PSA testing: Everything you need to know

Men over the age of 50 are at an increased risk of developing prostate cancer and, as a result, are recommended to take a PSA test. However, you may be wondering, what is it? Leading consultant urologist Mr Andrew Ballaro is here to answer any doubts that you may have about the PSA test.

What is a PSA test, and what does it measure?

The PSA test is a simple blood test that checks the levels of a protein called Prostatic Specific Antigen (PSA) in your blood. This protein is produced by the prostate gland in all men. While it's found in higher amounts in semen, there are also smaller amounts circulating in the bloodstream.

The test can help identify if there are elevated levels of PSA, which could indicate the presence of prostate cancer. However, PSA levels vary in healthy men with age and prostate size, and other prostate problems can cause levels of PSA to rise so although useful, PSA levels are not 100% specific and sensitive for the diagnosis of prostate cancer.   

When should someone consider getting a PSA test?

PSA testing is not currently advocated as a population-wide screening tool for prostate cancer, however, when levels are raised, this can lead to the early diagnosis of prostate cancer which would otherwise have gone undetected. It is therefore a good idea for any fully informed man over the age of 50 to have a PSA test after appropriate consultation with a urologist. Men with a strong family history of prostate cancer PSA testing should have a PSA test at least once every year.   

How accurate is the PSA test in detecting prostate cancer?

The PSA test is not 100% accurate in diagnosing prostate cancer. Studies have shown that over half of the men with higher PSA levels don't actually have prostate cancer when a biopsy is done. Additionally, about 15% of men with early-stage prostate cancer might not show elevated PSA levels.

However, although it's not foolproof, an elevated PSA result can still help to detect and treat early-stage prostate cancer that might otherwise go unnoticed. Generally, the higher the PSA level, the more likely that it indicates widespread prostate cancer.

Can PSA levels be affected by factors like medications or lifestyle habits?

Yes, PSA levels can be influenced by various factors other than cancer. Conditions such as prostate inflammation from infections or even physical trauma like vigorous cycling, can raise PSA levels. Additionally, PSA levels can be higher for up to two days after ejaculation.

Are there any downsides or risks to PSA testing?

The main drawback of PSA testing is the insensitivity of the test for prostate cancer. Many men with slightly elevated PSA levels don't actually have cancer, and this can lead to further uncomfortable tests and even biopsies. However, the current methods used for diagnosing prostate cancer, such as MRI and targeted biopsies, are much less invasive and more accurate than in the past, with very low complication rates.

It's also important to know that a normal PSA test can also lead to false reassurance as a proportion of men with prostate cancer do not have a raised PSA.

If you would like to learn more about PSA testing and would like to book a consultation with Mr Ballaro, do not hesitate to do so by visiting his Top Doctors profile today.