Explaining PSA Testing

We are pleased that so many men are coming forward to discuss their health and demonstrating an interest in screening but realise that the rationale around PSA testing is not always clear.

GP’s base decisions on PSA testing on the NHS Prostate Cancer Risk Management Guidance (PCRMP) which was updated in 2020. Currently the PCRMP does not recommend a national screening programme for prostate cancer and suggests that GPs should not raise the issue of PSA testing with men who do not have urinary symptoms.

They highlight two issues with screening for prostate cancer:

  • Slow-growing tumours are common and may not cause any symptoms or shorten life and therefore some tested men will face overdiagnosis and the associated anxiety, further medical tests and side effects of testing or treatment.
  • 3 quarters of men with PSA >3 ng/ml (a raised result) will not have cancer, but 15% of men with normal PSA do have cancer.

However, there are some instances where a PSA test in an asymptomatic man is appropriate. Some men are at higher risk for example those with a 1st degree relative with prostate cancer or those of black ethnic origin. Risk also increases with age so if you are over 50 years you can be offered a test but it is important that you understand the pros and cons and we recommend reading this information prior to explain these more fully.

The decision of whether to perform a PSA test is different in men with symptoms. Lower urinary tract symptoms (such as a poor stream, hesitancy, straining, urgency, going more often or at night) are very common and are estimated to be present in around 80% men over 60. Most men with lower urinary symptoms do not have prostate cancer but have other conditions such as a benign enlarged prostate, diabetes, kidney stones or a urine infection. However, if you have NEW urinary symptoms, particularly if you are in a higher risk group or notice other symptoms such as blood in your urine, erectile dysfunction, weight loss or bone pains please book an appointment to discuss this with a GP.

Because you have symptoms, you will likely be asked to provide a urine sample, offered a digital rectal examination and blood tests including PSA.

Certain factors can affect the result so before a PSA test please ensure you have not:

  • Had a UTI in the last 6 weeks
  • Ejaculated in <48 hours
  • Exercised vigorously in <48 hours
  • Had a prostate biopsy in the last 6 weeks

If your PSA test result comes back positive we will contact you and go through next steps.

This information was compiled by Dr Power (GP Partner at The Lodge Health Partnership) based on information from UK Government - PHE Screening and NB Medical Education Resources.