Prostate Specific Antigen (PSA) – Frequently Asked Questions

Prostate Specific Antigen (PSA) – Frequently Asked Questions

The prostate is a small gland in men around the size of a walnut that surrounds the neck of the bladder. It releases a fluid that is found in semen.

What is a prostate specific antigen (PSA)?

  • PSA is a protein produced by the prostate that can be detected in a blood test.
  • PSA can be elevated in older men and if the prostate enlarges.
  • PSA may also be high if cancer is present in the prostate.
  • It is important to note that an elevated PSA does not always mean that a patient has prostate cancer.

Benefits of having a PSA Test?

  • PSA testing can result in the early diagnosis of prostate cancer before the patient is aware of any symptoms.
  • Early detection of prostate cancer is associated with a better outcome and increases the likelihood of the patient being completely cured.

Limitations of having a PSA Test?

  • False Positives- about 75 out of 100 men with an elevated PSA test are not found to have any cancer (once they have had a biopsy).
  • This can result in:
  1. Over investigation: Unnecessary investigations, including a biopsy where small tissue from the prostate is removed and analysed to check for cancer. A biopsy can have side effects such as infection.
  2. Overtreatment: Unnecessary treatment as many prostate cancers tend to be slow-growing and may not cause any issues during the patient’s lifetime. Side effects of treatment can be significant and include erectile dysfunction and incontinence of urine.
  • False Negative- About 15 out of 100 men with a negative PSA may have prostate cancer, and the result may falsely reassure them.


Should I have a PSA Test?

  • In the UK, the PSA test is free to any adult man over 50 who requests it after discussing it with their GP or Practice Nurse.
  • The health professional will discuss with the patient their general health and symptoms and then counsel them about the PSA test so they understand the potential implications of the results.
  • Men aged <50 who are considered high risk should also consider having a PSA test. Risk factors include:
  1. Family History: having a father or brother diagnosed with prostate cancer under the age of 60 or a close female relative with breast cancer.
  2. Ethnicity: black men have a higher incidence of prostate cancer than Asian men.
  • In addition, the health professional may also wish to perform a prostate examination by placing a gloved and lubricated finger into the bottom.


What symptoms do I need to be aware of?

The following symptoms can caused by an enlarged prostate as men get older. They may also occur in prostate cancer, so it is very important to speak to your local surgery should they occur:

  • Needing to rush to the toilet.
  • Poor stream when passing urine.
  • Need to pass urine more often, especially at night.
  • Straining when trying to pass urine.
  • Blood in urine or in semen- requires an urgent review with a health professional to rule out other causes, such as infection.


What do I need to do before a PSA Test?

PSA testing should not be done in the following circumstances as they can result in inaccurate readings:

  • Strenuous exercise in the past 48 hours.
  • Ejaculation in the past 48 hours.
  • Current urine infection.
  • Prostate biopsy in the past six weeks.


Is there a Screening Programme?

  • There is currently no national screening test for prostate cancer in the UK, as PSA testing is not always accurate, as discussed above.


What does my result mean?

  • The patient will have a discussion about the results with their health professional, who will advise if any further investigations are required, such as a scan, urine test, or a referral to the urology team in the hospital.


Author: Dr Debs Basu, GP, Teladoc Health UK


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