Have you been thinking about getting a PSA test?
In the last few weeks there has been lots of media attention focussed on prostate cancer. Several celebrities have shared their experiences and data has been published showing deaths from prostate cancer have overtaken the number from breast cancer for the first time in the UK.
Unlike breast, bowel or cervical cancer there is not a national screening programme. This is because there is currently no single, reliable test that could be used like mammography or cervical smears. At the moment clinical history, physical examination, a blood test called prostate specific antigen (PSA) and sometimes a biopsy are used to make the diagnosis in men with symptoms. In those without symptoms it is important to consider carefully the advantages and disadvantages of testing, especially in those who are otherwise low risk; under 50 or without a family history of prostate cancer.
Prostate cancer is the commonest cancer in men; about 1 in 8 men will get it in their lifetime however, only about 1 in 25 will die from prostate cancer which means more men die with prostate cancer than of it.
To be clear this means some of the prostate cancers diagnosed will never cause any harm during the man’s lifetime. This is crucial to understand when talking about prostate cancer and PSA testing. As a result, PSA testing may lead to detection and treatment (with all the associated side effects) of a diagnosis that would otherwise not have caused any bother. Therefore, despite the increasing amounts of publicity there is still no evidence that the benefits of PSA screening in asymptomatic men, outweighs the risk of harm.
So where does that leave us? Well the UK national screening committee developed the Prostate Cancer Risk Management Programme. This is a tool health professionals can use alongside clinical assessment to assess each patient’s risk. This may then suggest a PSA blood test can be taken, in appropriate patients, once they have been fully counselled about the risks and benefits to them. There are also a few practicalities to consider prior to having the blood test, such as there should be no vigorous exercise or sexual intercourse for 48 hours before the test is taken as this can falsely raise the results.
The prostate is a gland that sits inside the pelvis around the urethra which is the tube that conveys urine from the bladder to the outside world via the penis. As a result prostate trouble can sometimes cause symptoms such as urinating more frequently, especially having to get up often overnight; urgency to pass urine and or hesitancy to start once you get there. Weakened, or reduced flow and then also the feeling of not completely emptying once you have been. In most men this is more likely related to an enlarged prostate and this is usually down to a very common non-cancerous condition but it is still a good idea to get it checked out.
If it is prostate cancer and it breaks out of the prostate or spreads to other parts of the body, it can cause other symptoms, including back pain, hip pain or pelvis pain; problems getting or keeping an erection or blood in the urine or semen and sometimes unexplained weight loss. Again all these symptoms can be caused by many other things that are not prostate cancer including prostatitis which is an infection and swelling of the prostate. Other health conditions like diabetes or some medicines can also be responsible.
Overall the most important thing is not to ignore any changes and see your GP to discuss them further so you can decide if tests are required. If you do not have symptoms and are wondering about asking for the PSA test have a look at these websites www.patient.co.uk or www.nhs.uk and search for PSA test or prostate cancer and arm yourself with the information about what it involves and then speak to your GP.PSA_testing_for_prostate_cancer_information_for_well_men
Other useful websites for information are below, you can also find these links on our Practice website:
The American Urology Association (AUA) have also produced guidelines for screening asymptomatic men – see below:
AUA Screening Guidelines
Recommendations based on age and risk
< Age 40: not recommended
Age 40-54: do not recommend routine screening
Age 55-69: informed shared decision making about screening risk and potential benefits
Age 70+ or patients with <10-15 years life expectancy: do not recommend routine screening
Alternatively, can individualise based on baseline PSA
<55 with positive family history or African-American race; decision should be individualised
If decision to screen, frequency should be 2+ years instead of annual
Panel believes this will reduce over diagnoses and false-positives while maintaining the majority of the benefits