PSA Screening

Q 1. What is prostate?

A. It is a gland located in the lower urinary tract, under the bladder and around the urethra and is exclusive to males. It produces the fluid which carries semen. A healthy prostate is about the size of a large walnut and has a volume of 15-25 millilitres (ml). The prostate slowly grows as men grow older.

Q 2. What is cancer prostate?

A. Prostate cancer is a malignant tumour in the prostate. The risk of getting prostate cancer increases with age. The average age for diagnosis of prostate cancer is 69.

However, most prostate cancers develop slowly and do not cause symptoms. Fast-growing prostate cancer is less common.

In the present era, with advancement in diagnostic tools, widespread use of PSA screening and longer life expectancy, more and more prostate cancers are being detected.

Prostate cancer is the most common cancer in men, with high survival rate.

Q3. What is a PSA test?

A. The PSA test is a blood test that measures the level of prostate specific antigen (PSA) in your blood. Prostate-specific antigen, or PSA, is a protein produced by the prostate gland that is present in the male’s blood. Depending on your age and the health of your prostate, PSA levels rise when there is a benign enlargement of the prostate, or an infection of the prostate, also known as prostatitis, or prostate cancer.

Although the PSA test is often done to detect cancer in men who have problems passing urine and is also used to help in the treatment of men who are known to have prostate cancer, it can also detect early prostate cancer before it causes symptoms or any abnormality of the prostate.

Although using the PSA test in this way to screen for prostate cancer is sometimes recommended, some doctors do not think it is necessarily a good thing because it may detect very small cancers that pose no risk to your health.

A raised level may mean you have prostate cancer. About two out of three men with a raised PSA level will not have prostate cancer. The higher the levels of PSA, the more likely it is to be a sign of cancer. The PSA test can also miss cancer.

However, other conditions which are not cancerous (for example, benign enlargement of the prostate, prostatitis, and urinary infection) can also cause higher PSA levels in the blood.

When you have a PSA test, you should not have:

• An active urinary infection
• Ejaculated within the last 48 hours
• Exercised heavily within the last 48 hours
• Had a prostate biopsy within the last six weeks
• Had a digital rectal examination (DRE) within the last week

Q 4. What happens if the PSA is high?

A. There are usually three main options after a PSA test:

• If your PSA level is not raised, you are unlikely to have prostate cancer and no immediate further action is needed, although you may have follow up PSA tests to confirm the result
• If your PSA level is slightly raised, you probably do not have cancer but you may need further tests, including follow up PSA tests
• If your PSA is definitely raised, you will need to undergo further tests to find out if you have prostate cancer
  The urologist will discuss whether further investigations should be done. A multi-parametric MRI or a biopsy may be advised to see if cancer is present. This is done with a transrectal ultrasound scanner, a metal probe passed into the rectum (back passage) with the help of local anaesthetic. This test is a little uncomfortable and can be painful, but does not normally need a general anaesthetic. Antibiotics are given to reduce the risk of infection.

Complications can follow this test – bleeding can occur or infection in the urine, the prostate or the blood.

Even if the biopsy test is negative, this does not necessarily completely rule out prostate cancer.

Usually, it will be necessary to have the PSA test repeated, and sometimes further biopsies are needed. It is important to realise that, if your PSA is raised, even if you do not have cancer, it can be very difficult to rule out cancer and you may need to go on having tests for some time.

Q 5. What if there is a family history of cancer?

A. You may be asking for a test because a relative has had prostate cancer. Prostate cancer can run in families, but it is only if it is a close relative (eg father or brother), or, especially, two or more close relatives, that the increased risk is important. This is particularly so if they have developed the disease at a young age.

• Although the chance of you having prostate cancer might be higher in these circumstances, it is still fairly small (10 to 15%)
• The higher the PSA value, the more likely cancer will be found. If your PSA is greater than 10 μg/l, the risk of finding prostate cancer is 50%
• Even if you have a family history of prostate cancer, all the information given above still applies to you and must be considered.

Q 6. What are the benefits of PSA testing?

A. 

• It may reassure you if the test result is normal
• It may give you an indication of cancer before symptoms develop
• It may find cancer at an early stage when treatments could be of benefit
• If treatment is successful, the worst possible outcomes of more advanced cancer, including death, are avoided
• Even if the cancer is more advanced and treatment is less successful, it will usually extend life.

Q 7. What are the limitations of PSA testing?

• It can miss cancer and provide false reassurance
• It may lead to unnecessary worry and medical tests when there is no cancer
• It cannot tell the difference between slow growing and fast-growing cancer
• It may make you worry by finding slow growing cancers that may never causes symptoms or shorten your life
• 48 men will undergo treatment in order to save one life