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Prostate Check (P.S.A)
This information is designed to help you decide whether to have the PSA blood test for Prostate cancers. You might have no symptoms but just want to check that you don’t have prostate cancer, or you might be thinking about the test because you’ve developed prostate symptoms.
There is no right or wrong answer when it comes to having a PSA test. Even the medical experts are uncertain about some of the important questions about the PSA test and the best treatment for prostate cancer. People deal with this uncertainty in different ways. Some men choose to be aggressive in looking for and treating early prostate cancers. Others may not even want to know if they have an early prostate cancer because they think that, on balance, having that information would do them more harm than good. With the help of your doctor, and this information, you need to make the right decision for you.
The Prostate Gland:
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The prostate gland is only found in men, and it sits just below the bladder (see diagram). It’s about the size and shape of a walnut and running through the middle of it is the urethra (the tube which carries urine and sperm out through the penis). The prostate’s job is to make some of the fluid that helps carry sperm when men have sex. You’re unlikely to be aware of your prostate until it causes trouble. The most common problem is prostate enlargement (called Benign Prostatic Hypertrophy, or BPH), which can make it difficult for you to pass urine. NB: BPH is non-cancerous and is not the same as prostate cancer.
Prostate Cancer:
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Cancer of the prostate is the second most common cancer in men (lung cancer is the first). Every year in the UK about 19 000 men are diagnosed with prostate cancer . About 10 000 men die from it, on average around four or five years after they were diagnosed. Prostate cancer is generally a disease of older men; 80% of prostate cancers occur in men over the age of 65. Unlike many other cancers, prostate cancers are often present for years without a man or his doctor knowing about it. That’s because they are usually slow growing and often don’t cause any symptoms at all during a man’s lifetime. By the age of 80, about half of all men will have some cancer cells in their prostate; but only 1 in 25 of them will actually die from it. On the other hand, some types of prostate cancer are faster growing and can spread to other parts of the body. Spread to the bones can cause bone pain and eventual death.
What causes it?
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We donot know what causes prostate cancer, but some things do seem to affect your chances of developing the disease:
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Age - prostate cancer is rare under 50 years, and your risk increases as you get older
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Having relatives who have had prostate cancer. One close relative (father, uncle, brother) roughly doubles your risk. Two close relatives increases your risk by about 4 times.
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African-American and African-Caribbean men seem to be more at risk than other ethnic groups.
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There’s some evidence that eating a diet low in animal fat and protein decreases your risk.
- Exposure to cadmium and X-rays increases the risk of prostate cancer.
- Several substances are currently under investigation which may offer protection from the disease. These include Vitamin E, Selenium and Lycopene from tomato-based foods.
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What are the symptoms?
Men with early prostate cancer are unlikely to have any symptoms at all. Prostate cancers usually only show themselves when they’re large enough to press on the urinary tube or disturb the bladder. For that reason the symptoms of prostate cancer, when they do appear, are very similar to the symptoms of simple enlargement of the prostate (BPH):
- Pain or difficulty when passing urine
- Passing urine more frequently than usual, and especially at night
- Rarely, blood in the urine or sperm
NB: The majority of men with these symptoms will not have prostate cancer.
Because prostate cancers can be very slow growing, even advanced prostate cancers may not cause any urinary symptoms. Sometimes, if a prostate cancer has spread to the bones, symptoms might include pain in the back, hips or pelvis.
How can you test for prostate cancer?
There are three main ways to check the prostate for cancer;
A Digital Rectal Examination.
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This involves the doctor inserting a gloved finger into your rectum (back passage) to feel the prostate. This is good for picking up advanced cancers, but overall it’s less than 50% accurate in detecting all prostate cancers. It may be uncomfortable, but its quick and it shouldn’t hurt.
The PSA test.
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This is a blood test. A small blood sample is taken from your arm using a needle and syringe. (see below)
Transrectal Needle Biopsy of the prostate.
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This involves putting a metal probe into the rectum (back passage) to take a sample from the prostate. The doctors will then use a microscope to look for any cancer cells in the sample. This is how doctors make a definite diagnosis of prostate cancer, usually after a PSA test and rectal examination.
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Why have a PSA test?
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The PSA test could find an early prostate cancer before you notice any symptoms, or before your doctor can detect any changes in your prostate. The benefit of finding a prostate cancer at this early stage is that it might be possible to remove the cancer by an operation or destroy it with radiotherapy.
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What is the PSA test?
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It’s a blood test. PSA (Prostate Specific Antigen) is a protein made by the prostate gland, which naturally leaks out into the bloodstream. The PSA test measures the level of PSA in your blood.
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What does it tell me about my prostate?
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Sometimes a raised PSA level can be a sign of prostate cancer. More often though, it points to something less serious like an inflamed prostate (prostatitis), or an enlargement of the prostate that often comes with aging (Benign Prostatic Hypertrophy, or BPH). A single PSA test cannot tell you whether a prostate cancer is slow or fast growing.
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How reliable is it?
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The PSA test is not a specific test for prostate cancer. For every 100 men with a raised PSA level, only about 30 of them turn out to have any cancer cells in their prostate. It’s also true that in occasional cases the PSA may read “normal” when there really is cancer there.
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What happens if my PSA test is high?
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There are no hard and fast rules, and even the experts don’t always agree on the best course of action. What happens next depends on whether or not you have any symptoms, your personal risk of prostate cancer, and how high the PSA level is. The older you are the higher your PSA level is likely to be (whether or not you’ve got prostate cancer). So what’s “normal” depends to some extent on your age.
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AGE (years) |
Normal PSA range (ng/ml) |
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40-49 |
0-2.5 |
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50-59 |
0-3.5 |
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60-69 |
0-4.5 |
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70-79 |
0-6.5 |
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As a rough guide, these are the three main options after a PSA test:
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1. PSA not raised Highly unlikely to have cancer. No further action.
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2. PSA slightly raised Probably not cancer, but might need to repeat PSA test
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3. PSA definitely raised Probably need a biopsy to find out if it really is cancer
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Biopsy of the Prostate:
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If your PSA test is raised, you’ll probably need a biopsy (see earlier). This is because doctors can only make a definite diagnosis of prostate cancer by taking cells from the prostate and then looking at them under a microscope. A biopsy involves using an ultrasound scanner to guide a metal probe into the rectum. Men who’ve had this tend to describe it as uncomfortable or painful, though you won’t need a general anaesthetic. The biopsy is not without its own risks. Because there is a chance of infection, you’ll be given antibiotics to cover the procedure. For every 100 men having a biopsy, about 3 will have to have a further course of antibiotics, and 1 will need to be admitted to hospital for intravenous antibiotics. About 30 may have some bleeding in the urine or following sex for up to three weeks afterwards. The risk of death from a biopsy is less than 1 in 10 000.
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It’s worth saying that the biopsy itself isn’t a hundred per cent accurate. If the biopsy doesn’t show any cancer cells, that doesn’t completely rule out cancer. Of every 100 men who have cancer of the prostate, the biopsy will miss the cancer in about 20 of them. So you might need to have further PSA tests and biopsies to monitor your prostate.
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What if I have got early prostate cancer?
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Treating some cancers while they are still small may stop them spreading and causing problems. But doctors don’t all agree on the best way to treat early prostate cancer, and there’s no proof that treating early prostate cancers helps men live any longer than simply having regular check-ups. Most men with early prostate cancer will not die as a result of it; that’s particularly true of older men in their 70’s or 80’s, or those with a slow-growing cancer. It’s also worth bearing in mind that if you were to have surgery or radiotherapy (the two main treatments for early prostate cancer), there can be complications like erections problems, leaking of urine or damage to the rectum (back passage).
What are the treatment options?
1.Watchful Waiting (regular check-ups treat only if cancer is growing)
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Because some early stage prostate cancers may be the types that are very slow growing, some patients and specialists opt to wait and see whether the cancer progresses before starting any treatment. The “watchful waiting” approach involves regular check-ups with PSA tests and rectal examination of the prostate. This avoids the complications of surgery, but some men find it difficult just to wait and see if their cancer progresses before starting any therapy.
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2.Radical Prostatectomy (a surgical operation to remove the whole prostate gland)
Success: Removing the entire prostate may stop an early cancer from spreading and may achieve a cure. Radical prostatectomy appears to prolong life for men with more malignant cancer, but for men with less malignant cancers the benefits are debatable, and probably only apply to younger men. In 40% of men, cancer cells are not fully removed, and therefore the operation may not be curative.
Risks: For every 1000 men: 5 will die, up to 200 will develop leaking of the urine, and about 500 will have problems getting an erection.
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3.Radiotherapy (External Beam - high-energy rays to destroy cancer cells)
Success: Radiotherapy may achieve a cure in early prostate cancer, but as with prostatectomy, the benefits in less malignant cancers are debatable. A complete course takes up to six weeks. Giving hormone therapy at the same time may improve the results.
Risks: For every 1000 men: up to 300 will develop lasting discomfort or bleeding in the rectum (back passage) and around 500 will develop erection problems (though this depends on age).
Brachytherapy (A new version of radiotherapy which uses radioactive seeds inserted into the prostate).
Success: look promising. 8-10 year results are as good as radical prostatectomy in selected cases. A one or two day stay in hospital only.
Risks: Bladder side effects may be more severe than external beam radiotherapy, but bowel problems and impotence are expected to be less of a problem
So, should I have the PSA test?
First, ask yourself if you are at particular risk of prostate cancer. Your risk increases slightlly-
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the older you are (but in older men, prostate cancer is less likely to cause problems)
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if you have close relatives who have had prostate cancer (father, uncle, brother)
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if you are of Afro-Caribbean or African-American descent
Possible Advantages:
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It could reassure you if it’s normal
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It can find cancers before any symptoms develop
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Treatment in the early stages could help you live longer and avoid the complications of cancer (although there is no good evidence that this is so).
Possible Disadvantages:
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It could miss cancer in the prostate, and falsely reassure you that all is well
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It could lead to anxiety and a biopsy when you have no cancer
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If you have cancer it can’t tell you if it’s likely to cause problems in the future
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Treatment of early prostate cancers might not help you live longer
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The main treatments for early prostate cancer do carry risk
Finally, to help you make your decision, try answering these three question:
1. What happens if your PSA is elevated?
2. What happens if you do have cancer?
3. What difference will it make for you to know?
If you can answer these three questions, focusing on what’s really important to you, you’ll have your own best PSA decision
Click here for information on Prostate assessment and brachytherapy for prostate cancer. |
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