Who should be tested for prostate cancer?
Pros and cons of the PSA test
It's the most common cause of cancer in men, and the second biggest cause of death from cancer after lung cancer. Each year around 37,000 men are diagnosed with prostate cancer and more than 10,000 die from it.
At the start of Prostate Cancer Awareness Month, we look at the pros and cons of the prostate specific antigen (PSA) test, which can indicate whether a man has prostate cancer.
Currently, the UK does not have a screening programme for prostate cancer, simply because the PSA test is not reliable enough.
The PSA is the only blood test available which can indicate that a man may have prostate cancer, but it is often positive for men who do not have the disease.
For men without symptoms of prostate cancer, the test can help to identify a fast-growing cancer that needs to treated ASAP, but it can also expose a slow-growing cancer with which the man could have lived without treatment until the end of his life.
For these reasons, the UK National Screening Programme recommends that men over the age of 50 should make an informed decision on whether they wish to be tested or not, after a discussion with their GP.
[Related story: Signs you may have a prostate problem]
The PSA test
The PSA is a blood test which measures the level of a protein made by normal cells of the prostate gland. Prostate cancer cells also produce this protein.
PSA levels in the blood naturally increase with age as the prostate gland gets bigger. Raised PSA levels can also occur as a result of a urine infection, ejaculation, vigorous exercise (such as cycling) and other prostate conditions such as benign prostatic hyperplasia and prostatitis in addition to prostate cancer.
Pros and cons
Pros
- May detect prostate cancer at an early stage before symptoms appear, particularly more aggressive cancers.
- The higher the levels of PSA, the more likely it is to be caused by prostate cancer.
- If PSA results are low, this can provide reassurance to the man.
- It can also help to pick up other prostate problems.
Cons
- The test is not specific for prostate cancer. Two out of three men with raised PSA levels won't have prostate cancer.
- The PSA test cannot differentiate between slow and fast growing prostate cancers.
- The test is not sensitive enough - i.e. it cannot pick up all prostate cancers. This could provide false reassurance to men and even cause them to ignore any early symptoms which should be checked out by their GP.
If PSA levels are raised, but the prostate gland feels normal during a rectal examination, a doctor may decide to wait and then repeat the test.
If PSA levels are high, further tests - such as a prostate biopsy - may be carried out to determine the cause. Prostate biopsies are carried out under a local anaesthetic. Despite this, some men may find the procedure uncomfortable or embarrassing.
Risk factors for prostate cancer
Being at a higher risk of prostate cancer may influence your decision on whether you want to be tested.
Risk factors include:
- Age. The risk in men under the age of 50 is low, but starts to increase after this. Over 70 per cent of new cases occur in men over the age of 65.
- Having a close family member who has the disease - father, brother or son.
- A family history of breast cancer may also increase the risk of a small number of prostate cancers.
- Ethnicity - Men of African Caribbean or African descent have a higher risk of disease.
- A diet high in animal fats and low in fresh fruit and vegaetables may increase the risk of disease.
Warning signs to be aware of
In its early stages, the symptoms of prostate cancer may not be obvious. But they may include any of the following:
- Need to urinate often, especially at night
- Passing urine more often, daytime and/or night-time
- Slow at getting the flow of urine started
- Weaker flow of urine
- Starting and stopping whilst passing urine
- Discomfort (pain or burning) whilst peeing
- Feeling of not having emptied the bladder fully
- Dribbling after you've finished urinating
- Blood in urine or semen
- Pain or stiffness in the back, hips or pelvis
- Painful ejaculation
- Difficulty having an erection
More information: The Prostate Cancer Charity
KARUNAKARAN
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