Prostate Specific Antigen (PSA) Test for Prostate Cancer

The Prostate Specific Antigen (PSA) test is a simple blood test that measures the level of prostate specific antigen in the blood, and helps to detect and monitor prostate cancer. If you have recently had a PSA test or are considering having it done, here we provide an overview about what’s involved, the benefits and risks of having the test and where to go for more information from reliable Australian sources.

What is the Prostate Specific Antigen (PSA)?

The prostate gland produces a protein called the Prostate Specific Antigen (PSA) which has the main function of nourishing semen. Small amounts of this protein can also be detected in the bloodstream. If cancer cells are present in the prostate, they can interfere with its proper functioning and cause large amounts of PSA to enter the bloodstream. Therefore, high levels of PSA in the blood can be an indicator of prostate cancer.

Should I have the PSA test?

If you have clear symptoms or a family history of prostate cancer, your GP may recommend having the PSA test to screen for prostate cancer.  If you are healthy, aged 50-69 years with no signs or symptoms, and have no family history of prostate cancer; your GP may not necessarily screen you for prostate cancer or ask you to have the PSA test.

However, you can still request to be tested.

The Cancer Council Guidelines acknowledges it’s a “hard decision” for men to decide whether or not to have the PSA test. In fact, there is much debate and controversy about PSA testing.  So what considerations should you take into account before having the test?

What do I need to consider?

The benefit of a PSA test is that it can detect prostate cancer early and therefore be monitored and treated quickly.  However, an elevated PSA level does not necessarily mean you have prostate cancer. Similarly, you might have prostate cancer but your PSA result is normal. PSA testing can also lead to the ‘over-diagnosis’ of some cancers that might never have caused problems and would not have otherwise been diagnosed if there were no symptoms.    

In response to these concerns, The Royal Australian College of General Practitioners (RACGP) have produced a patient information sheet Should I have prostate cancer screening? to help men consider and discuss the benefits and risks of PSA testing.

Will I need regular PSA testing?

The Prostate Cancer Foundation Australia (PCFA) and Cancer Council Australia have produced clinical practice guidelines which recommend the frequency of PSA testing.   The key points are:

Men at average risk of prostate cancer who decide to undergo regular testing should be offered PSA testing every 2 years from age 50 to 69.

Men with a family history of prostate cancer who decide to be tested should be offered PSA testing every 2 years from age 40/45 to 69, with the starting age depending on the strength of their family history.

For men aged 70 and older, the risks of PSA testing may outweigh the benefits.

How much does it cost?

Medicare reimbursement of PSA tests depends on how the test is being used. Medicare will pay for one test per patient per year. An asymptomatic (i.e. no symptoms) male is entitled to one PSA screening test within a 12 month period. Any additional screening tests requested within this period is privately billed. For those diagnosed with prostate cancer, Medicare will reimburse multiple PSA tests within a year for monitoring purposes. Read this Pathology Fact Sheet for more information.

There is currently no government-sponsored prostate screening program in Australia unlike those available for breast, bowel or cervical cancers.

How is the test done?

The PSA test is a simple blood test organised by your doctor. Blood is taken from your vein – usually in the arm – and sent to the pathology lab for analysis.

Do I need to prepare for the test?

No special preparation is required; however certain factors can temporarily raise your PSA level. RACGP guidelines recommend that tests should not be taken within 24 hours of ejaculation or after vigorous physical activities such as bike riding.

What is considered ‘normal’ and ‘abnormal’ levels?

A ‘normal’ PSA level is dependent on age and typically increases as men get older since the prostate becomes enlarged with age. There is no specific cut-off point between a normal and abnormal PSA result. As a general guide, Labs Tests Online outline the following:

Total PSA levels greater than 10.0 µg/L may indicate a high probability of prostate cancer. Levels between 4.0 µg/L and 10.0 µg/L may indicate non-cancerous conditions (e.g. Benign Prostatic Hypertrophy, Prostatitis) or prostate cancer.

What factors can produce an abnormal result?

A high PSA result can be due to a variety of reasons including non-cancerous prostate conditions:

Benign Prostatic Hypertrophy (BPH): enlargement of the prostate
Prostatitis: swelling of the prostate due to infection
Urinary Tract Infection (UTI)

Other factors can affect PSA levels:

Vigorous exercise and bike riding
Recent sexual activity
Certain medications
A recent pelvic injury
Medical treatment such as a prostate biopsy, examination or surgery

It is recommended that the test is repeated after 1–3 months if results are markedly different from that expected.  Your doctor may consider other tests including age specific reference ranges, PSA velocity and free-to-total PSA.

Will I need to have a Digital Rectal Examination (DRE)?

A Digital Rectal Examination (DRE) is when a specialist inserts a gloved finger into your rectum to feel the back of the prostate to check for enlargement of the prostate gland or any other changes in shape. On referral to a urologist or other specialist, the DRE remains an important assessment procedure prior to consideration for biopsy.

My PSA levels are high. What now?

If your PSA test results are abnormally high for your age, your GP will likely refer you to a urologist. A urologist is a specialist surgeon who treats urological problems, and problems of the penis, testicles and prostate gland. The urologist will undertake further tests and investigations, which might include a prostate biopsy.

A biopsy helps to identify if cancer cells are in your prostate. This involves taking small samples of tissue from your prostate gland. A biopsy is usually done as an outpatient procedure (you will be sent home on the same day). The tissue samples are then sent to a pathologist to see if cancer cells are present. The pathologist will assign a grade (Gleason Score) to the cancer cells based on how they compare to normal cells within the prostate. In some cases, your doctor may also suggest a Magnetic Resonance Imaging (MRI) scan of the prostate to help locate specific areas in the prostate that may be cancerous.

If you are diagnosed with prostate cancer, the urologist will work out a treatment plan with you, in consultation with your GP and other specialists as required.

Where can I get more help/information?

The information provided in this article is for education purposes only. It is not intended to replace the medical advice or clinical diagnosis from a fully qualified health professional. It is therefore advised that readers seek the services and advice from their GP (doctor) or urologist for any personal health concerns.

If you are reading this article before June 2020 and have recently been diagnosed with early-stage, low-risk prostate cancer, please consider joining our research trial www.navigateprostate.com.au to help navigate your treatment options.

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