Understanding the PSA test A guide for men concerned about prostate cancer

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1 Understanding the PSA test A guide for men concerned about prostate cancer

2 2 Understanding the PSA test A guide for men concerned about prostate cancer About this booklet This booklet is for men who want to know more about having a blood test, called a PSA test, which can help diagnose prostate problems and prostate cancer. Your partner or family might also find it useful. We explain what the prostate is, different types of prostate problems and how the PSA test can help to diagnose them. We also explain the pros and cons of the test, what the results mean, and what might happen afterwards. Each GP practice or hospital will do things slightly differently so use this booklet as a general guide to what to expect and ask your GP for more information. You can also speak to our Specialist Nurses, in confidence, on The following symbols appear throughout the booklet to guide you to sources of further information: Prostate Cancer UK Specialist Nurses Prostate Cancer UK publications Sections for you to fill in

3 Specialist Nurses Contents About this booklet The PSA test: in brief What is the prostate? What can go wrong? What changes should I look out for? What is an enlarged prostate? What is prostatitis? What is prostate cancer? Having a PSA test The digital rectal examination (DRE) Seeing a specialist If I am diagnosed with prostate cancer what are my options? Should I have a PSA test? Why isn t there a prostate cancer screening programme? Questions to ask your GP or practice nurse Questions to ask your hospital specialist PSA Levels More information from us Other useful organisations About Prostate Cancer UK

4 4 Understanding the PSA test A guide for men concerned about prostate cancer The PSA test: in brief 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 produced by normal cells in the prostate and also by prostate cancer cells. It is normal for all men to have a small amount of PSA in their blood, and this amount rises as you get older. A raised PSA level may suggest you have a problem with your prostate, but not necessarily cancer. You can have a PSA test at your GP surgery. You will need to discuss it with your GP first. At some GP surgeries, you can discuss the test with the practice nurse, and they can do a test if you decide you want one. Who can have a PSA test? You have the right to have a PSA test if you re over 50 and you ve talked through the pros and cons with your GP or practice nurse (see page 30). If you re under 50 but have a higher risk of prostate cancer (see page 5), you might want to talk to your GP about having a PSA test. Your GP or practice nurse may not recommend the PSA test if you have other serious health problems which might cause you more problems than prostate cancer would.

5 Specialist Nurses What can the PSA test tell me? A raised PSA level can be a sign of a problem with your prostate. This could be: an enlarged prostate inflammation or infection of the prostate called prostatitis a urine infection prostate cancer. Other things can also cause your PSA level to rise (see page 19). If you have a raised PSA level, there are other tests your GP can do to find out what s causing it. The PSA test and prostate cancer A raised PSA level can be a sign of prostate cancer. But around three quarters of men (76 per cent) with a raised PSA level don t have prostate cancer. And some men with a normal PSA level do have prostate cancer. You may be more likely to get prostate cancer if: you are aged 50 or over you are Black your father or brother has had it. Read more about your risk of prostate cancer on pages To decide whether you need to see a hospital specialist for more tests, your GP will look at more than just your PSA level. They will also look at your risk of prostate cancer and whether you ve had a prostate biopsy in the past (see page 25). They will also do an examination of your prostate called a digital rectal examination (DRE see page 23).

6 6 Understanding the PSA test A guide for men concerned about prostate cancer Should I have a PSA test? It s up to you whether or not you have a PSA test. Before you decide you may want to find out more about: the different types of prostate problems and prostate cancer see pages whether you are more at risk of prostate cancer see pages what the PSA test involves see page 18 the pros and cons of the test see page 30 any other tests you might need to have after a PSA test see pages It might help to talk this over with your partner, family or friends. You could also talk to your GP or call our Specialist Nurses on

7 Specialist Nurses What is the prostate? Only men have a prostate gland. The prostate is usually the size and shape of a walnut and grows larger as you get older. It sits underneath the bladder and surrounds the urethra, which is the tube that men urinate and ejaculate through. Its main job is to help make semen, which is the fluid that carries sperm. What is the prostate gland? bladder uretha penis prostate gland testicle

8 8 Understanding the PSA test A guide for men concerned about prostate cancer What can go wrong? The three most common types of prostate problems are: an enlarged prostate this is the most common prostate problem prostatitis inflammation or infection in the prostate prostate cancer. What changes should I look out for? Problems urinating are common in older men, and they can be a sign of a prostate problem, usually an enlarged prostate. They can also be a sign of a urine infection, prostatitis or sometimes prostate cancer. But early prostate cancer doesn t usually cause symptoms. Symptoms of prostate problems can include: needing to urinate more often, especially at night for example if you often need to go again two hours after urinating difficulty starting to urinate straining or taking a long time to finish urinating a weak flow when you urinate a feeling that your bladder has not emptied properly needing to rush to the toilet you may occasionally leak before you get there dribbling urine.

9 Specialist Nurses Less common symptoms include: pain when urinating pain when ejaculating blood in your urine or semen* problems getting or keeping an erection.** *Blood in your urine can also be caused by other health problems, including other cancers. You should always go to your doctor if you notice any blood in your urine. **Erection problems aren t usually caused by a prostate problem, although they are more common in men with an enlarged prostate. They are more often caused by other health problems such as diabetes and heart problems. Tick any symptoms you have and take this booklet with you if you go to see your GP. These symptoms can be caused by other things and might be nothing to do with the prostate. But if you have any of them, it s a good idea to go to your GP to get them checked out. Remember most men with early prostate cancer don t have any symptoms. If you re worried about prostate cancer, speak to your GP, even if you don t have symptoms.

10 10 Understanding the PSA test A guide for men concerned about prostate cancer What is an enlarged prostate? Benign prostatic enlargement (BPE) is the medical term used to describe an enlarged prostate. It means an enlargement of the prostate gland that isn t caused by cancer. You might also hear it called benign prostatic hyperplasia (BPH). As your prostate grows, it can make the urethra (the tube you urinate through) narrower. This can cause urinary symptoms see page 8. An enlarged prostate is common in men after the age of about 50, and it s the most common cause of urinary symptoms as men get older. Having an enlarged prostate doesn t increase your risk of getting prostate cancer. But men can have an enlarged prostate and prostate cancer at the same time. There are things that can help with urinary symptoms if you have an enlarged prostate. Mild problems may be relieved by making some simple changes to your lifestyle, such as avoiding alcohol and caffeine. If these changes don t help, your doctor may prescribe medicines or recommend surgery. Find out more in our booklet Enlarged prostate: A guide to diagnosis and treatment.

11 Specialist Nurses What is prostatitis? Prostatitis is the name given to a set of symptoms which are thought to be caused by an infection or by inflammation of the prostate gland. It s not cancer. It can cause a wide variety of symptoms, which vary from man to man and can include those on page 8. In severe cases it can cause fever and sweating and you may need treatment in hospital. Prostatitis is common. It can affect men of any age but it s most common in younger and middle aged men, typically between 30 and 50. It s a complicated condition. There are different types of prostatitis which are treated in different ways. It can take some time to get a diagnosis, and you might need a number of tests. Read our booklet Prostatitis: A guide to infection and inflammation of the prostate for more information.

12 12 Understanding the PSA test A guide for men concerned about prostate cancer What is prostate cancer? Normally the growth of all cells is carefully controlled in the body. As cells die, they are replaced in an orderly fashion. Cancer can develop when cells start to grow in an uncontrolled way. If this happens in the prostate, prostate cancer can develop. Prostate cancer is the most common cancer in men in the UK. About 1 in 8 men will get prostate cancer at some point in their lives. Prostate cancer often grows slowly and has a low risk of spreading, so it may never cause you any symptoms or problems in your lifetime. In other words, it s often not life-threatening. Because of this, slow-growing prostate cancer might not need to be treated. You might be able to have your cancer monitored with regular check-ups instead. If the check-ups show that your cancer is growing, you will be offered treatment. But some men will have cancer that is faster growing and has a higher risk of spreading. This is more likely to cause problems, and needs treatment to stop it spreading outside the prostate. Who is at risk? There are several things that may mean you are more likely to get prostate cancer.

13 Specialist Nurses Age Prostate cancer mainly affects men over the age of 50 and your risk increases as you get older. The average age for men to be diagnosed with prostate cancer is between 70 and 74 years. If you are under 50 then your risk of getting prostate cancer is very low. Men under 50 can get it, but it isn t common. Family history Inside every cell in our body is a set of instructions called genes. These are inherited from our parents. Genes control how the body grows, works and what it looks like. If something goes wrong with one or more gene (known as a fault or mutation), it can cause cancer. Some faults in genes can be passed on from your parents and could increase your risk of developing prostate cancer. You are two and a half times more likely to get prostate cancer if your father or brother has been diagnosed with it, compared to a man who has no relatives with prostate cancer. You may have a higher chance of getting prostate cancer if your relative was under 60 when they were diagnosed with prostate cancer, or if you have more than one first degree relative (father or brother) with prostate cancer. You may have a higher risk of prostate cancer if your mother or sister has had breast cancer, particularly if they were diagnosed under the age of 60. This risk is only higher for men whose relative s breast cancer was linked to faults in genes called BRCA1 or BRCA2.

14 14 Understanding the PSA test A guide for men concerned about prostate cancer The BRCA1 and BRCA2 genes are sometimes known as breast cancer genes. Faults in these genes can increase a woman s chance of getting breast cancer. They can also increase a man s chance of getting prostate cancer, particularly under the age of 65. Faults in these genes are rare but if you have relatives with prostate cancer or breast cancer and are worried about this, speak to your GP. Although the risk is increased, it doesn t necessarily mean you will get prostate cancer. Faults in other genes may also increase the risk of prostate cancer. Each of these faults may only increase your risk a small amount. But if you have lots of these faults, you may have a higher risk of prostate cancer. We need more research to fully understand how faults in genes affect a man s risk of prostate cancer. Ethnicity Black men are more likely to get prostate cancer than men of other ethnic backgrounds. The reasons for this are not yet clear but might be linked to genes. In the UK, about 1 in 4 Black men will get prostate cancer at some point in their lives. Lifestyle No one knows how to prevent prostate cancer, but a healthy diet and lifestyle may be important in protecting against it. We need more research before we can say for sure how diet affects prostate cancer. Read more in our leaflet, Diet, activity and your risk of prostate cancer.

15 Specialist Nurses What are the symptoms of prostate cancer? Early prostate cancer doesn t usually cause symptoms. Some men may have problems peeing, including those described on page 8. These may be mild and happen over many years. For some men the first noticeable symptoms might be new pain in the back, hips or pelvis. This can be caused by cancer that has spread to the bones. These symptoms are usually caused by other problems such as general wear and tear or arthritis. But it s still a good idea to get them checked out by the GP if they don t settle down quickly.

16 16 Understanding the PSA test A guide for men concerned about prostate cancer Having a PSA test You can have a PSA test at your GP surgery. You might speak to your GP or practice nurse if you have symptoms such as problems urinating, if you re worried about prostate problems, or because you re more at risk of prostate cancer (see pages 12-14). It s important that you think through whether the PSA test is right for you before you decide whether or not to have one. There are pros and cons to the test, and a number of things you might want to think about (see page 30). You have the right to have a PSA test if you re over 50 and you ve talked through the pros and cons with your GP or practice nurse. If you re under 50 but have a higher risk of prostate cancer because you have a family history of it or you re Black you might want to talk to your GP or practice nurse about having a PSA test. Sometimes men are offered a PSA test as part of a general check-up. You should still think about whether a PSA test is right for you before you agree to have one. What will happen at the GP surgery? Your GP or practice nurse should talk to you about the pros and cons of the PSA test before you decide to have one. They will also discuss your risk of prostate cancer, and ask you about any symptoms you might have. Your GP or practice nurse will also talk to you about your general health and other health problems. They might not recommend a PSA test if you have other serious health problems which might cause you more problems than prostate cancer would.

17 Specialist Nurses If you decide you want a PSA test, your GP or practice nurse may also do a digital rectal examination (see page 23), and a urine test to rule out a urine infection. What if my GP won t give me a PSA test? If you re over 50 and have discussed the pros and cons of the PSA test with your GP or practice nurse, and decide that you want to have one, they should give you a PSA test. But we know that some men have trouble getting the test. There are things that you can do if your GP or practice nurse won t give you a test. Explain that you are entitled to a PSA test under the Prostate Cancer Risk Management Programme (see page 33). It might help to take this booklet along with you. If they still say no, try speaking to another GP or practice nurse. If they also say no, speak to the practice manager at your GP surgery. Your GP surgery should have information explaining its complaints procedure. You can follow this procedure, or write to the GP or practice manager explaining your complaint. If you still have trouble getting a PSA test, you could make a complaint through the NHS complaints procedure. If you live in England, you can complain to NHS England. NHS Choices has more information.

18 18 Understanding the PSA test A guide for men concerned about prostate cancer If you live in Scotland, you can make a complaint to your local health board. The Patient Advice and Support Service can provide information, advice and support in making a complaint. Get more information from NHS National Services Scotland. If you live in Wales, you can make a complaint to your local health board. If you need help in making a complaint, contact your local Community Health Council for advice. Health in Wales has more information. If you live in Northern Ireland, you can make a complaint to the health and social care board. The Patient and Client Council can provide advice and support in making a complaint. Get more information from nidirect. Find contact details for all these organisations on page 39. In your complaint, include: your name your contact details such as your home address or a clear description of your complaint including what happened, where and when details of any relevant conversations, letters or s you ve had. You can get advice and support about making a complaint from your local Citizens Advice Bureau. What does the PSA test involve? A sample of your blood is taken and sent to a laboratory to be tested. The amount of PSA in your blood is measured in nanograms (a billionth of a gram) per millilitre of blood (ng/ml).

19 Specialist Nurses What could affect my PSA level? PSA is produced by healthy cells in the prostate, so it s normal for all men to have a small amount of PSA in their blood. There are lots of things that can affect your PSA level not just a prostate problem. A urine infection You may have a test for a urine infection as this can raise your PSA level. You will have treatment for any infection. You will need to wait until the infection has cleared up around four to six weeks before you have a PSA test. Vigorous exercise You might be asked not to do any vigorous exercise, especially cycling, in the 48 hours before a PSA test as it could raise your PSA level. Ejaculation You may be told to avoid any sexual activity that leads to ejaculation in the 48 hours before a PSA test, as this could cause a temporary rise in your PSA level. Anal sex and prostate stimulation If you are gay, bisexual or a man who has sex with men, being the receptive partner during anal sex might raise your PSA level for a while. Having your prostate stimulated during sex might also raise your PSA level. It might be worth avoiding this for a week before a PSA test. Digital rectal examination (DRE) Having a DRE before a PSA test might raise your PSA level a small amount (see page 23).

20 20 Understanding the PSA test A guide for men concerned about prostate cancer Biopsy If you have had a prostate biopsy in the six weeks before a PSA test, this could raise your PSA level. Medicines You should let your GP or practice nurse know if you re taking any prescription or over-the-counter medicines as some might affect your PSA level. For example, 5-alpha-reductase inhibitors to treat an enlarged prostate, such as finasteride (Proscar ) or dutasteride (Avodart ), can reduce your PSA level. Other investigations or operations If you have a catheter or have had any investigations or operations on your bladder or prostate, these could raise your PSA level. You may need to wait up to six weeks after these procedures before having a PSA test. What will the test results tell me? A PSA test alone can t tell you whether you have prostate cancer, because other things can affect your PSA level. It s normal to have a small amount of PSA in your blood, and the amount rises as you get older. The prostate gland gets bigger with age, and may produce more PSA. The following figures are a very rough guide to normal PSA levels, depending on your age. A normal PSA level is less than: 3 ng/ml for men aged ng/ml for men aged ng/ml for men aged 70 and over.

21 Specialist Nurses This is just a guide different GP surgeries might use slightly different figures. For example, in some places, a PSA level of less than 7 ng/ml might be seen as normal for men aged Speak to your GP or practice nurse about what your results mean. A high PSA level for your age can be a sign of prostate cancer. But it can also be a sign of other prostate problems such as an enlarged prostate (see page 10) or prostatitis (see page 11). Neither of these are cancer. If your test results are normal for your age, then you may not need any further tests. Or you may need another PSA test in the future. A very high PSA level (for example in the hundreds or thousands) normally means that a man has prostate cancer. But if your PSA level is only slightly high for your age, then you will need other tests to help find out if there is a problem. Your GP will look at several factors together with your PSA level to help you agree on the next step. These include: the results of a DRE see page 23 whether you are at higher risk of prostate cancer see pages any other health problems or things that may have affected the results see page 19 whether you ve had a prostate biopsy in the past see page 25. Your GP should discuss all this with you. They may also do another PSA test, especially if your PSA is only slightly raised. Your GP will make an appointment for you to see a specialist at the hospital if they think you need more tests to work out whether you have a prostate problem. You can also ask your GP to refer you to a specialist.

22 22 Understanding the PSA test A guide for men concerned about prostate cancer The PSA test can help to pick up early prostate cancer before you have any symptoms. But it can t tell whether it s a slow-growing cancer which may never cause problems or affect how long you live or a fast-growing cancer which needs treatment. Regular PSA tests After some men have had their first PSA test they might want to have regular tests every few years, particularly if they are more at risk of prostate cancer. This might be a good way to spot any changes in your PSA level which might suggest prostate cancer. But we need more research to show how often you might need a test. You could discuss this with your GP or practice nurse, or call our Specialist Nurses. There is some research that suggests that if you have a PSA test in your 40s, it might be possible to predict how likely you are to get fast-growing prostate cancer later in life. However, we don t yet know exactly what PSA level would show this, or how often you should have more tests. You can keep a record of your PSA level in the table on page 37. This might be useful if you see a specialist or ask for a second opinion.

23 Specialist Nurses The digital rectal examination (DRE) A digital rectal examination (DRE) is where your GP or practice nurse feels the prostate gland through the wall of the back passage (rectum). It s a useful test to help diagnose a prostate problem. You might have a DRE if you have any of the symptoms listed on page 8. The digital rectal examination bladder rectum uretha prostate gland the doctor or nurse feels here

24 24 Understanding the PSA test A guide for men concerned about prostate cancer The GP or practice nurse will wear gloves and put some gel on their finger to make the DRE more comfortable. They ll feel your prostate for any hard or irregular areas and to get an idea of its size. This may be uncomfortable, and some men find it slightly painful. You may feel like you want to pee when they press on your prostate. Some men find it embarrassing but it will be over quickly. If the prostate feels larger than expected for your age this could be a sign of an enlarged prostate. If there are any hard bumpy areas this might suggest prostate cancer. You may be referred to a specialist at the hospital if your prostate feels unusual, even if you have a normal PSA level. If you have a DRE, you might need to wait a few days before having a PSA test. This is because the DRE can raise your PSA level a small amount. Read more about the DRE in our Tool Kit fact sheet, How prostate cancer is diagnosed.

25 Specialist Nurses Seeing a specialist If your GP thinks you need further tests to work out if you have a prostate problem, they will refer you to see a specialist urology team at a hospital. They may repeat some of the tests you were given by your GP or practice nurse. Depending on your test results they may offer you another PSA test in the near future to check that your PSA is not rising. Or they might recommend a prostate biopsy. This is usually a TRUS (trans-rectal ultrasound) guided biopsy. In some hospitals you might be offered an MRI (magnetic resonance imaging) scan before a biopsy to help the doctor decide if you need a biopsy. An MRI scan uses magnets to create a detailed picture of your prostate. It can help to show whether there is anything unusual in the prostate that might be cancer, and whether you need a biopsy to check if it is cancer. TRUS guided prostate biopsy A prostate biopsy involves taking small pieces of prostate tissue to be looked at under the microscope, to see if there is any prostate cancer. A raised PSA level alone does not automatically mean that you must have a biopsy. Your specialist should talk to you about the pros and cons of a biopsy, and discuss any questions you may have before you decide whether to have it (see page 27).

26 26 Understanding the PSA test A guide for men concerned about prostate cancer A TRUS biopsy involves using thin needles to take 10 to 12 small samples of tissue from the prostate. This is done through the back passage. An ultrasound scan will be done at the same time to help guide the biopsy needles. You will have a local anaesthetic injection into your back passage to numb the area and reduce any discomfort. Some men find the biopsy painful, but others have only slight discomfort. The biopsy will take about five minutes. You will be given some antibiotics to take, to help prevent infection. The trans-rectal ultrasound guided biopsy bladder rectum probe prostate gland needle bones

27 Specialist Nurses What are the advantages and disadvantages of having a biopsy? Advantages It s the most accurate way of finding out whether there s prostate cancer present. It can help find out how aggressive any cancer might be and how likely it is to spread. It can pick up a faster growing cancer at an early stage, when treatment may prevent the cancer from spreading to other parts of the body. It can help your doctor or nurse decide which treatment options may be suitable for you. Disadvantages The biopsy can only show whether there was cancer found in the samples taken. The biopsy collects tissue from small areas of the prostate, so it s possible that cancer might be missed. It can pick up a slow-growing or non-aggressive cancer that might not cause any symptoms or problems in your lifetime. You may then have to decide whether to have treatment or have your cancer monitored. A biopsy can cause short term side effects such as urine infection, difficulty passing urine, and blood in your urine, bowel movements or semen. Up to 3 in 50 men (six per cent) may have a more serious infection. You will have antibiotics to help prevent this although antibiotics don t prevent all serious infections. Read more about all the tests for prostate cancer in our Tool Kit fact sheet, How prostate cancer is diagnosed.

28 28 Understanding the PSA test A guide for men concerned about prostate cancer If I am diagnosed with prostate cancer what are my options? You may need more tests such as an MRI (magnetic resonance imaging) scan, CT (computerised tomography) scan, or bone scan to find out whether the cancer has spread outside the prostate. Your doctor will look at all your test results to get an idea of how far the cancer has spread and how quickly it might be growing. This will help you and your doctor discuss the best possible treatments for you. There are several treatment options available for prostate cancer. If you have a slow-growing cancer, it may never cause you any problems or affect how long you live. Because of this, slow-growing prostate cancer might not need to be treated. You might be able to have your cancer monitored with regular check-ups instead. This is called active surveillance. The aim is to avoid unnecessary treatment, or delay treatment and the possible side effects. You will have regular tests, including PSA tests, DREs and biopsies, to check whether the cancer is growing. If the cancer does start to grow you will have treatment that aims to cure it. Other treatment options include: surgery to remove the prostate (radical prostatectomy) external beam radiotherapy (EBRT) which uses X-ray beams to kill the cancer brachytherapy a type of internal radiotherapy hormone therapy to stop testosterone reaching the cancer cells, which helps to stop the cancer growing.

29 Specialist Nurses You may also be offered high intensity focused ultrasound (HIFU) or cryotherapy. These are newer than some of the other treatments for prostate cancer so we don t know as much about how well they work and the risk of side effects in the long term. Because of this they are only available in specialist centres or as part of a clinical trial. All treatments for prostate cancer can cause side effects, including problems getting an erection, urinary problems and bowel problems. There are treatments available to help manage side effects. Read our Tool Kit fact sheets for more information about treatments and side effects.

30 30 Understanding the PSA test A guide for men concerned about prostate cancer Should I have a PSA test? Talk to your GP or practice nurse about whether to have a PSA test. They should discuss whether you re at risk of prostate cancer, any symptoms you might have, any other health problems you have, and the pros and cons of the test. You might find it helpful to make a note of any questions you have before you speak to your GP. What are the advantages and disadvantages of the PSA test? It s important you think through the advantages and disadvantages of the PSA test. Having a PSA test is a personal decision what might be an advantage for one man may not be for another. Advantages A PSA test can help pick up prostate cancer before you have any symptoms. A PSA test may help to pick up a fast-growing cancer at an early stage when treatment may stop the cancer spreading and causing problems. Slow-growing prostate cancer might not need treatment. You might be able to have regular check-ups, including PSA tests, to keep an eye on your cancer. This can avoid or delay the side effects of treatment. Having regular PSA tests could be helpful for men who are more at risk of prostate cancer. This can help spot any changes in your PSA level, which might be a sign of prostate cancer. But we need more research to show how often you might need a test.

31 Specialist Nurses Disadvantages You might have a raised PSA level, even if you don t have prostate cancer. Around three quarters of men (76 per cent) with a raised PSA level don t have prostate cancer. If your PSA level is raised you may need more tests, including a biopsy. The biopsy has some risks, such as pain, infection and blood in the urine and semen. Up to 3 in 50 men (six per cent) may get a serious infection after a biopsy. The PSA test can miss prostate cancer. 1 in 50 men (two per cent) with fast-growing prostate cancer have a normal PSA level. You might be diagnosed with a slow-growing prostate cancer which would never have caused you any problems or shortened your life. But being diagnosed with cancer could make you worry, and you might decide to have treatment that you didn t need. Treatments for prostate cancer have side effects which can affect your daily life. These include urinary and bowel problems, and problems getting and keeping an erection.

32 32 Understanding the PSA test A guide for men concerned about prostate cancer Before you decide whether to have the test, think about the information in this booklet. Try asking yourself these questions, or discuss them with your GP or practice nurse. Are you more at risk of prostate cancer? If the result of your PSA test was normal, would this reassure you? If your PSA level was high, what would you do? If you were diagnosed with slow-growing prostate cancer that might not cause you any problems in your lifetime, would you want to have treatment that may cause side effects that affect your daily life? It can be difficult to decide whether or not to have a PSA test. If you want to discuss the test, call our Specialist Nurses on

33 Specialist Nurses Why isn t there a prostate cancer screening programme? Screening programmes aim to spot the early signs of cancers in people who do not have any symptoms. By finding cancer early, it could be treated in time to cure it. In the UK there are screening programmes for breast, cervical and bowel cancer. There is currently no screening programme for prostate cancer. One reason for this is that the PSA test isn t good enough at finding prostate cancer to be used as part of a screening programme the list of disadvantages on page 31 explains why. It s important that the benefits of a screening programme outweigh any disadvantages. But it s not clear that screening with the PSA test would have more benefits than disadvantages. Some studies have found that screening with the PSA test could mean fewer men die from prostate cancer. But it would also mean that a large number of men would be diagnosed with a slow-growing cancer that wouldn t have caused any symptoms or shortened their life. And a large number of these men would have treatment they didn t need which could cause side effects. Other studies have found that screening doesn t reduce the number of deaths from prostate cancer. Although there s no screening programme for prostate cancer, many men who are worried about it want a PSA test. So the Prostate Cancer Risk Management Programme was set up. This programme gives men over 50 who want a PSA test the right to have one on the NHS as long as they have talked through the pros and cons with their GP.

34 34 Understanding the PSA test A guide for men concerned about prostate cancer

35 Specialist Nurses Questions to ask your GP or practice nurse Am I at risk of prostate cancer? What are the advantages and disadvantages of having a PSA test? How long will I have to wait for the results? If I have a PSA test and the result is normal, will I need to have regular tests in the future? Will I need a DRE?

36 36 Understanding the PSA test A guide for men concerned about prostate cancer Questions to ask your hospital specialist Do I need a biopsy? Will I have an MRI scan before having a biopsy? What are the risks and side effects of a biopsy? How soon will I get the results? Will I need any other tests? What support can I get?

37 Specialist Nurses PSA Levels You can use this table to record the results of your PSA tests. If you need more space, you can order PSA record cards by calling Prostate Cancer UK on Date PSA level Date PSA level

38 38 Understanding the PSA test A guide for men concerned about prostate cancer More information from us Leaflets and booklets We have a range of other leaflets and booklets about prostate cancer and other prostate problems. To order publications: All our publications are free and available to order or download online. To order them: Call us on Visit our website at /publications Call our Specialist Nurses If you want to talk about prostate cancer or other prostate problems, call our Specialist Nurses in confidence. Or text NURSE to and one of the Specialist Nurses will call you back. You can also the nurses using the contact form on our website. Visit and click on We can help. Speak to our Specialist Nurses * * Calls are recorded for training purposes only. Confidentiality is maintained between callers and Prostate Cancer UK.

39 Specialist Nurses Other useful organisations Citizens Advice Bureau Online advice Advice on a wide range of issues including financial and legal matters. Find your nearest Citizens Advice Bureau in the phonebook or online. Health in Wales Information about health and health services in Wales. Provides information about making a complaint about NHS services in Wales. Healthtalkonline Watch, listen to, or read personal experiences of men with prostate cancer and other medical conditions. NHS Choices Information about conditions, treatments and lifestyle, and a directory of health services in England. Provides information about making a complaint about your GP. NHS National Services Scotland Supports the NHS in Scotland. Provides information about making a complaint about NHS services in Scotland.

40 40 Understanding the PSA test A guide for men concerned about prostate cancer NHS Shared Decision Making sdm.rightcare.nhs.uk Decision aids to help people make difficult decisions about their healthcare. Includes a decision aid to help men decide whether to have a PSA test and to help them discuss this with their GP. nidirect Information about government services in Northern Ireland, including health services. Provides information about making a complaint about NHS services in Northern Ireland. Prostate Cancer Risk Management Programme NHS information about the pros and cons of the PSA test for diagnosing prostate cancer.

41 Specialist Nurses About Prostate Cancer UK Prostate Cancer UK fights to help more men survive prostate cancer and deal with other prostate diseases so they can enjoy a better life. We support men by providing vital information and services. We find answers by funding research into causes and treatments and we lead change, raising the profile of all prostate diseases and improving care. We believe that men deserve better. At Prostate Cancer UK, we take great care to provide up-to-date, unbiased and accurate facts about prostate diseases. We hope these will add to the medical advice you have had and help you to make decisions. Our services are not intended to replace advice from your doctor. References to sources of information used in the production of this booklet are available at This publication was written and edited by: Prostate Cancer UK s Information Team. It was reviewed by: James Catto, Professor of Urology, University of Sheffield Mr Vincent J Gnanapragasam, University Lecturer in Uro-oncology & Honorary Consultant Urological Surgeon, University of Cambridge Mike James, Consultant Urologist, Chesterfield Hospital, Derbyshire Lyn Kirkwood, CNS Urology, Continence and Stoma, Weston General Hospital, Weston-super-Mare Chris Parker, Consultant Clinical Oncologist and Honorary Reader, Royal Marsden Hospital and Institute of Cancer Research

42 42 Understanding the PSA test A guide for men concerned about prostate cancer James Phillips, GP Principal, Maclean Medical Practice, Glasgow Jonathan Rees, GP with a special interest in Urology and Men's Health, Backwell and Nailsea Medical Group, Bristol Bruce Turner, Uro-oncology Nurse Practioner, Homerton Univeristy Hospital NHS Foundation Trust and Bart's Health NHS Trust, London Karen Wilkinson, Urology Nurse Specialist, Barts Health NHS Trust, London Prostate Cancer UK Volunteers Prostate Cancer UK Specialist Nurses

43 Specialist Nurses Donate today help others like you Did you find this information useful? Would you like to help others in your situation access the facts they need? Every year, 40,000 men face a prostate cancer diagnosis and millions more face other prostate diseases. Thanks to our generous supporters, we offer information free to all who need it. If you would like to help us continue this service, please consider making a donation. Your gift could fund the following services: 10 could buy a Tool Kit a set of fact sheets, tailored to the needs of each man with vital information on diagnosis, treatment and lifestyle. 25 could give a man diagnosed with a prostate problem unlimited time to talk over treatment options with one of our specialist nurses. To make a donation of any amount, please call us on , visit /donations or text PROSTATE to 70004*. There are many other ways to support us. For more details please visit /get-involved *You can donate up to 10 via SMS and we will receive 100% of your donation. Texts are charged at your standard rate. For full terms and conditions and more information, please visit /terms/terms

44 Speak to our Specialist Nurses * Like us on Facebook: Prostate Cancer UK Follow us on Prostate Cancer UK July 2014 To be reviewed July 2016 Call our Specialist Nurses from Mon to Fri 9am - 6pm, Wed 10am - 8pm * Calls are recorded for training purposes only. Confidentiality is maintained between callers and Prostate Cancer UK. Prostate Cancer UK is a registered charity in England and Wales ( ) and in Scotland (SC039332). Registered company number PSA/JUL14

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