PSA testing
Prostate-specific antigen (PSA) testing is one of the first checks to find prostate problems.
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Prostate problems and your PSA levels
The prostate is a small gland that sits just below the bladder in men. Issues such as needing to urinate a lot or blood in your semen can be signs that there’s a problem with the prostate, but it may not always mean cancer. To check for cancer, a PSA test is often used to help detect any issues. The test is pretty quick and simple. You can get the basics on how prostate cancer is diagnosed and treated here.
What is a 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 such as an infection, prostatitis, benign prostatic hyperplasia or prostate cancer.
What’s a PSA test?
A PSA test is just a 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 issues right now, factors like your age, being Black and a family history of cancer may put you at higher risk of developing prostate cancer. Having a discussion with your doctor can help guide 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 (for example, your father or brother) have been diagnosed with prostate cancer—you should start checking in with your doctor at 40 to 45 years.
If you’re Black you’re at higher risk for prostate cancer and should check in earlier with your doctor at 40 to 45 years.
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.
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. It can be due to an enlargement of the prostate (this is normal with age), a urine infection, inflammation of the prostate or even after 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.
Prostate cancer is confirmed by performing a biopsy. This involves using a special needle to take small pieces of tissue from different parts of the prostate. The decision to perform a biopsy is based upon your likelihood of having prostate cancer. This includes the result of the PSA blood test, any abnormalities noticed during the digital rectal examination (DRE), and whether you have a family history of prostate cancer. Sometimes a magnetic resonance imaging (MRI) scan of the prostate is ordered to help decide if a biopsy is required and to help doctors direct the needle to areas of the prostate that looks most suspicious.
I have been diagnosed with prostate cancer—do I still need to check my PSA level?
Yes, it’s very important to have your PSA levels checked after prostate cancer diagnosis and treatment.
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.
Active surveillance
If you have low-risk prostate cancer that isn’t causing any symptoms and is not being actively treated, PSA levels are usually checked every 3 to 6 months and a physical examination, including DRE, is usually offered every 6 to 12 months.
Along with regular PSA testing, a biopsy is usually done within 6 to 12 months of starting active surveillance. You may also have MRI to monitor for disease progression, or any changes in the cancer.
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.
After treatment
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?
Surgery
After surgery, your doctor will usually wait anywhere from 6 to 12 weeks before checking your PSA level, which should be very low or undetectable. Following this, your PSA may be checked every 3 to 6 months for the first 2 years.
Radiation therapy (radiotherapy)
If you’ve had radiation therapy, the PSA level tends to drop slowly, reaching its lowest level after 18 months to 2 years. Your doctor will probably check your PSA levels once or twice a year to look for any patterns. There may be a small rise in levels before falling again (‘PSA bounce’) in the 3 years after treatment—but this is normal and should not cause concern. A PSA level that keeps rising, however, may indicate the cancer is still there.
After prostate cancer treatment, and depending on your previous PSA levels, testing is usually every 6 to 12 months (or more frequently, depending on your doctor) for the first five years and once every 12 months after that. Discuss with your physician how often they want to check your PSA levels and when to start testing.
What should I do if I think my cancer has returned?
A rising PSA is usually the first sign that the prostate cancer has come back or spread to other parts of the body. Stay on top of your doctor appointments, so your care team can keep an eye on your PSA levels and check for issues.
What if I’m experiencing prostate cancer symptoms?
It’s unusual to experience any symptoms within a year of having a normal PSA test result after prostate cancer treatment. Any symptoms that do occur are unlikely to be due to the cancer returning or spreading.
However, if you are experiencing any new symptoms (which can include pain, loss of energy or weight loss) or think your cancer might have returned, it’s important to contact your doctor, nurse, or care team. They can try to find out what’s causing these symptoms and help you manage them. Your doctor can also check your PSA levels to see whether your cancer might have returned.
When can I stop checking my PSA levels?
If you’ve been treated for prostate cancer and you aren’t experiencing any problems—the PSA tests should become less frequent over time. Your doctor will guide you on how often you’ll need them.
If you have not been diagnosed with prostate cancer and your PSA level is low, it is not recommended to continue testing PSA levels after 70 to 75 years.
Why not?
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.
