Prostate cancer is a serious condition. The PSA test, which can give an early indication that prostate cancer may be present, is now available to men who wish to be tested. However, experts disagree on the usefulness of the PSA test. It is not yet known whether or not PSA testing will save lives from prostate cancer. The aim of this sheet is to give you balanced information about the PSA test, which we hope will help you to decide whether or not having the test is the right thing for you.

You may wish to discuss this information with your doctor or practice nurse.

What do we know about Prostate Cancer?

Prostate cancer is the second most common cause of cancer deaths in men. Each year in the UK about 22,000 men are diagnosed with prostate cancer and 9,500 die from the disease. Prostate cancer is rare in men below the age of 50 years, and the average age of diagnosis is 75 years. The risk is greater in those with a family history and is also known to be greater in African American men. Prostate cancer is also more common in the West, suggesting that there may be alink with western lifestyle factors, such as diet.

The prostate gland lies below the bladder. Prostate cancers range from very fast growing cancers to slow growing cancers. Slow growing cancers are common and may not cause any symptoms or shorten life.

If the PSA level is raised, what further tests would be carried out?

If your PSA is definitely raised, a prostate biopsy is required to determine if cancer is present. This involves taking samples from the prostate through the back passage (bottom). Most men find this an uncomfortable experience and some describe it as painful. Sometimes complications or infections may occur. Approximately 2 out of 3 men who have a prostate biopsy will not have prostate cancer. However, biopsies can miss some cancers and worry about prostate cancer may remain even after a clear result.

The PSA test is a blood test that measures the level of PSA in your blood. PSA (Prostate Specific Antigen) is a substance made by the prostate gland, which naturally leaks out into the blood stream. A raised PSA can be an early indication of prostate cancer. However, other conditions which are not cancer (e.g. enlargement of the prostate, prostatitis, urinary infection) can also cause a rise in PSA

Approximately 2 out of 3 men with a raised PSA level will not have prostate cancer. The higher the level of PSA the more likely it is to be cancer.

The PSA test can also miss prostate cancer.

What happens after the PSA test?

As a rough guide there are three main options after a PSA test:

If early prostate cancer is detected, what treatments are used?

There are three main options for treating early prostate cancer which are summarised below:

Radiotherapy: This involves a course of radiotherapy treatment on the prostate gland at an outpatient clinic. The aim is to cure, although there are possible side effects. Impotence (erection problems) may be suffered by between 2 and 6 out of every 10 men (25-60%). Up to 1 in every 10 men (10%) may experience diarrhoea or bowel problems, and up to 1 in every 20 men (5%) may experience bladder problems.

Surgery: this involves an operation to remove the prostate gland. The aim is to cure, although again there are possible side effects. Up to 2 in every 10 men (20%) may experience some bladder problems, and between 2 and 8 out of every 10 men (20-80%) may experience impotence (erection problems) after surgery.

Active monitoring:

This involves regular check-ups to monitor the cancer and check it is not growing. the advantage is that for many men it avoids the side effects of radiotherapy and surgery. If there are signs that the cancer is developing, treatment would be offered. The disadvantage is that the cancer may grow to a more advanced stage. Some men find the uncertainty difficult to cope with.

This information sheet was prepared by Jo Brett, Dr Eila Watson, Colleen Bukach, and Dr Joan Austoker,
Cancer Research UK Primary Care Education Research Group, University of Oxford.
The information sheet is based on information initially prepared by Dr Graham Easton.  Last edited 07/08/08