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Frequently Asked Questions (FAQs)
What is a PSA test?
PSA stands for prostate-specific antigen. It is a protein produced by cells in the prostate gland and can be detected in the blood.
A PSA blood test measures the amount of PSA in your bloodstream. PSA testing can be used for several reasons, including:
- Assessing men with symptoms that could be related to the prostate
- Helping to assess the risk of prostate cancer
- Monitoring PSA levels over time
- Supporting investigations following a raised PSA
- Monitoring men who have already been diagnosed or treated for prostate cancer
PSA testing is an important part of prostate cancer assessment, but it is not a definitive test for cancer. A result needs to be considered alongside factors such as age, symptoms, family history, prostate size, previous PSA results and other investigations.
What does a PSA blood test involve?
A PSA test is a straightforward blood test. A small sample of blood is taken and sent to a laboratory to measure the PSA level.
There is usually no need to fast before a PSA test. However, certain activities and conditions can temporarily affect PSA levels.
Before having a PSA test, it is generally recommended to avoid ejaculation, vigorous exercise and cycling for 48 hours. If you have a urinary infection, your doctor may recommend waiting until the infection has cleared before testing because an infection can raise PSA levels.
What is a normal PSA level?
There is no single PSA level that can definitively be described as ‘normal’.
PSA levels tend to increase with age, and different thresholds may be used when assessing men of different ages. NICE provides age-specific PSA thresholds for people with possible symptoms of prostate cancer, although these thresholds are not a diagnosis of prostate cancer and should be interpreted alongside the wider clinical picture.
Your previous PSA results can also be important. Looking at how your PSA changes over time can provide more information than looking at one result in isolation.
Does a raised PSA mean I have prostate cancer?
No. A raised PSA does not automatically mean that you have prostate cancer.
PSA can be increased by a number of conditions and circumstances, including:
- Prostate cancer
- Benign prostate enlargement
- Prostatitis or inflammation of the prostate
- Urinary infection
- Recent ejaculation
- Vigorous exercise or cycling
- Recent procedures involving the prostate or urinary tract
This is why further assessment may be recommended following a raised PSA rather than assuming that cancer is present.
Who should consider having a PSA test?
Whether a PSA test is appropriate depends on your age, symptoms, family history, risk factors and individual circumstances.
In the UK, there is currently no routine national PSA screening programme. Men and anyone with a prostate can discuss PSA testing with their GP or specialist, who can explain the potential benefits and limitations of testing.
Some men may have a higher risk of prostate cancer and may therefore wish to discuss testing earlier. This can include men with a family history of prostate cancer and men from Black African or Caribbean backgrounds.
Age is also an important consideration. PSA testing in younger men needs to be considered carefully because prostate cancer is less common at younger ages, while testing can also lead to unnecessary investigations in some people.
What happens if my PSA is raised?
If your PSA is higher than expected, your doctor may recommend repeating the test or carrying out further investigations.
The next step depends on your PSA level, previous results, symptoms, family history, prostate examination and other risk factors.
Further investigation may include:
Repeat PSA testing
A repeat PSA test can help determine whether the level remains raised or has changed over time.
Prostate MRI
If your PSA result or other clinical findings raise concerns about prostate cancer, you may be referred for a multiparametric MRI scan. This provides detailed images of the prostate and helps your specialist decide whether further investigation, such as a biopsy, is needed.
Prostate biopsy
If an MRI or other assessment suggests that further investigation is needed, a prostate biopsy may be recommended. Small samples of prostate tissue are taken and examined under a microscope to determine whether cancer is present.
A biopsy is not automatically required simply because your PSA is raised. The decision should take into account the full clinical picture.
PSA density and PSA velocity
Sometimes your PSA result needs to be looked at in more detail.
PSA density compares your PSA level with the size of your prostate. This can provide additional information because a larger prostate can naturally produce more PSA.
PSA velocity looks at how quickly your PSA level is changing over time.
These measurements can help a specialist assess your individual risk alongside your MRI findings and other clinical information.
What if my MRI is normal but my PSA is rising?
A normal prostate MRI can be reassuring, but it does not completely rule out prostate cancer.
If your PSA continues to rise despite a normal MRI, your doctor may consider your PSA history, PSA density, family history and other risk factors before deciding whether further monitoring or investigation is appropriate.
There is no single pathway that applies to everyone.
PSA testing after prostate cancer treatment
PSA testing also has an important role after treatment for prostate cancer.
Following a radical prostatectomy, the prostate gland has been removed, so PSA should fall to a very low or undetectable level. PSA testing is then used as part of ongoing surveillance to monitor for signs that the cancer may have returned.
After radical prostatectomy, PSA testing is used to monitor your recovery and check for any signs that prostate cancer may have returned. Your first PSA test is usually carried out several weeks after surgery, with further tests at regular intervals based on your individual circumstances.
Understanding your PSA result
A PSA result can understandably cause concern, particularly if it is higher than expected.
However, one PSA number does not tell the whole story. Your age, symptoms, prostate size, family history, previous PSA results and any MRI or biopsy findings all need to be considered when assessing your individual risk.
If you have received a raised PSA result and are unsure what it means, a consultation with a specialist can help you understand what the result means and whether any further investigation is appropriate.
PSA testing with Dr Edward Calleja
Dr Edward Calleja is a Consultant Urological Surgeon specialising in prostate cancer and prostate conditions. He provides assessment and treatment for NHS and private patients across Sussex, Kent and London.
If you have concerns about your PSA level, have experienced a change in your PSA results or have been advised to undergo further prostate investigations, Dr Calleja can discuss your individual circumstances and the appropriate next steps.
