WHY and WHAT

WHY you should have a PSA test if you are between 50 and 70*:

  • Prostate cancer is the most common type of cancer in men. In the UK more than 11,500 men die from prostate cancer each year.
  • 90% of men who have their prostate cancer diagnosed early are cured.
  • Prostate cancer in its early stages usually causes no symptoms – better to catch it before symptoms develop.
  • The PSA test is currently the only way of finding out whether you may have early prostate cancer.
    *or 45 if you are black or a family member (brother, father or uncle) has had prostate cancer

WHY you shouldn’t worry:

  • Less than 3% of men tested have prostate cancer that needs treatment –
    but if you are in that 3%, the PSA test is the route to saving your life.
  • 75% of men with high PSA readings do not have prostate cancer: their high reading is due to other factors – see below.
  • Most men will have some cancer in their prostate by the time they die. A PSA test starts the process of finding if that cancer needs treatment, or can safely just be monitored.

WHAT is the PSA test?

The PSA test is a blood test which checks for a protein called Prostate Specific Antigen (PSA) which is made in the prostate. PSA is normally made by the prostate in small amounts. Prostate cancer allows more of the PSA to leak into the blood stream; this can be detected by a simple blood test.

Conditions other than prostate cancer can put the PSA reading up, for example an enlarged or inflamed prostate, a recent urinary tract infection, vigorous exercise, especially cycling 48 hours before the test, or sexual activity leading to ejaculation 48 hours before the test.

WHAT happens next?

Most men will have a PSA reading below 3 ng/ml (although that limit varies slightly with age) in which case no further action is needed. The test should be repeated every 2 – 4 years.

About 20% of men will have PSA readings above the ‘normal’ level. This does not necessarily mean that prostate cancer is present, but it does mean that further investigation may explain the high reading. Further investigation may include an MRI scan (more information below) and possibly a biopsy of the prostate (more information below). If your reading is above 3 ng/ml you may wish to make an appointment with your GP who will refer you to the local Urology Dept..

WHAT is an MRI scan?
An MRI scan is a scan of your pelvis using magnetic fields. It is performed to see if there is any cancer in the prostate. Your lower body passes into a hollow tunnel, your head remains outside the tunnel. A small needle may be placed in your arm to inject a dye that passes to the prostate. The scanner makes some noise as it images the prostate. You are likely to be in the scanner for 30-40 minutes but it is painless and entirely safe to you.
See more at https://www.nhs.uk/conditions/mri-scan/.

WHAT is a biopsy?
A biopsy involves taking a number of samples of prostate tissue. The biopsies may be targeted at abnormalities seen on an MRI scan. A probe (ultrasound scanner) is placed in the rectum and then needles are passed either through the rectum (transrectal) or through the skin behind the scrotum (transperineal) to get to the prostate. These may be done with you awake, with a local anaesthetic or asleep, under general anaesthetic. The samples are sent to a lab and analysed to see if cancer is present and, if it is, the aggressiveness can also be assessed.

More about transperineal biopsy: https://www.cancerresearchuk.org/about-cancer/prostate-cancer/getting-diagnosed/tests-diagnose/transperineal-template-or-targeted-biopsy

More about transrectal biopsy: https://www.cancerresearchuk.org/about-cancer/prostate-cancer/getting-diagnosed/tests-diagnose/transrectal-ultrasound-guided-trus-biopsy

WHAT is the treatment?

If the cancer is very small, contained within the prostate, and likely to develop very slowly or not at all, you may be recommended active surveillance. In active surveillance you are closely monitored and only have treatment if there are signs that the cancer is growing. How closely you are monitored is a decision for you and your urologist.

If the cancer is larger but still contained within the prostate, then you may be offered a choice of treatments, including surgery (prostatectomy), brachytherapy, or radiotherapy. All these treatments are successful at treating the cancer but one or other might be a better option for you. Your urologist or nurse specialist will discuss these options with you.

If the cancer has spread to other parts of the body you can still be successfully treated with hormone treatment which is usually given as an injection every three months. Sometimes men may be offered chemotherapy in addition to hormone treatment.

WHAT is the prostate?

It is a small gland in men, about the size of a walnut,  which lies just below the bladder.

It surrounds the water-pipe (urethra).

It makes the semen and mixes this with the sperm.

It gets bigger with age and can press on the water-pipe, affecting the urine flow. An enlarging prostate can raise the PSA reading even if no cancer is present.

Prostate problems are very common as men get older; most prostate symptoms are not due to prostate cancer.