What is a PSA Test and Should All Men Have One?

PSA stands for prostate specific antigen – a protein produced by the male prostate gland which plays a role in nourishing the sperm. A PSA test is a blood test to determine if PSA levels in the blood are elevated – which may indicate prostate cancer or alternately another problem with the prostate gland.

Prostate diseases

While prostate cancer may be the disease of the prostate that we tend to hear the most about, other non-cancerous prostate problems can also occur. These include:
•    Prostatitis – acute or chronic bacterial infection of the prostate.
•    Chronic non-bacterial prostatitis.
•    Sterile pyuria – elevated white cells in the urine.
•    Non-cancerous enlargement of the prostate.

So as you can see, prostate cancer is not the only concern. However, when having a PSA test done, the aim is usually to detect if cancer might be present.

How common is prostate cancer?

This cancer is rare in the under-50s, even though it is the commonest type of cancer in Australian men apart from certain skin cancers. According to the federal government, approximately 20,000 men are diagnosed with the disease each year in Australia, and this is expected to rise over time. The most common risk factors are advancing age and genetic predisposition. Around 60% of men with the disease are older than 65.

What can a PSA test show?

Normally, only small amounts of PSA enter the bloodstream. Where the PSA reading is higher than 4ng/ml, a follow-up might be recommended.

A PSA test is not enough on its own to determine if prostate cancer is present – often a digital rectal examination (DRE) is performed as well for confirmation. Other tests may include a biopsy, MRI, and / or a CT scan.

For older men – those over 70 – testing and treatment is not always recommended, especially if it is considered they are likely to die of other causes within a few years. Prostate cancer treatments can have a number of side effects – including damaged nerves and muscles, urinary incontinence, erectile dysfunction and reduced libido. For an older man who is asymptomatic, it may not be worth the risk involved.

What treatments are available?

The type of treatment recommended will depend on the age and health of the patient and how advanced the cancer is. Treatments include surveillance, radiotherapy, surgery, androgen-deprivation therapy, chemotherapy, brachytherapy, and high-intensity focused ultrasound. With some patients, surveillance or watchful waiting may well be the main course of action recommended – especially for older men or where the cancer is low-grade and do not appear to be advancing.

Should all men have a regular PSA test?

As indicated earlier, PSA levels can become elevated for any number of reasons. In addition, testing can sometimes result in false positives, which can lead to undue anxiety and even unnecessary treatments or procedures that do not necessarily improve the patient’s quality of life.

The current guidelines for men without symptoms recommend testing every two years for men aged 50-69, and only for those that genuinely want the test and who understand all the risks and benefits involved. PSA testing is not recommended for men who are likely to die from any cause within seven years.

So in a nutshell, broad-based PSA for men is not recommended. However men with symptoms such as an increased need to urinate especially during the night, difficulty urinating, or a feeling of the bladder not being completely emptied after going to the toilet, should speak to their medical practitioner about their symptoms and about the options that are available to them.