higher for black men and men with a family history of prostate cancer.
So can I test for prostate cancer? Can you tell me about the PSA test?
The PSA blood test 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 prostate cancer though there are other reasons for it to be raised, and it is important to keep this in mind.
What could affect my PSA level?
Prostate problems, such as an enlarged prostate, prostatitis or prostate cancer, can cause your PSA level to rise – but lots of other things can affect your PSA level too, including the following.
• Vigorous exercise – You might be asked not to do any vigorous exercise 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.
• A urine or prostate infection
• Medicines – some medicines used to treat an enlarged prostate, and male pattern baldness, known as 5-alpha-reductase inhibitors, such as finasteride (Proscar®) (Propecia®) or dutasteride (Avodart®), can reduce your PSA level and give a false test result.
• Anal sex and prostate stimulation – Receiving anal sex, or having your prostate stimulated during sex, might raise your PSA level for a while. It might be worth avoiding this for a week before a PSA test.
• Prostate biopsy, bladder surgery and urinary catheters – If you’ve had a biopsy in the six weeks before a PSA test, this could raise your PSA level.
How can I do a PSA blood test?
You can book a PSA blood test with Sloane Street Surgery or with your local GP. A one-off value is useful, but tracking your PSA over time will give you and your GP valuable insights. The amount of PSA in your blood is measured in nanograms (a billionth of a gram) per millilitre of blood (ng/ml). You can eat and drink as normal before having a PSA test.
It can take one to two weeks to get your test results.
David’s Story
After I lost my cousin to prostate cancer my wife insisted with the GP for a prostate cancer test. The GP was helpful and we discussed the test thoroughly. I was surprised to hear that the test is by no means perfect, but after discussing the advantages and disadvantages, we agreed to go ahead. We also discussed adding tests to part of my annual screening. I have had my test 2 years running now, and the value is really similar, so whilst I accept the test is not perfect I feel much more reassured.
What will the test results tell me?
The PSA test helps you understand more about your prostate but the PSA is not a perfect test.
A raised result needs answers and can lead to early treatment, but not all high PSA results are due to prostate cancer.
A normal result is reassuring, but not all normal results mean you are all clear. Like all tests, the PSA test can fail or be misleading.1 in 50 patients with fast-growing prostate cancer will have a normal PSA, and 1 in 7 patients with slow-growing prostate cancer will have a normal PSA.
To decide whether you need to see a specialist at the hospital, your GP will talk to you and examine you.
What are the advantages and disadvantages of the PSA blood test?
It’s important to think through the advantages and disadvantages of the PSA test before doing it.
Advantages
• It can help pick up prostate cancer early when treatment could be most effective.
• A regular PSA test could be helpful, particularly if you have an increased risk of prostate cancer. This could detect any unusual increase in your PSA level that might be a sign of prostate cancer.
Disadvantages
• Your PSA level might be raised, even if you don’t have prostate cancer. Many men with a raised PSA level don’t have prostate cancer. The raised level can lead to further tests such as MRI scans or biopsies.
• The PSA test can miss prostate cancer.
• Being diagnosed with a slow-growing prostate cancer that is unlikely to cause any problems or shorten your life may still make you worry.
Some people have a PSA in their 40s as a baseline. Can you tell me more?
A baseline prostate-specific antigen (PSA) test involves having a PSA test while your risk of getting prostate cancer is low – for example, in your 40s.
Research suggests that it could be used to predict how likely you are to get prostate cancer in the future. For example, if a man’s PSA level in his 40s is slightly higher than expected, 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 to spot any changes that might suggest prostate cancer.
The challenge is that we don’t know exactly what PSA level in your 40s would suggest an increased risk of prostate cancer in the future or how often you should have a PSA test after the baseline test.
If you want to know more about prostate cancer, we recommend these resources
– https://patient.info/mens-health/prostate-and-urethra-problems/prostate-specific-antigen-test-psa
– prostatecanceruk.org
Or book an appointment with Sloane Street Surgery, and one of our GPs would be happy to answer any questions you may have.
