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DIAGNOSIS AND TESTS - When you see your GP

The PSA blood test

Prostate-Specific Antigen (PSA): A blood test that measures a protein manufactured solely by prostate gland cells. A raised reading indicates an abnormal condition of the prostate gland, either benign or malignant. It is currently the most sensitive marker for the identification and monitoring of prostate cancer cells.

Make sure that you obtain a copy of the results and do not accept merely being told it is "satisfactory". Record your results and draw them to your GPs attention if succeeding results increase year on year.

PSA levels often increase with age because of benign growth of the prostate (BPH).

http://www.bbc.co.uk/health/conditions/bph1.shtml

and this increases with age and so the referral values for PSA are age related.

In other words, if you are in the age range 50-59 and your PSA is over 3.0 then the official advice is that your GP should refer you to hospital.

The table shows that benign growth of the prostate causes a slow steady increase in PSA levels. However, prostate cancer can cause a much faster increase, depending on the aggressiveness of the cancer. Therefore, it is also important that the rate of change of PSA levels should be monitored.

At the same time your doctor will usually carry out a Digital Rectal Examination (DRE). For this procedure the physician inserts a gloved, lubricated finger into the rectum to feel the outside of the prostate gland for signs of cancer. Unfortunately, many early prostate cancers cannot be detected by DRE.

PSA  screening is controversial

Unlike many countries in Europe, there is no national Prostate Screening Programme in the UK. In France, for example, all men over 50 are tested annually.

Instead the Department of Health has established a Prostate Cancer Risk Management Programme to help men decide to have a PSA test or not.  You can ask your GP for information about the advantages and disadvantages of the PSA test and if you want one you can ask your GP for one.  You are entitled to have a PSA test if you are aged over 50, or if you have an increased risk of prostate cancer.

In the UK, the official argument is that "To date there is no good evidence to say whether or not screening healthy asymptomatic men would reduce mortality from prostate cancer". However, in our view, screening would result in earlier diagnosis of prostate cancer and earlier treatment of cancers is more likely to be successful. Therefore, this should reduce mortalities from prostate cancer, although there would be a delay until the scientific evidence has finally been collected to establish this. It is also clear that earlier treatment of prostate cancers will lead to greater longevity for prostate cancer patients, where the disease ultimately causes their death. Women fought for and achieved screening programmes for breast and cervical cancer, many years ago, in order to obtain early diagnosis and more successful treatment.

In a series of 3675 PSA tests on volunteers between April 2004 and December 2007 (conducted by Kidderminster Prostate Cancer Support Group and the Graham Fulford Charitable Trust) 6% showed PSA levels raised sufficiently to warrant further examination and half of these were subsequently diagnosed with prostate cancer.

If PSA levels are very high then this is strongly indicative of prostate cancer. The position is not so clear when the PSA is only mildly raised. With regular PSA tests a patient and his doctor can tell whether the rate of change of the reading is increasing (whether the time for the reading to double is getting shorter).  This rate of change (or acceleration) is acknowledged by researchers as being a guide to the presence of multiplying cancerous prostate cells.

Prostate cancer is a major cause of mortality today and men should not allow themselves to be dissuaded from taking it seriously.

PROSPECT supports screening for prostate cancer for men.

Some GPs are dissuaded from giving PSA tests to men who do not have symptoms. Our experience is that this can extend to reluctance to giving PSA tests to men with symptoms. This can often lead to a delay of years between the initial symptoms and the diagnosis of cancer.

Under the NHS you can demand PSA tests whatever your GP says.