PSA test for prostate cancer

Deciding whether or not to have the PSA test

There is still much controversy about the PSA test. One of the men we talked to recalled that he had heard GPs talking on the golf course, and that they completely disagreed about the value of the test. 

If a man has symptoms some doctors do a PSA test as routine, but experts differ on whether it should be routine or whether men should be counselled and encouraged to make an informed decision beforehand.

Most of the men we talked to had consulted their GP either because they had symptoms or because they had heard about the test and thought it might be a good idea to have one. 

Because the test is of uncertain benefit doctors are supposed to inform their patients about the benefits and limitations of the PSA test before one is done. Some of the men said that their GPs had discussed the test and had offered them a useful information leaflet.

However, some men recalled little discussion about the PSA test before being tested. A young man, for example, who had recently requested a PSA test, was given no written information or advice.

When doctors feel that a test is an important part of investigating symptoms they may not present it as a matter of choice. An elderly man who consulted his GP with symptoms was told it was 'crucial' that he had the test, but he knew very little about it. Another man, in the same situation had been tested for 'prostate problems', but knew little about the test itself. 

A man who asked a urologist in the USA for advice about mild impotence, regretted that he had had a PSA test without understanding the implications. 

Other men we talked to felt much better informed. They knew about the PSA test and some of them had asked for it. They felt that the decision to have the test was entirely driven by them.

Some men said that the decision to have a PSA test was very much a shared decision, involving themselves, their GPs and their partners. 

Decision-making can be difficult, particularly if GPs seem to give conflicting advice. One man was told about the pros and cons of having a test but advised by his GP not to have one. When he consulted another GP in the practice, having seen a nurse about a suspected urinary infection, he was dismayed to find that this GP had decided that he should have a PSA test and had asked a nurse to do one. He wondered if this was due to defensive medicine. 

Men's experiences of making decisions about the PSA test reflect the uncertainty about the benefits of the test. Some saw it as a routine test, as 'responsible health behaviour', akin to cervical and breast screening, and recommended that other men their age should consider it, but others emphasised that it is less straightforward than a cholesterol or blood pressure check and that men need to be fully informed and prepared for the consequences if their results are 'abnormal'.

Last reviewed May 2016.

Last updated May 2016.

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