Prostate specific antigen (PSA) testing

Prostate problems and your PSA levels

The prostate is a small gland that sits just below the bladder in men. Symptoms like the urge to urinate often or suddenly, including at night, blood appearing in your urine or semen, pain in your back or hips, or unexplained weight loss can be some of the signs that there’s a problem with the prostate, but it may not always mean cancer. A PSA test is a simple blood test that will help your doctor decide if further investigations are needed.

What is prostate specific antigen (PSA)?

PSA is a protein which is made by your prostate and found in the blood. PSA is found in both healthy cells and cancerous cells, so it’s normal to have some in your blood. High or increasing PSA levels in your blood usually suggest problems related to the prostate which could be an infection, prostatitis, benign prostatic hyperplasia or in some cases it could be prostate cancer.

What is a PSA test?

A PSA test is just a blood test. Like any other blood test, you’ll have a small blood sample taken from your arm and sent off for lab testing.

I don’t think I have prostate problems: Do I need a PSA test?

Even if you don’t think you have prostate symptoms right now, certain factors may put you at higher risk of developing prostate cancer. These include older age, being Black or having sub-Saharan African ancestry, or a family history of cancer. Speak to your doctor about your risk of prostate cancer and when a PSA test is right for you.

• If you have no symptoms and no family history of prostate cancer, speak to your doctor about having a PSA test as part of your overall health check-up from the age of 50 years.
• If you have a family history of prostate cancer (if others in your family like your father or brother have been diagnosed with prostate cancer) you should start checking in with your doctor at 40 to 45 years (the exact age to start testing depends on where you live so ask your doctor).
• If you’re Black or have sub-Saharan African or Caribbean ancestry, you’re at higher risk for prostate cancer and should check in earlier with your doctor from the age of 45.

If no prostate cancer is detected and depending on the result of the PSA test, the doctor will usually offer ongoing testing PSA testing every 1-3 years up to the age of 69. Depending on where you live, regular testing may stop after the age of 70 but your doctor can discuss this with you and help decide if ongoing testing is appropriate.

It’s important to talk to your doctor about your risk of developing prostate cancer and discuss the benefits, harms, and uncertainties of PSA testing so you can decide if it’s right for you.

My PSA levels are raised: What does this mean?

An elevated prostate specific antigen level may mean a few things:

• Enlargement of the prostate (this is normal with age)
• Urine infection
• Inflammation of the prostate
• Recent intercourse and ejaculation

If your PSA level is increased, another test may be required within 1 to 3 months. This is because the PSA can sometimes return to normal levels. If the levels are still raised after the second test, this may suggest something is going on in the prostate and further tests may be done to determine if it is cancer or something else.

How is prostate cancer diagnosed?

The next step is usually a detailed scan of the prostate using multiparametric magnetic resonance imaging (mpMRI), but this will depend on where you live and the availability of mpMRI. The mpMRI helps determine whether a biopsy is needed and, if so, what part of the prostate should be biopsied.  

Your specialist may also perform a digital rectal examination (DRE) to check the prostate for abnormalities. 

The decision to proceed to biopsy is based on your overall likelihood of having prostate cancer, which considers your PSA results, mpMRI findings, DRE findings, age, family history and ancestry. A biopsy will be used to confirm a prostate cancer diagnosis. It involves using a special needle to take small samples of tissue from different parts of the prostate, which are then examined under a microscope. 

I have been diagnosed with prostate cancer: Do I still need to check my PSA level?

Yes, PSA levels usually continue to be checked after prostate cancer diagnosis and treatment, but your health care team will advise and guide you.

Before diagnosis, the PSA level is one factor doctors consider when deciding to investigate the possibility of prostate cancer. Once you’re diagnosed with prostate cancer, however, the reasons to have a PSA test might change.

Following diagnosis, the PSA test is done to see if the cancer is growing or spreading, or to make sure the cancer is absent or controlled after treatment. For this reason, the PSA levels your doctor is interested in might be different to the levels before diagnosis.

PSA levels during active surveillance

If you have early stage prostate cancer it may not need active treatment. Instead, you'll be monitored closely with regular PSA tests, DREs, mpMRI scans or biopsies, dependent on the risk of your cancer developing to a stage where it needs treatment.

Checking PSA levels during treatment

PSA testing can be one way of checking how well certain treatments are working in more advanced prostate cancer. These include hormone therapy (also called androgen deprivation therapy), chemotherapy, and immunotherapy.

PSA tests after treatment is completed

A PSA test is a good way to check if treatment was successful. While it’s normal to feel anxious every time you have a follow-up appointment, remember that it is important to keep track of your PSA levels with regular tests.

How often should I check my PSA levels after treatment?

As a general guideline, PSA levels tend to be checked every 6-12 months in the first five years following treatment and once a year thereafter. But exactly how often you are required to be tested will be decided by the doctor treating you. It can vary depending on a number of factors, including prostate cancer risk and treatment type, and it may change depending on results and how long it has been since you had treatment.

What should I do if I think my cancer has returned?

A rising PSA can be the first sign that the prostate cancer has returned. Stay on top of your doctor appointments, so your care team can keep an eye on your PSA levels and check for changes.

What if I’m experiencing prostate cancer symptoms?

If you are experiencing any ongoing symptoms or, in particular, new symptoms (which can include pain, loss of energy or weight loss) or you think your cancer might have returned, it’s important to contact your doctor or healthcare team. They can try to find out what’s causing these symptoms and help you manage them.

When can I stop checking my PSA levels?

If you’ve been treated for prostate cancer and are not experiencing any problems, the PSA tests should become less frequent over time. Your doctor will guide you on how often you’ll need them.

From the age of 70 onwards, if you have not been diagnosed with prostate cancer and your PSA level is low the doctor will guide you on whether testing should be continued.

Why stop PSA testing?

Any benefit from finding prostate cancer early decreases as you get older. Other health problems you may have (like heart disease) are likely to become more important to take care of so you can focus on your quality of life.

Speak to your doctor about how often they need to see you.