Prostate Specific Antigen (PSA) Blood Test

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1 TO PROVIDE THE VERY BEST CARE FOR EACH PATIENT ON EVERY OCCASION Prostate Specific Antigen (PSA) Blood Test An information guide

2 Prostate Specific Antigen (PSA) Blood Test Prostate Specific Antigen (PSA) The Blood PSA Test blood test for prostate cancer This The PSA leaflet blood is to test help for prostate you to decide cancer whether or not to have the PSA blood test for prostate cancer. You may be experiencing prostate This leaflet is to help you to decide whether or not to have the symptoms PSA blood test and for prostate be considering cancer. You taking may be experiencing the test, or have no symptoms at prostate all but symptoms want to and check be considering that you taking don t the test, have or have prostate cancer. There are no symptoms advantages at all but and want disadvantages to check that you to don t having have the test, the details of prostate cancer. There are advantages and disadvantages to which follow below: having the test, the details of which follow below: What is the prostate gland? What is the prostate gland? The prostate is a gland which is only found in men. It sits just below the base of the bladder. It is usually about the size of a walnut. When you pass urine it flows through a tube (the urethra). The urethra passes through the prostate before reaching the penis. This is why some men experience problems with urinating when they have an enlarged prostate. The prostate produces fluid that helps to make semen and helps to nourish sperm, although most semen is made by the seminal vesicles. The prostate is a gland which is only found in men. It sits just below the base of the bladder. It is usually about the size of a walnut. When you pass urine it flows through a tube (the urethra). The urethra passes through the prostate before reaching the penis. This is why some men experience problems with urinating when they have an enlarged prostate. The prostate produces fluid that helps to make semen and helps to nourish sperm, although most semen is 2 made by the seminal vesicles. What can go wrong with the prostate? As men get older, the prostate gland increases in size. Benign prostatic hyperplasia (BPH) is the most common problem of prostate enlargement. BPH is not cancer. By the age of 70 2

3 approximately 8 in 10 men will have an enlarged prostate gland. This may cause symptoms such as:- difficulty (and/or) pain in passing urine frequency (and/or) urgency in urination a poor flow of urine starting and stopping while urinating dribbling urine a feeling of incomplete emptying of the bladder. The other main condition which can affect the prostate is cancer. Prostate cancer is more common in older men. In the UK approximately 22,000 men each year are diagnosed with the disease. It is rare in men under 50 but 4 out of 10 men who are 70 years or older will have prostate cancer. However most of them will live their whole lives without this affecting them, or ever being diagnosed. Prostate cancer can be present for many years without you realising, as in many cases the cancer is slow growing and can take some years to cause any symptoms. However some prostate cancers can be aggressive and spread to other parts of the body (metastasise). The causes are unknown. It is more common in some ethnic groups and there is evidence that it runs in families. What is the PSA test and why have it done? The PSA stands for prostate specific antigen. It is a blood test that measures the level of PSA in the blood stream. PSA is a protein made by the prostate and some of it leaks into the blood. You may consider having this test if you are experiencing prostate symptoms. About 80% of men with prostate cancer at the time of diagnosis will have a raised PSA. However, only 1 in 4 men with a PSA level between 4 and 10 micrograms per litre have prostate cancer. Some men without prostate symptoms consider taking the test to screen for prostate cancer. However, with both the above 3

4 situations the decision to have a PSA test can be controversial, as there are pros and cons to doing so. How reliable is it? the PSA blood test is not a foolproof test for prostate cancer two out of three men with a raised PSA level will not have any cancer cells in biopsies of their prostate up to 20% of men with prostate cancer will have a normal PSA result. Advantages and disadvantages of the PSA Test Possible benefits it can help to detect prostate cancer before any symptoms develop treatment in the early stages of prostate cancer could help you live longer and avoid the complications of cancer (although there is no good evidence that this is so) it may provide reassurance if the test result is normal. Possible disadvantages it may detect a slow growing cancer that may never cause symptoms nor shorten your life span; however, the cancer diagnosis may cause significant anxiety which can affect your quality of life it may lead you to undergo treatment(s) for early prostate cancer that may not help you live longer. The main treatments for early prostate cancer do carry risks and can cause distressing side-effects:- it can miss cancer in the prostate and give false reassurance it may cause anxiety and lead to a biopsy when you have no cancer. The decision should be taken by yourself along with your 4

5 G.P and/or Urologist who can give further advice and know your particular medical history and circumstances. What does the PSA test tell me about prostate cancer? There are various reasons for a raised PSA level. A high PSA does not necessarily mean you have prostate cancer, whereas a lower level does not necessarily mean you do not! The PSA level can be raised for the reasons stated below, not just prostate cancer infections a urinary catheter (a tube to drain urine) urinary retention (not being able to pass urine) ejaculation recent prostate biopsies prolonged exercise, such as long distance running or cycling prostate or bladder surgery some drugs such as Finasteride (Proscar) or Dutasteride (Avodart) can affect the PSA level. It is important to tell your doctor about any medicines/drugs you are taking. What will happen if my PSA level is high? If your PSA level is raised you may be referred to a Urologist/ Urology department for more tests. Prostate cancer is usually diagnosed from the results of several tests. There are no hard and fast rules and sometimes even the experts do not agree on the next step forward. This usually depends on:- how high the PSA level is your personal risk of prostate cancer your symptoms. If your PSA level is high you will probably need to undergo prostatic biopsies. This is because usually a definite diagnosis of prostate 5

6 cancer can only be made by taking prostate cells and then looking at them under a microscope. The procedure to take these biopsies involves an ultrasound scan machine that helps to guide a plastic probe into the rectum. This scans the prostate gland and assists in guiding a needle into the wall of the rectum via the probe to take samples of the prostate. This test can be uncomfortable or painful, although some men experience very little discomfort. You may need a local anaesthetic injection or entonox gas to help with any of the discomfort/pain. Trans-rectal ultrasound scan & prostate biopsies: risks There is a small chance of introducing infection into the prostate during the investigation. Occasionally this can be serious. You will be given antibiotics before and after the procedure in an attempt to prevent this. 3% of men need a second course of antibiotics and 1% require hospital admission for intravenous antibiotics (given by a drip into the vein). Some men experience bleeding in the urine, semen and from the back passage, which can last for approximately 3 weeks afterwards. The risk of death from a prostatic biopsy is less than 1 in 10,000. The biopsies are not always 100% accurate. Should the results not show any cancer cells this does not completely rule out cancer. In approximately 20% of men who have cancer of the prostate the biopsies miss the cancer; therefore, you may require further PSA tests and biopsies to monitor the prostate. Early prostate cancer The PSA test may pick up a prostate cancer early; however, there is no certainty that treating early prostate cancer helps men live any longer. There is still some disagreement amongst the experts as to when to treat and what the best treatment is. Most men with early prostate cancer will not die from it, particularly if they are in their seventies or eighties, or those with a slow growing cancer. Some of the treatments for prostate cancer, such as radiotherapy and 6

7 surgery, can cause side effects which include incontinence, erection problems and damage to the back passage (rectum). This is also worth considering. Further help and information Prostate UK 10 Northfields Prospect, Putney Bridge Road, London SW18 1PE. Telephone: Prostate Cancer Support Association BM Box 9434, London WC1N 3XX. National Helpline: Macmillan Telephone

8 If English is not your frst language and you need help, please contact the Ethnic Health Team on Jeżeli angielski nie jest twoim pierwszym językiem i potrzebujesz pomocy proszę skontaktować się z załogą Ethnic Health pod numerem telefonu For general enquiries please contact the Patient Advice and Liaison Service (PALS) on For enquiries regarding clinic appointments, clinical care and treatment please contact and the Switchboard Operator will put you through to the correct department / service Date of publication: December 2008 Date of review: March 2014 Date of next review: March 2017 Ref: PI_SU_500 The Pennine Acute Hospitals NHS Trust Wood pulp sourced from sustainable forests