The first step in testing for prostate cancer is taking a blood test to check your level of PSA (prostate specific antigen). It’s a substance that is produced by your prostate normally and is detectable in the blood of all men. However, a number of factors are known to increase it:
- increasing age;
- increasing size of prostate;
- urinary infection;
- an obstructed bladder due to benign enlargement of the prostate;
- prostate injury, such as a biopsy or a long and bumpy bike ride;
- prostate cancer.
Although an elevated PSA level increases the risk of prostate cancer, it is important to know that PSA is not a test for prostate cancer specifically – it is only an indicator. Its main use is to identify men who need further investigation. Having said this, the largest prostate screening trial ever conducted (the European Randomised Screening Study for Prostate Cancer) found it to be a very reliable indicator. You can have prostate cancer with a normal PSA reading – so there are other tests we can perform later if necessary. But it’s a good first step.
If your GP recommends a PSA test (you can also demand one if they refuse), then you will be able to have it performed at your surgery. Your results will take around 1-2 weeks to be available, and like other test results, you can get them by telephoning the surgery or scheduling a follow-up appointment.
If you would rather be seen urgently or are encountering difficulties getting a PSA test with your GP, it may be worth arranging a PSA blood test at a private clinic. Many offer an appointment on the same day, with results available within 3 working days. For example, the Surrey Park Clinic in Guildford, Surrey charges around £75 for a PSA test.
What your results mean:
- As the amount of PSA that a prostate produces normally rises with age the NHS has produced the following age-specific normal ranges: 0-2.5 if 40-49, 0-3.5 if 50-59 and 0-4.5 above the age of 60.
- The units of PSA are nanograms (ng) per millilitre (ml) of blood. As stated above, an elevated PSA level does not definitively mean that you have prostate cancer.
- Equally, a normal PSA does not mean that you don’t have prostate cancer: 20% of men with prostate cancer have a normal PSA. This why a rectal examination is important.
- If your PSA is 4 – 10, then your likelihood of having prostate cancer rises to around 25%.
- If it is over 10 then your likelihood is over 50%, with the likelihood increasing the higher the PSA level is.
It varies by GP, but if your PSA test result is above your age-adjusted normal level then you should be referred to a urologist for further testing (such as an MRI scan and/or a biopsy) to determine if you really do have prostate cancer and if you do, to additionally determine the stage of the prostate cancer and what the best treatment is.
Remember, you can choose which urologist you want to consult with and possibly treat you and your choice is not just limited to your local urologist. For example, you may want to see your local urologist for convenience, but you may want to do some research about which urologists specialise in prostate cancer and then travel further afield to see them. This is very common in some countries, like the US, and you shouldn’t feel awkward about doing this. Alternatively, you can make a private appointment directly with a urologist rather than going through the NHS system. At Santis for example, we usually see 10-20 new patients every week.