Summary

  • There are two common tests for prostate cancer: a digital rectal examination and a prostate-specific antigen blood test. Neither of these is completely accurate.
  • A biopsy of some prostate tissue may be needed to confirm a diagnosis of prostate cancer.
  • It is not recommended that all men are routinely tested for prostate cancer – men with a family history of prostate cancer, or men who have had an elevated test result in the past will benefit most from regular testing.
  • Discuss the benefits and limitations of prostate cancer testing and treatment with your doctor before having a PSA test.

The two common tests for prostate cancer are a digital rectal examination (DRE) and a prostate-specific antigen (PSA) blood test. Neither of these is completely accurate, so it is recommended to have both if you decide to be tested for prostate cancer. If the tests suggest there is a problem, your doctor may repeat the test or refer you to a specialist. A biopsy (removal of some prostate tissue) may be needed to confirm a suspected diagnosis.

Discuss testing with your doctor. It is not recommended that all men are routinely tested for prostate cancer. You will need to consider the benefits, risks and uncertainties of testing, as well as your own risk of developing the disease.

PSA test for prostate cancer

The prostate gland makes a protein called PSA. This protein helps to nourish sperm. Normally, only tiny amounts of it enter the bloodstream.

Cancer cells in the prostate interfere with proper functioning and can cause large amounts of PSA to enter the bloodstream. Therefore, when high levels of PSA are detected in the bloodstream, this may indicate cancer.

Early prostate cancer often has no symptoms. However, high PSA levels can occur five to 10 years before the onset of prostate cancer symptoms. In such circumstances, the PSA test can help to indicate the presence of cancer at an early stage.

Other tests are needed to confirm a diagnosis because an abnormal PSA test can be due to non-cancerous causes. Equally, it is possible for a man to have a normal PSA level when cancer is present.

Normal PSA levels

The prostate slowly enlarges with age, and the production of PSA will also rise. Generally, the healthy upper limits of PSA levels in the blood increase with age. One study suggests they may be between two and 5.6 ng/ml (nanograms per millilitre) in men over 40 years. It is usually recommended that a PSA level of greater than 4 ng/ml should be followed up with further tests.

Other factors that influence PSA levels

The PSA blood test alone cannot diagnose prostate cancer. It is possible, although rare, to have prostate cancer without raised PSA levels in the blood. A higher-than-normal PSA level doesn’t automatically indicate prostate cancer either. A high PSA level is due to cancer in around one in three cases.

PSA can be raised by other factors, including:

  • infection of the prostate (prostatitis)
  • benign prostatic hyperplasia (BPH), also known as benign prostatic enlargement (BPE).

For this reason, the PSA blood test isn’t used in isolation when checking for prostate cancer. 

DRE test for prostate cancer

As the PSA test is not a reliable indicator of prostate cancer on its own, a digital rectal examination (DRE) is usually also recommended – the doctor inserts their gloved finger into your rectum (back passage) to check for enlargement of the prostate gland or other changes.

Further tests for prostate cancer

If results of the PSA test or the DRE are abnormal, a urologist will likely recommend a biopsy, where small samples of tissue are removed from the prostate and examined.

If cancer is diagnosed, other tests may be used to check the progression of the cancer, including:

  • magnetic resonance imaging (MRI) scan of the prostate – often done before a biopsy
  • bone scan – to check whether or not cancer cells have travelled to the bones
  • computed tomography (CT) scan – a specialised x-ray
  • pelvic lymph node dissection – a nearby lymph node is removed and examined to check whether or not cancer cells have entered the lymphatic system (this is only done during surgery on the prostate).

Discuss prostate cancer testing with your doctor

Medical authorities do not recommend that all men should be tested for prostate cancer. In fact, most authorities suggest that men should make their own choice about whether or not to have a PSA test.

While we now have some evidence that regular testing may prevent prostate cancer deaths, there are concerns that many men may be diagnosed and treated unnecessarily as a result of being screened, with a high cost to their health and quality of life (such as incontinence and impotence). However, the option of active surveillance, where a low-risk cancer is watched closely instead of being treated, helps to lower these risks.

Some men prefer to have a test anyway, to reassure themselves. One approach now recommended by the Urological Society of Australia and New Zealand is to have a single PSA test at age 40. The results of the test might give an indication of risk from prostate cancer over the following 15 to 20 years.

Men with a family history of prostate cancer (a father or brother diagnosed at an early age) or men who have previously had an elevated test result are at higher risk and may also consider a test. Ultimately, it is a decision only you can make, but your doctor can help you with information and support.

If you are unsure after considering the benefits and uncertainties of testing and your own risk from the disease, discuss it with your doctor.

If you choose to be tested for prostate cancer, both a PSA test and DRE are recommended to give the best chance of detecting the cancer. In Australia, these tests are covered by Medicare.

Monitoring prostate cancer

After a diagnosis of cancer, regular PSA blood tests are used to monitor the cancer activity in a man’s body. Generally, prostate cancer causes PSA levels in the blood to get higher as the tumour grows. Regular blood tests can indicate whether the tumour is shrinking or enlarging, and whether the current treatment is working or not.

Where to get help

  • Your doctor
  • Urology specialist
  • Cancer Council Victoria Helpline, which can link you to prostate cancer support groups Tel. 13 11 20
  • Multilingual Cancer Information Line, Victoria Tel. 13 14 50

Things to remember

  • There are two common tests for prostate cancer: a digital rectal examination and a prostate-specific antigen blood test. Neither of these is completely accurate.
  • A biopsy of some prostate tissue may be needed to confirm a diagnosis of prostate cancer.
  • It is not recommended that all men are routinely tested for prostate cancer – men with a family history of prostate cancer, or men who have had an elevated test result in the past will benefit most from regular testing.
  • Discuss the benefits and limitations of prostate cancer testing and treatment with your doctor before having a PSA test.
References
  • Baade PD, Steginga SK, Aitken JF, et al. 2005, ‘Communicating prostate cancer risk: what should we be telling our patients?’, Medical Journal of Australia, vol. 182, no. 9, pp. 472–475. More information here.
  • USANZ 2009 PSA testing policy, 2009, Urological Society of Australia and New Zealand. More information here.
  • Schröder FH, Hugosson J, Roobol MJ, et al. 2009, ‘Screening and prostate-cancer mortality in a randomized European study’,New England Journal of Medicine, vol. 360, no. 13, pp. 1320–1328. More information here.
  • Diagnosing prostate cancer, 2010, Cancer Council Victoria. More information here.
  • Prostate cancer screening: joint key messages, 2010, Australian Health Ministers’ Advisory Council and Cancer Council Australia. More information here.
  • Draft clinical practice guidelines PSA Testing and Early Management of Test-Detected Prostate Cancer, Prostate Cancer Foundation of Australia and Cancer Council Australia PSA Testing Guidelines Expert Advisory Panel. Cancer Council Australia. More information here.

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Last updated: March 2015

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