The Pros and Cons of the PSA Test

Date: 12 March 2020

 

Awareness of prostate cancer is at an all-time high thanks to celebrities like Stephen Fry and Bill Turnbull, who have recently shared their personal experiences and urged other men to get tested.

Known as the Fry and Turnbull effect, more men than ever before are seeing their GP with concerns about prostate cancer.

In fact, so many men are now seeking medical advice that prostate cancer became the most commonly diagnosed cancer in England in 2018.

Finding cancer at the earliest possible stage is key to successful treatment and higher survival rates, and we recommend that anyone experiencing unusual signs or symptoms visits their GP as soon as possible. 

But what happens when cancer is at such an early stage that no symptoms can be noticed?

The recent increase in awareness has led to more men over 50 seeing their doctor without any of the usual symptoms that indicate prostate cancer, such as needing to urinate more frequently or experiencing a weak flow.

For breast, bowel and cervical cancer, high risk groups of the population are screened for signs of pre-cancerous cells or early cancers that are too small to see or feel. 

At the moment there isn’t a national screening programme for prostate cancer, but one method used by GPs to assess a man’s likelihood of having the disease is the ‘PSA test’.

 

What is the PSA test?


The PSA test is a blood test that measures the levels of a protein called ‘prostate-specific antigen’ (PSA).

PSA is made in the prostate gland, which lies just below the bladder and helps produce healthy sperm. Some PSA molecules are released into the blood. 

It’s normal for men to have some PSA in their blood, but if the test shows a high PSA level then further tests may be needed.

Men with a high PSA level may be referred to a specialist and have further investigations like an MRI scan of the prostate and a biopsy.

A raised PSA level may indicate prostate cancer, but it can be high for other reasons, including:

•    An enlarged prostate
•    A urinary infection
•    Recent vigorous exercise
•    Recent ejaculation
•    Some medications
•    Other tests such as a prostate biopsy, which is used when men have symptoms of prostate cancer, can also increase PSA levels 

Why isn’t the PSA test offered to all men?

The PSA test can help to find prostate cancer before any symptoms are present. It can also help pick up a fast-growing cancer at an early stage, when treatment is likely to be more successful. 

When found early, prostate cancer is highly treatable. So why isn’t the PSA test offered to all men through a national screening programme?

The PSA test can help to find more prostate cancers, but sadly it has no effect on the number of men who die from the disease.

This is because many men are diagnosed with a cancer that would never have needed treatment. This is called ‘overdiagnosis’.

Many prostate cancers don’t cause problems for men during their lifetime because they are very slow-growing. 

Overdiagnosis can lead to unnecessary worry and anxiety as well as side effects related to the diagnosis and treatment of cancer

Treatment for prostate cancer can mean having surgery, radiotherapy and hormone therapy. The side effects of these treatments - such as incontinence and erectile dysfunction - can have a significant impact on everyday life.

Some prostate cancers will kill and some won’t and at the moment, we can’t tell the difference between them.

The pros and cons 

If you’re over 50 and not experiencing any signs and prostate cancer, you may wish to discuss the PSA test with your GP, practice nurse or your family before deciding to have it.

It is your personal decision whether to have the test or not.

We’ve summed up the advantages and disadvantages below to help you make an informed choice.


Advantages of having a PSA Test

•    Can help pick up prostate cancer before you have any symptoms

•    Can help pick up a fast-growing cancer at an early stage, when treatment could stop it spreading and causing problems or shortening your life
 

Disadvantages of a PSA Test

•    You might have a raised PSA level, even if you don’t have cancer. Many men with a raised PSA level do not have prostate cancer.

•    It can miss prostate cancer. 1 in 7 men with a normal PSA level may have prostate cancer, and 1 in 50 men with a normal PSA level may have a fast-growing cancer.

•    If your PSA level is raised you may need a biopsy to discover what the problem with your prostate is.  This can cause side effects, such as pain, infection and bleeding. Not all men will need to have a biopsy. 

•    You might be diagnosed with a slow-growing cancer that would never have caused any problems or shortened your life. Being diagnosed with cancer could make you worry, and you might decide to have treatment that you would never have needed. Treatments can cause side effects which can affect your daily life, such as urinary, bowel and erection problems.

 

The future

Before a national screening programme for prostate cancer can be introduced, we must find a better way to use the PSA test or develop a more reliable test.
More research is needed to find a way of diagnosing prostate cancers that are likely to cause harm, so we only treat men whose lives are at risk.
In the meantime, it’s vital we continue to raise awareness of prostate cancer signs and symptoms so even without a screening programme, we can try to increase the number of men diagnosed at the earliest possible stage.

Prostate cancer symptoms include:

•    needing to urinate more frequently, often during the night
•    needing to rush to the toilet
•    difficulty in starting to pee (hesitancy)
•    straining or taking a long time while urinating
•    weak flow
•    feeling that your bladder has not emptied fully

If you notice any unusual changes to your body, please talk to your GP.

References

Cancer registration statistics 2018
PSA testing and prostate cancer: advice for well men aged 50 and over

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