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The Pros and Cons of the PSA test

Awareness of prostate cancer reached an all-time high in 2018 thanks to celebrities like Stephen Fry and Bill Turnbull, who shared their personal experiences and urged other men to get tested.

Man talking to a doctor in consulting room

Known as the Fry and Turnbull effect, more men than ever before were seeing their GP with concerns about prostate cancer.

Because of this, the number of prostate cancers being diagnosed in Yorkshire peaked in 2018, increasing by 26% from the previous year to 4,710. Recent figures show that this number has fallen since then, and in 2021 around 4,032 men were diagnosed with prostate cancer.

Finding cancer at the earliest possible stage is key to successful treatment and higher survival rates, and we recommend that anyone experiencing unusual signs or symptoms contacts their GP as soon as possible.

But what happens when cancer is at such an early stage that no symptoms can be noticed?

The increased awareness of prostate cancer has led to more men over 50 seeing their doctor without any of the usual symptoms that indicate prostate cancer, such as needing to urinate more frequently or experiencing a weak flow. In recent years the number of men receiving checks for prostate cancer has hit an all-time high.

For breast, bowel and cervical cancer, high-risk groups of the population are screened for signs of pre-cancerous cells or early cancers that are too small to see or feel.

At the moment there isn’t a national screening programme for prostate cancer because it hasn’t been proved that the benefits would outweigh the risks. But one method used by GPs to help detect signs of the disease is the ‘PSA test’.

What is the PSA test?

The PSA test is a blood test that measures the amount of 'prostate-specific antigen' (PSA) in your blood.

PSA is a protein made in the prostate gland, which lies just below the bladder and helps produce healthy sperm. Some PSA molecules are released into the blood.

It’s normal for men to have some PSA in their blood, but if the test shows a high PSA level, then further tests may be needed.

Men with a high PSA level may be referred to a specialist and have further investigations like an MRI scan of the prostate and a biopsy.

Research has shown that around 3 in 4 men with a raised PSA level will not have cancer.

A raised PSA level may indicate prostate cancer, but it can be high for other reasons, including:

  • An enlarged prostate
  • A urinary infection
  • Recent vigorous exercise
  • Recent ejaculation
  • Anal sex or prostate stimulation
  • Some medications
  • Other tests such as a prostate biopsy, which is used when men have symptoms of prostate cancer, can also increase PSA levels. You may need to wait for up to 6 weeks to have a PSA test following any tests on your bladder or prostate.
  • Urinary catheters. You may need to wait for up to 6 weeks to have a PSA test after a catheter to drain urine has been put

Why isn’t the PSA test offered to all men?

The PSA test can help to find prostate cancer before any symptoms are present. It can also help pick up a fast-growing cancer at an early stage, when treatment is likely to be more successful.

When found early, prostate cancer is highly treatable. So why isn’t the PSA test offered to all men through a national screening programme?

The PSA test can help to find more prostate cancers, and although screening has been shown to reduce the chance of dying from prostate cancer, many men would receive unnecessary treatment. This is called 'overdiagnosis'.

Many prostate cancers don't cause problems for men during their lifetime because they are very slow growing.

Overdiagnosis can lead to unnecessary worry and anxiety as well as side effects related to the diagnosis and treatment of cancer.

Treatment for prostate cancer can mean having surgery, radiotherapy and hormone therapy. The side effects of these treatments - such as incontinence and erectile dysfunction - can have a significant impact on everyday life.

Some prostate cancers will be fatal and some won’t and at the moment, we can’t tell the difference between them.

The pros and cons

If you’re over 50 and not experiencing any signs of prostate cancer, you may wish to discuss the PSA test with your GP, practice nurse or your family before deciding to have it.

It is your personal decision whether to have the test or not.

We’ve summed up the advantages and disadvantages below to help you make an informed choice.

Advantages of having a PSA Test

Can help pick up prostate cancer before you have any symptoms

Can help pick up a fast-growing cancer at an early stage, when treatment could stop it from spreading and causing problems or shortening your life

Disadvantages of a PSA Test

You might have a raised PSA level, even if you don’t have cancer. Most men with a raised PSA level do not have prostate cancer. This could cause unnecessary stress or anxiety.

It can miss prostate cancer. 1 in 7 men with prostate cancer would have a normal PSA level, and 1 in 50 men with a normal PSA level may have a fast-growing cancer.

If your PSA level is raised you may need a biopsy to discover what the problem with your prostate is. This can cause side effects, such as pain, infection and bleeding. Not all men will need to have a biopsy.

You might be diagnosed with a slow-growing cancer that would never have caused any problems or shortened your life. Being diagnosed with cancer could make you worry, and you might decide to have treatment that you would never have needed. Treatments can cause side effects which can affect your daily life, such as urinary, bowel and erection problems.

The future

Before a national screening programme for prostate cancer can be introduced, we must find a better way to use the PSA test or develop a more reliable test.

More research is needed to find a way of diagnosing prostate cancers that are likely to cause harm, so we only treat men whose lives are at risk

In the meantime, it’s vital we continue to raise awareness of prostate cancer signs and symptoms so even without a screening programme, we can try to increase the number of men diagnosed at the earliest possible stage.

Prostate cancer symptoms include:

  • Having to wee more often than usual, often at night 
  • Having to rush to the toilet to wee
  • Difficulty in starting or straining when trying to wee
  • Having a weak flow 
  • A sense of not being able to completely empty your bladder
  • Blood in wee or semen 

However, for some of these symptoms there are many possible causes. So having these symptoms does not mean you definitely have prostate cancer. If you notice any unusual changes to your body, please talk to your GP.