PSA testing and prostate cancer risk

PSA testing: Checking your prostate

Prostate health is important for men, especially as they get older. A PSA test is a simple blood test that can help spot potential problems early, including prostate cancer.

Before we talk about the test, it's helpful to understand what the prostate is. The prostate is a small gland, about the size and shape of a walnut that is part of the male reproductive system. It sits just below the bladder and surrounds the urethra (the tube that carries urine from the bladder out through the penis).

The prostate's main job is to produce fluid that makes up part of semen. This fluid helps nourish and transport sperm. During ejaculation, the prostate's muscles squeeze this fluid into the urethra, where it mixes with sperm from the testicles. So, while it's not directly involved in urination, its location means that prostate problems can affect urination.

When to Think About a PSA Test

The EAU guidelines do not recommend routine PSA testing for everyone. Instead, they suggest a risk-adapted approach. This means talking to your doctor about testing if:

• You're 50 or over.

• You're 45 or over and have a family history of prostate cancer (father or brother).

• You're 40 or over and carry a BRCA2 gene mutation (which increases cancer risk).

• You are of Afro-Caribbean descent.

It is also reasonable to consider a test if:

• You have urinary problems (like trouble peeing), but these are often caused by non-cancerous prostate enlargement rather than prostate cancer.

The key is a conversation with your doctor to decide if testing is right for you.

What is PSA?

PSA is a protein made by your prostate. It's normal to have some in your blood, and it usually goes up a bit as you age. A higher-than-expected PSA level doesn't automatically mean cancer. It could mean:

• Prostate cancer (early detection is best).

• An enlarged prostate (common and not cancer).

• Prostate inflammation (an infection).

If Your PSA is Raised: Next Steps

A single raised PSA isn't usually enough to diagnose cancer. Your doctor might suggest:

• Waiting and repeating the test: To see if the level changes.

• A rectal exam: The doctor checks your prostate with a gloved finger.

• An MRI scan: A scan which images the prostate to further assess the risk of prostate cancer.

• Use a prostate cancer risk calculator to inform you of your specific risks

• A prostate biopsy: Taking tiny samples of your prostate to check for cancer cells. This is the only way to know for sure if it's cancer.

Treatment

If prostate cancer is found, treatment isn't always needed right away. It depends on how aggressive the cancer seems and your overall health. Options include:

• Active Surveillance: Keeping a close eye on it with regular tests. This is often for slow-growing cancers.

• Surgery: Removing the prostate.

• Radiotherapy: Using radiation to kill the cancer.

• Hormone therapy: Slowing cancer growth by lowering testosterone.

Talk to Your Doctor

The EAU guidelines stress informed decision-making. This means:

• Your doctor explains the possible benefits and possible harms of PSA testing.

• You understand that a raised PSA might lead to more tests, and sometimes treatment, even if the cancer is slow-growing and might never have caused problems.

• You make the decision together, based on your individual risk and preferences.

In Short

PSA testing can be helpful, but it's not a one-size-fits-all answer. Talk to your GP or urologist about your risk, understand the pros and cons, and make a decision that's right for you. Early detection can be important, but so is avoiding unnecessary treatment. Your doctor is your partner in this process. Your health is your most valuable asset, take care of it and reach out to your doctor or urologist.

Mr Ivo Dukic is an experienced Consultant Urologist who regularly discusses prostate cancer risk and diagnoses patients with prostate cancer. You can schedule an appointment with him for expert, bespoke advice through his Top Doctors profile or book an appointment through the Harborne Hospital, HCA Healthcare or the Priory Hospital, Edgbaston, Circle Health Group.

Have any questions?

If you have any questions or wish to make an appointment please get in contact.