A prostate-specific antigen (PSA) blood test helps to screen for prostate cancer. However, like most tests, PSA doesn’t give a definitive result. For example, about three in four men with raised PSA do not have prostate cancer. In this case, the test gives a false positive and can cause unnecessary worry.
Sometimes, the PSA blood test gives a normal result in men with prostate cancer. Although this is rare, it may be harmful if the man has fast-growing cancer. This raises the concern and question, ‘is the PSA test necessary’.
PSA is a protein produced by healthy cells in the prostate. As men grow older, the prostate gets bigger, which makes it normal for PSA levels to increase gradually. Prostate cancer can cause PSA levels to rise considerably. This makes PSA test a useful screening tool.
The PSA blood test can help detect prostate cancer at the earliest stage when treatment may be more effective. However, PSA may be elevated for other reasons, leading to a false result.
PSA testing depends on personal choice, as the results may cause unnecessary anxiety and stress for some people.
In the UK, there is an informed choice programme. This programme allows men over 50 who have considered the pros and cons of PSA testing to request this test. Although men under 50 can get prostate cancer, the risk is less.
Sometimes, the GP may give you a valid reason not to get the PSA testing. For example, testing will offer little or no benefit if your general health makes you unsuitable for prostate cancer screening.
Ensure you consider the advantages and disadvantages of PSA testing before making a decision.
The treatments and investigations for prostate cancer also have side effects. For example, a biopsy can cause bleeding, infection or pain. Surgery may also cause complications such as erection problems or urinary symptoms, which are lifelong issues. These factors make carefully considering your options important if you have raised PSA levels.
Your risk of prostate cancer is also a significant factor. If you are non-binary or trans, your risk may be different.
Non-binary people who were assigned male at birth and trans women still have a prostate, even after reconstructive surgery. This means they can get prostate cancer, including some intersex people. In these cases, prostate cancer risk will vary depending on whether they have had treatment affecting testosterone levels.
If you aren’t taking gender-affirming hormones and haven’t had gender-affirming surgery, your risk is the same as cis men – those whose sex assigned at birth and gender identity is male.
People taking medications that lower testosterone (testosterone blockers or feminising hormones) or have had gender-affirming surgery have a slightly lesser risk of prostate cancer than cis men of the same age.
These treatments can falsely reduce PSA levels, so their blood test requires interpretation with caution while taking testosterone levels and hormone regimen into consideration.
The insufficient data on PSA levels in trans women makes it difficult to define the normal PSA range in this population.
No PSA reading is considered normal. Your doctor’s decision to refer you to a specialist or not depends on several factors, including the doctor’s judgement and experience, your symptoms, findings of your exam and local guidelines.
The range of PSA levels varies with age. You may get a specialist referral if your PSA level is above the following.
| Age | PSA level |
|---|---|
| 40 – 49 | 2.5 ng/ml |
| 50 – 59 | 3.5 ng/ml |
| 60 – 69 | 4.5 ng/ml |
| 70 – 79 | 6.5 ng/ml |
The above ranges apply to people with possible symptoms of prostate cancer, but there isn’t any generally accepted range for people without symptoms.
You may not have prostate cancer if you have an elevated PSA result. A raised PSA level may result for many reasons, most are treatable or benign.
They include:
As you grow older, the prostate naturally gets bigger, and this causes a gradual increase in PSA levels. Some people also develop benign prostatic hyperplasia (BPH). This condition usually affects men older than 50, and the symptoms may affect how you urinate.
Prostatitis or inflamed prostate often results from a bacterial infection which may result in symptoms like difficulty urinating and pain.
A urinary tract infection can cause an increase in PSA levels. Healthcare professionals advise waiting eight weeks after treating an infection before retesting PSA levels.
PSA levels become elevated in some men after ejaculation and may remain elevated for 24 – 48 hours afterwards. Ensure you avoid ejaculation before your PSA test.
Recent prostate stimulation, including receptive anal sex or a rectal examination, can increase your PSA levels. It’s advisable to wait one week before PSA testing.
Biopsies and procedures of the prostate can cause an increase in PSA levels, which return to normal within six weeks.
If you use a urinary catheter, consider waiting for up to six weeks after removing the catheter before PSA testing.
Some evidence shows that forced bowel movement can affect PSA, so treating constipation before testing is necessary.
Saddle sports can put pressure on the prostate, so you may need to avoid these activities for 24 – 48 hours before testing.
You may need to avoid strenuous exercise at least 48 hours before your test.
Medications are available to reduce high PSA levels. These medication target reducing the size of the prostate.
The medications include:
Ensure you inform your healthcare provider before the PSA test if you are taking these medications because these medications can falsely lower your result.
Recent studies show that medications like non-steroidal anti-inflammatory drugs (NSAIDs) and statins lower PSA.
A PSA blood test is only the first step. If the result is slightly raised, the doctor may recommend repeating the test after a few weeks.
If your result is still raised or you experience other prostate cancer symptoms, you may be referred to a specialist for more tests, like an MRI. An MRI may help determine if you need a biopsy. Some prostate cancer cases aren’t aggressive and may not need treatment.
If you’ve decided to get a PSA test, visit our clinic at Suite E, 117a Harley St, Marylebone, London W1G 6AT for testing or call us on 02071830244 to schedule an appointment with our health care professional.