Screening for prostate cancer
This page tells you about the screening for prostate cancer. There is information about
- A quick guide to what's on this page
- The aim of cancer screening
- Why there is no prostate screening programme
- The PSA test
- Possible benefits of the PSA test
- Risks of the PSA test
PSA testing for prostate cancer
At the moment, there is no national screening programme for prostate cancer in the UK. Before we can screen for a disease, there must be an accurate test to use. Some trials have shown that using a test for prostate specific antigen protein (PSA) to screen for prostate cancer may reduce deaths from the disease. But other trials have shown no benefit. And a review of all the trials together showed no benefit.
PSA levels in the blood may be raised in prostate cancer. But PSA can be raised for other reasons, such as infection or an enlarged prostate that is not cancer. So the PSA test is not reliable enough to use in a screening programme.
Many prostate cancers grow very slowly and may never cause any problems in a man's lifetime. If these cancers are found through screening, it can lead to men having unnecessary tests or treatments that can severely reduce their quality of life. Problems caused by treatments may include problems with bladder control (incontinence) or problems getting an erection (impotence). So, the disadvantages of screening outweigh the benefits.
If you want a PSA test
If you are over 50 and want to have a PSA test, you can ask your GP. They will talk you through the benefits and possible harms. After the discussion, if you still want to have the test, your doctor will take a blood sample to test your PSA levels. They may also examine your prostate by putting a gloved finger into your back passage and feeling the prostate gland. This is called a digital rectal examination or DRE.
Clinical trials are still looking into tests that we may be able to use for prostate screening in the future.
If you are at higher risk of prostate cancer
You may be at a higher risk of developing prostate cancer if you
- Have close relatives with prostate cancer
- Have inherited a faulty gene
- Are of black-African or black-Caribbean heritage
You may be able to have regular checks with a PSA test or rectal examination from the age of 40 to 45. These regular tests may lead to treatment for a cancer that would never cause any problems. Your doctor can tell you about the possible benefits and harms.
You can view and print the quick guides for all the pages in the About prostate cancer section.
Screening means looking for early signs of a particular disease in healthy people who don't have any symptoms. The aim of screening is to diagnose disease at an early stage before symptoms start. It is then easier to treat and more likely to be cured.
To have a prostate cancer screening programme we would need a test that can reliably find cancers that would cause problems during a man's lifetime. There is a test called the PSA test that can help doctors work out how likely a man is to have prostate cancer. But this test is not specific enough to use as part of a national screening programme. There currently is no clear evidence that screening using PSA testing could save lives. And we do know that the test can lead to tests and treatment for some men that cause harm.
Research studies into using the PSA test for prostate cancer screening have had conflicting results. So we don't know whether screening would help to reduce deaths from prostate cancer.
Many prostate cancers grow very slowly and may be present for years before they are found. This type of cancer may not cause any symptoms or problems at all during a man's lifetime. PSA testing can pick up some of these cancers and may lead to tests and treatment that the man doesn't need. The treatments can cause side effects such as problems with bladder control (incontinence) or problems with getting a erection (impotence).
By the age of 80, many men will have some cancer cells in their prostate, but only 1 in 25 of them will actually die from prostate cancer. On the other hand, some prostate cancers are faster growing and can spread to other parts of the body within a few years. For screening to be most helpful, it would only pick up prostate cancers that are faster growing and likely to be a threat to a man's health. But there is currently no test that can reliably do this.
PSA stands for prostate specific antigen. It is a protein produced by prostate cells and can be measured with a blood test.
PSA levels can be raised if a man has prostate cancer. But the levels can also be raised when a man has other medical conditions, such as an enlarged prostate that is not cancer called benign prostatic hyperplasia or BPH.
PSA can also be raised by prostate infection (prostatitis), exercise and sex. Some drugs used to treat a benign enlarged prostate can lower PSA.
Another problem is that all men have slightly different PSA levels. So it is hard to say what is normal, and what is high. This means that not all men with high PSA have prostate cancer. And not all men with prostate cancer have high PSA levels.
- A PSA level of 4 or lower is usually considered normal but some men with this reading will have prostate cancer
- A PSA between 4 and about 10 is usually caused by an enlarged prostate, not cancer. But some men with this reading will have prostate cancer
- A PSA level above 10 is a sign that cancer is more likely to be present. But it can also be caused by an enlarged prostate that is not cancer
Generally speaking, the higher the PSA level, the more likely it is that there is a cancer in the prostate. But in early prostate cancer, PSA levels are usually relatively low. It is not possible to pick out a particular PSA reading and say “people above this level have cancer and those below don't”. The PSA level also naturally tends to get higher as men get older.
The PSA test may help to find some prostate cancers early before any symptoms develop.
Treating prostate cancer in the early stages may save some men's lives but the evidence for this is not clear.
Finding prostate cancer early may help to avoid the problems of a more advanced cancer, such as symptoms due to cancer spread.
The PSA test can't really tell us clearly whether a man has prostate cancer. It misses some cancers. So some men with a normal reading will have cancer but will be falsely reassured that they don't.
Up to 2 out of 3 men with raised PSA levels don't have cancer and will have unnecessary worry and tests.
Men with a high PSA reading will need further tests such as a prostate biopsy. These tests can be uncomfortable and many men find them embarrassing. They also have risks. Some men who have a needle biopsy will have infection or ongoing bleeding afterwards.
The test can pick up very slowly growing cancers that would never cause any problems or symptoms in a man's lifetime. This is called overdiagnosis. Doctors can't always tell which cancers will grow quickly and which will grow slowly. If a cancer is diagnosed and treated, the treatment can cause side effects for some men that may greatly reduce their quality of life. Possible side effects include difficulty getting an erection (impotence) and leaking of urine (incontinence). So some men will have treatment for a cancer that would not have caused them any problems. This is called overtreatment.
Although there is no prostate screening programme, men aged over 50 can ask their GP for a PSA test. This is part of the UK Prostate Cancer Risk Management programme.
If you ask to have the test your GP first explains all the possible benefits and risks. They give you written information to read. Your doctor or practice nurse can answer any questions that you have.
If you still want to have the test after considering the information, your GP or practice nurse will take a blood sample.
If you have the test you should not have
- A urine infection
- Ejaculated for 48 hours beforehand
- Exercised heavily in the previous 48 hours
- Had a prostate biopsy within the last 6 weeks
These things may raise your PSA level.
Your GP may also examine your prostate. They do this by gently putting a gloved finger into your back passage (bottom) and feeling your prostate gland. They call this digital rectal examination or DRE.
You usually get your PSA test result within a couple of weeks.
If you have a normal PSA level, experts currently think that you don't need another test for at least 2 years.
If your PSA level is slightly raised, you should have a repeat test 1 to 3 months later to see if the PSA level is going up or is stable. There are guidelines for GPs about what to do in these circumstances.
If you have a raised PSA, your doctor will refer you to a specialist for further tests. These tests include an examination of your prostate gland and possibly a prostate biopsy. We have detailed information about prostate cancer tests.
Some men may start having regular PSA tests at an earlier age if they have an increased risk of developing prostate cancer.
If you have family members with prostate cancer
There is some evidence to show that prostate cancer can run in families. This means that if you have a relative diagnosed with prostate cancer, your risk is higher than in the general population. Your risk is higher if
- It is your brother who was diagnosed
- The relative was younger than 60 when they were diagnosed
- You have several relatives diagnosed with prostate cancer
Currently doctors don’t know the best way to monitor people who are at high risk. But if you have a family history of prostate cancer, you may want to discuss screening with your GP. They will look at your family history and the ages of your relatives when they were diagnosed.
If you have a strong family history of prostate cancer your GP may suggest that you have regular PSA tests and examinations of the prostate gland. They may refer you to a genetics clinic if they think that may be helpful.
If you are black-African or black-Caribbean
Men of black-African or black-Caribbean heritage have an increased risk of prostate cancer. You can talk to your GP about the possible risks and benefits of having a PSA test.
A lot of research has been carried out into prostate cancer screening in recent years. A review of 6 large prostate cancer screening trials reported in 2010. It found that screening increased the number of men diagnosed with early stage prostate cancer. But screening didn't reduce deaths from prostate cancer. A 20 year Swedish study reported in 2011. It also found that prostate cancer screening in the general population has very limited benefit.
The European Randomised Study of Screening for Prostate Cancer (ERSPC) was set up in 1991 and is still going on. For this study, 182,000 European men aged 50 to 74 were divided into 2 groups. One group was offered PSA screening on average every 4 years. The other group did not have screening. The latest findings were published in 2014.
The ERSPC study found that fewer men died from prostate cancer when they had screening. But many doctors and researchers feel that it still doesn't tell us whether this benefit outweighs the side effects of treatment, such as impotence and incontinence. The screening also used a lot of resources. The researchers said that to prevent one death from prostate cancer over the 11 years, 1,055 men had to be invited for screening, with 37 cancers being found.
A similar study in the US is called the Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening trial. For prostate cancer it involved 76,000 men aged 55 to 74. Half of the men in the study were offered a yearly PSA test for 6 years. After 10 years the researchers found that more men in the screening group were diagnosed with prostate cancer than in the other group. But the number of men in each group who died was very similar.
So currently it does not look as though it is helpful to regularly screen men for prostate cancer. Researchers are trying to find tests that are better than the PSA test in the hope that this will make screening more helpful.
You can read about these tests on the research into diagnosing prostate cancer page.
Research into screening for men at higher risk
Currently doctors don't know the best way to follow people up who are at higher risk of prostate cancer. A UK trial called IMPACT aims to find out how best to monitor men who have inherited a gene change that increases their risk. The trial is giving yearly PSA tests to 1,700 men who have inherited faulty BRCA1 or BRCA2 genes.
Early results of the IMPACT trial were released in September 2010 for the first 300 men. The results show that regular PSA screening may be helpful for men at higher risk of prostate cancer. It found that men with faulty BRCA genes who developed prostate cancer tended to have faster growing cancers than men without the faulty genes.
These are early results and it will be some time before we know the final results of this trial. The researchers need to monitor the men for at least 5 years.
You can find out more about the IMPACT trial.
You can also find out about trials into prostate cancer screening on our clinical trials database.
We have information about clinical trials for prostate cancer on our clinical trials database.
You can find further information and resources such as DVDs on the NHS prostate cancer risk management website.
Even if you have had a normal PSA test it is still important to be aware of any changes in your body that could be due to prostate cancer. You can look at our information about the symptoms of prostate cancer.
See your doctor if you have any changes. They can arrange for tests if necessary.
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