Prostate cancer does not always present with symptoms in the early stages and quite often by the time symptoms are noticeable the cancer may have moved to an advanced stage. As the UK does not have a national screening campaign this means that many men go undiagnosed until they are at an advanced stage.
Critically, it is essential to catch prostate cancer at the earliest opportunity in order to be able to have the option to take advantage of newer, less invasive treatment pathways. Prostate cancer screening needs to become more like that for breast cancer, but right now it lags behind progress made in that sector by many years. This is despite prostate cancer now overtaking breast cancer as a killer in the UK.
So, what can men do to check if they have prostate cancer?
The most common test at the moment is a simple blood test known as a PSA test. PSA stands for prostate specific antigen which is a hormone present in the blood produced by the prostate gland, and which can increase due to several causes, one of which is prostate cancer. However, a high PSA reading does not automatically mean the patient has cancer as many benign conditions can cause a rise, as can recent sexual activity or even cycling.
A PSA test may identify cancer in its early stages as detection makes it much more treatable. The need for early screening is supported by the fact that one man dies of prostate cancer every 45 minutes, mostly due to late diagnosis.
But did you know that if you’re over the age of 50, you are entitled to request a PSA test by visiting your GP? The GP will take you through a series of questions and symptom checks to ensure you are aware of the possible consequences, but you can insist on the test regardless.
The following will help to explain the terminology and clarify any questions you may have regarding early screening for prostate cancer including PSA tests and DRE’s (digital rectal examinations). Remember, if you don’t understand what your doctor is saying, tell them and ask for further clarification.
What is a PSA Test, and What Does It Involve?
The prostate gland produces a type of protein called Prostate Specific Antigen (PSA). Some PSA leaks out of the prostate and into the bloodstream, so it’s completely normal for some PSA to be in your blood. Your doctor will take a blood sample and send it to a laboratory which will measure how much PSA is in your blood. This will be referred to as your PSA level.
Why is a PSA Test Carried Out?
The main reason that a PSA test is carried out is to check if anything is going wrong with your prostate such as Benign Prostatic Hyperplasia (also known as Benign Prostatic Enlargement), Prostatitis or prostate cancer. A test can also be carried out for the following reasons:
- If you have difficulty passing urine.
- If a close relative (particularly your father or a brother) has been affected by prostate cancer.
- If You’re from an African or Caribbean background as there is a higher risk of you developing prostate cancer.
- Your doctor wants you to get tested to rule out prostate cancer.
- There’s a strong family history of other types of cancer such as breast cancer.
What Your PSA Level Will Tell You
If you have a raised PSA level, then the most usual causes of this are:
- You have a urinary tract infection.
- Your prostate is inflamed, which is medically known as Prostatitis.
- Your prostate is becoming enlarged as part of the aging process; this is called Benign Prostatic Hyperplasia (BPH).
It’s important to note that 2 out of 3 men with a raised PSA level will not have prostate cancer. However, for some, it can be a sign.
A PSA test on its own will not confirm whether you have prostate cancer or how advanced it is. It is often accompanied by another examination known as a Digital Rectal Examination (DRE).
What is a Digital Rectal Examination?
A Digital Rectal Examination is a relatively straightforward procedure and one of the first examinations your GP will do if you have a raised PSA level. A DRE will give your doctor a much better idea of the size, shape and current condition of your prostate. Your doctor will be looking for any unusual lumps, shapes or hardened areas. Having this examination, together with a PSA test, will help your doctor decide what may be the best next step for you.
What to Expect During a Digital Rectal Examination
Because your prostate can’t be checked from outside of your body, you’ll be asked to lie on your side. Your doctor will then put a lubricated, gloved finger into your rectum to feel your prostate.
Although you may feel a little bit uncomfortable or embarrassed, this procedure shouldn’t be painful. It is much better for you and your doctor if you relax throughout. And remember, your doctor will have done this many times and will fully understand how you might be feeling.
What is a Normal PSA Level?
To a certain extent, this depends on how old you are. The older you get, the higher your PSA level is likely to be. So, when your doctor receives your results, he/she will take this into account. In certain cases, there may be slight differences in men’s PSA levels but don’t worry, your doctor will explain this to you.
Age/Suggested Upper Level of PSA (Ng/Ml)
40 – 49 years old: 2.5
50 – 59 years old: 3
60 – 69 years old: 4
70+ years old: 5
Please note, NHS Wales levels differ. An Age/Suggested Upper Level of PSA (Ng/Ml) of than 3 is abnormal if less than 70 years old.
It’s important to highlight that with any medical test; it’s better to get a clear answer of “no you don’t have cancer”, or “yes you do have cancer”. But a PSA test can’t definitively tell you whether you have prostate cancer or not. It’s best used as a guide to the possibility of you having prostate cancer. In fact, as many as 8 out of 10 men who have a raised PSA level will not have prostate cancer.
The Benefits and Drawbacks of Taking a PSA Test
Almost every medical test or procedure will have its benefits and drawbacks. But taking a PSA test is a good idea because it can help detect prostate cancer at its earliest and most treatable stage. Regardless of this, it’s important to be aware of the benefits and drawbacks associated with PSA so you can make an informed decision that’s right for you. After all, testing for prostate cancer early and before you have any symptoms is entirely your choice.
The Benefits of Taking A PSA Test
- It helps to detect prostate cancer before any symptoms develop.
- It will reassure you if your test results come back as normal.
- It may find cancer in the early stage, which makes treating it more effective.
- For many men and their families, knowing is better than not knowing.
- Even if advanced cancer is found and treatment isn’t successful, having a test earlier may help you live longer.
The Drawbacks of Taking A PSA Test
- Your test results could come back with a false negative. This means that your PSA level could be normal even though there’s cancer in your prostate.
- Your PSA level could be raised even though you don’t have prostate cancer. This is called a false positive result.
- If your PSA level is raised then you will be considered for non-invasive investigation, in the form of Multiparametric MRI scan, rather than an immediate invasive test, such as prostate biopsy.
- A PSA test can’t tell whether prostate cancer will be slow or fast growing.
- The treatment for early stage prostate cancer might not help you live longer. And some treatments themselves have adverse side effects.
Making a Decision That’s Right for You
Your reasons for taking a PSA test can be different from those made by a relative, friend or colleague. But it’s important to make a decision that you feel is completely right for you. Here’s some things to think about and consider:
- Think through all of the benefits and drawbacks that we’ve mentioned. This will also help you come up with some questions when you speak with your doctor.
- Speak to your partner to see if they have any thoughts.
- Also, speak to any men in your family that have taken a PSA test.
- Do further research. There’s plenty of websites out there that offer advice (but avoid general web searches, stick with respected charities, national bodies and the NHS websites).
If you have a raised PSA level, then you may be given an appointment to have a non-invasive investigation, in the form of Multiparametric MRI scan. This allows your specialist to assess the prostate externally, and, according to recently published evidence, a negative scan will allow you to be fully reassured that there is no clinically significant cancer present.
Crucially, if the scan does show an abnormality, your specialist can advise if this is localised to your prostate, and more importantly, accurately “target” this area using a biopsy, rather than a traditionally performed random prostate biopsy.
But please remember that being anxious and worried is completely normal. Many hospitals across the UK now have specialist nurses who can talk to you if you have any questions or concerns.
What Should I Do If I Can’t Make a Decision?
It’s important to remember that every man is different. For some, it’s important that they’re involved in all decisions when it comes to their health. However, others prefer to not make decisions for themselves and instead opt to take their doctor’s guidance. If you’re struggling to make a decision, then talk to your doctor and let them know that you are thinking about having a PSA test.
What Happens If I Request a PSA Test and My Doctor Say “No”?
Within the Prostate Cancer Risk Management Programme (PCRMP), there’s information that helps GP’s provide balanced information to asymptomatic men who ask about PSA testing. A PSA test is free and available to any man over 50 years old who requests one.
Your doctor should use the National Institute for Health and Care Excellence (NICE) guidance and their clinical judgement when you request a PSA test.
So, before going to see your GP:
- Consider the benefits and drawbacks and why you want to have a PSA test.
- Have your reasons for wanting a test clear in your mind.
- Write these reasons down, so you don’t forget anything.
Are There Any Circumstances When I Shouldn’t Have a PSA Test?
Your PSA level can be affected by several factors which may cause a false level of PSA in your blood. For this reason, you should tell your doctor if any of the below applies to you:
- If you’ve ejaculated in the past 48 hours.
- If you’ve had a Digital Rectal Examination in the past 7 days.
- If you’ve had a prostate biopsy in the past 6 weeks.
- If you’ve recently or currently have a urinary infection.
- If you cycle frequently.
You must also tell your doctor about any medication or herbal remedies you may be taking.
Will I Need to Have a Second PSA Test?
This will ultimately depend on the results of your first test. But, you should talk about the possibility of a second test with your doctor. However, if the results of your first test were borderline or not conclusive enough, your doctor may want to do a second test to measure the level of free PSA in your blood. This is because PSA travels in the blood in 2 forms:
- Bound to a protein in the blood. This is medically known as Bound PSA.
- Unattached to a protein in the blood. This is medically known as Free PSA.
A Free PSA test measures the amount of unattached PSA to the total amount of PSA in your blood. The higher amount of free PSA means there’s a lower chance of you having prostate cancer.
A second PSA test may also be more likely if your father or brother have had or currently have prostate cancer or if you’re from an African or Caribbean background.
Will I Be Referred To Someone Else Following The Test(s)?
Following your PSA test(s), your doctor might refer you to a hospital to a urologist who specialises in prostate cancer for further tests and/or examinations. For example, you may need to have a prostate biopsy. You should let your urologist know if you have any concerns or questions and what the results might mean before the procedure takes place.
During this test, a thin needle is passed through the perineum (the skin between your scrotum and your anus) which takes small samples of tissue from the prostate gland. Sometimes (but not often) a rectal biopsy is used where a small probe is passed into your back passage, and then a specialist needle will take the tissue samples through the rectal wall. These samples will then get sent to a specialist lab to be examined under a microscope.
A biopsy is used to detect the presence of cancerous prostate cells and how aggressive they’re likely to be. Thanks to a variety of biopsy techniques and equipment to analyse the results, doctors are able to predict when cancer is slow-growing or when it’s likely to be aggressive. This, in turn, can help your urologist and doctor choose the best course of treatment.
Prost8 UK and Our Campaign Initiatives
At Prost8 UK we strongly support getting a PSA test as soon as you can. Receiving a prostate cancer diagnosis in its non-metastatic form (whilst it is still contained within the prostate capsule) doesn’t just make it far more manageable and treatable, but it also means that you could receive far less invasive treatment options such as focal ablation.
These ground-breaking procedures treat prostate cancer cells directly whilst avoiding damage to surrounding tissue and organs. This is important as it can minimise some of the less desirable side effects which often accompany more invasive treatment options such as surgery or radiotherapy which often lead to erectile dysfunction and incontinence.
Focal ablation includes HIFU (high intensity focal ultrasound) which uses focused soundwaves to create a point of heat which destroys cancerous cells with minimal damage to the surrounding tissue. Sometimes cryotherapy is the better option which uses needles to inject ice directly into the cancerous tissue to destroy the cells, again with minimal collateral damage.
The advantages of HIFU and cryotherapy treatment for prostate cancer is that it is usually performed as a day stay procedure with fast recovery times and minimal life affecting side effects.
Prost8 UK is campaigning to raise funds to buy, donate and deploy focal therapy suites into strategic NHS hospitals across the UK. This will provide accelerated access to these preferred treatment pathways and better lifestyle outcomes for up to 12,000 men each and every year who are diagnosed with early stage prostate cancer. As it stands right now these men are routinely offered the same invasive treatments that are given to those with advanced cancers.
If you would like to support our very important cause and help us help all men in the UK, then please visit our donation page today.
Written by Lloyd Parkinson.
Professor Hashim U. Ahmed PhD, FRCS(Urol), BM, BCh, BA(Hons) – Chair & Professor of Urology, Imperial College London. Chair, NCRI Prostate Research Group. Hashim specialises in raised PSA, investigations for prostate cancer, MRI image-fusion targeted prostate biopsies, focal therapy, high intensity focused ultrasound (HIFU), cryotherapy, enlarged prostate, benign prostate hyperplasia, greenlight laser for prostate and Rezum water vapour therapy.
Professor Iqbal Shergill BSc FRCS (Urol) FEBU – Consultant Urologist in Wrexham, North Wales, and Urologist in Chester, Cheshire specialising in contemporary prostate cancer diagnosis (Multi-parametric MP-MRI and Transperineal Template Mapping Biopsies), laser management of kidney stones, and minimally invasive treatments for benign prostate disorders (Urolift, Rezum and HOLEP) and all urological conditions.
Mr David Eldred-Evans, MBBS, BA(Hons) – Senior Clinical Research Fellow, Imperial College London and Specialist Registrar in Urology. David’s research has focused on prostate cancer screening using imaging and he has received research grants from the BMA Foundation, Urology Foundation, Imperial Health Charity and the Royal College of Surgeons.
Paul Sayer – CEO and founder of Prost8 UK, a charity leading the challenge to widen the availability of focal therapy treatments for both early stage and radio-recurrent prostate cancer. Lead for the ‘Prostate Cancer – Know Your Choices’ campaign launching in late 2020 to ensure that men understand that there are options other than radiotherapy and surgery in suitable cases. Also championing early diagnosis to enable more men to access less invasive treatment pathways.
Victor Griffin – Expert clinical application specialist of the HIFU system with Sonacare Medical Inc., supporting clinical trials in the UK and surgical teams internationally.
Major Mark Vertue TD MBA, BSc Hons, Cert Ed, RN – Head of Department and Trustee & Clinical Director at Prost8 UK.