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PSA test for prostate cancer

Getting the results and understanding them

Men usually got their PSA results from their GP, from the practice nurse, or from a receptionist, either face-to-face, by phone or by email. A man who had had a number of blood tests for a company health check received his results by post. 

 

Results of other tests, such as cholesterol, were sent by post at the same time as the result of...

Results of other tests, such as cholesterol, were sent by post at the same time as the result of...

Age at interview: 57
Sex: Male
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And how were the results delivered to you?

They were delivered by post, and with some accompanying information. There were a lot of things were tested including my cholesterol level and other things. My cholesterol is slightly high so I had recommendations based on that, and I presume the same would've happened had there been something positive about PSA.
 
 

He got the result of his PSA test by phoning the receptionist at his local surgery, who said it...

He got the result of his PSA test by phoning the receptionist at his local surgery, who said it...

Age at interview: 55
Sex: Male
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And did you have to wait long for the results?

No, I was told to ring in within the next fortnight. While I was there, I mean I didn't only have the sample of blood I had a full, a full medical as it were, they took a sample of blood for liver function and you know they did all the normal things that they do on a health check, blood pressure etc etc they check for diabetes and a thousand and one other things. So it was all part and parcel of going for that sort of once, once yearly or once every two-year test just to check on your health. I have good health, I don't, you know I have no worries about my health but I just feel it's important to.

And did you get the results over the telephone then?

Yes I did I spoke with one of the receptionists and I told her the reason for my call and she didn't quote me any facts or figures she just said, 'There is nothing, nothing untoward with, you know with your blood sample.' So...

Did you ever ask for details of the level of the PSA?

I didn't no, I didn't I was, I was satisfied with what she said to me.

One man was upset because one of the practice office staff told him that his results had been mislaid and then later told him that there was a query about one of the measurements. A phone call from the GP put his mind at rest.

 

The practice thought they had mislaid his results but he felt reassured when the GP rang him to...

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The practice thought they had mislaid his results but he felt reassured when the GP rang him to...

Age at interview: 78
Sex: Male
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The only thing was when I rang through to the doctors' surgery saying you know, Has the result come through', they said, 'Oh we think so but we've lost it,' which seemed to me a little bit slap happy [laughs]. 

Oh dear.

'But we'll get somebody to ring you back by such and such a time.' And then when I rang them back again they, this is you know through the day so it could be concerning for somebody who wasn't too au fait with it. They said, 'Oh we've got it, we have found it, we didn't lose it,' mislaid I think was what they said, 'but there's a query about the, one of the measurements in it.' Now that shouldn't have been said.

No

It was just ordinary, one of the office staff I think, anyway eventually the GP rang me back, gave me the details and that was fine.

Some men explained that they had PSA tests regularly as part of their follow-up after treatment for cancer. They were often given their test results when they attended an outpatient clinic at the hospital.

 

The specialist gives him his PSA result when he goes to the hospital for 3-monthly check-up.

The specialist gives him his PSA result when he goes to the hospital for 3-monthly check-up.

Age at interview: 65
Sex: Male
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Have you been given any information about the PSA test itself?

No, no, no it's just all that I know is that I've just got, they take a blood sample and then they know from there, that is sent to, to my specialist and then he will turn round and tell me exactly.

So you get the results when you go back to the hospital?

When I go back to the hospital and see the specialist which is every 3 months he tells me whether I'm doing alright or what.

Has he explained to you what's the normal range for a man of your age, does he explain that?

Yeah I think, well I think they said that it's I thought they said that you go up to 3 is it something like that 3 to 4? It's not, you know they're not really concerned.

And yours now is?

Well I'm down to 1.5 at the moment, I mean they even hope to bring it down further than that but I mean whether they do or whether, I mean it could vary I mean I don't know, I mean as long as it's not so high as what it was I mean that's the only thing which I, well put it this way I think what they've given me is working because I feel in myself feeling how I feel now I feel great and that is honest.
 

PSA test results are usually reported as nanogrammes of PSA per millilitre (ng/ml) of blood. The older the man the higher the PSA level is likely to be, whether or not there is any cancer present. So what is 'normal' depends to some extent on a man's age. The prostate cancer risk management programme says that men with a PSA greater than or equal to 3ng/ml and aged between 50-59 years should be referred for further tests.

 

He finds it worrying that cancer may be present even if a man's PSA level is within the 'normal'...

He finds it worrying that cancer may be present even if a man's PSA level is within the 'normal'...

Age at interview: 66
Sex: Male
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I think the main thing that, and this will probably come out during my routine check-ups, there hasn't been a full explanation of what one would expect the PSA reading to be, during the check-up periods, relative to the time after treatment, there seem to be varying opinions on this and in fact if you go on the various websites available on the Internet on PSA readings what they should be before and after, before and after treatment, I feel there's still a bit of a way to go in terms of, it may be because the precise figure on PSA can vary from patient to patient relative to the type of treatment they've had and therefore they are hesitant in publishing more accurate figures. But there does seem to be quite a variation.

A lack of clarity?

Yes on what one should expect. Because I, in fact strangely enough when I went for my first check-up I was a little concerned because it had gone up from .4 to .8 which you know in pure mathematical terms is double but I was assured there was nothing to worry about at this stage and it was probably partly due to the hormone treatment wearing off slightly. But I think one of the, looking at it from a logical point of view I think for my age before the treatment and anyone who actually got, or been diagnosed with prostate cancer for my particular age a normal figure is anything from 3 to 4.5 and one assumes that if it's in this range there's no cancer present. But it has been proven that this is not necessarily the case, that cancer can be there even when the so-called normal range of PSA is shown in your blood test. I find that to be slightly worrying.

The uncertainty?

Yes because one would sort of read into that that whatever your PSA reading you should still have a biopsy but obviously the implications of carrying that out in all cases would be considerable to the Health Service and they could be doing biopsies that weren't necessary. So I think it is quite a thin dividing line between these readings as to what is normal and what isn't normal, especially at the lower range of the figures.

Some of the men we talked to were well informed and felt they understood their PSA results. One man worked for the pharmaceutical industry and got information about the PSA test at work. A few had looked at websites, such as that of The National Cancer Institute, in the USA.

 

A website helped him to understand what it meant to have a PSA level of 2.3.

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A website helped him to understand what it meant to have a PSA level of 2.3.

Age at interview: 78
Sex: Male
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There is a website on this from the National Cancer Institute in the USA.

And what did you, what did you find on that website about the PSA test?

Nothing that I didn't know already.

Would you mind expanding on that a little bit for other people?

Oh the only thing that I wasn't too sure about were the levels that I'll describe, the doctor when he rang me up giving me the result of the test said, 'The finding was 2.3.' Now that particular website of course explains more clearly, although rather subjectively what the levels are and that level is defined as low. High comes you know way over 10 and that sort of thing. So it's a slightly arbitrary scale anyway.

Others had obtained information from Prostate Cancer UK or Cancerbackup (now merged with Macmillan Cancer Support).

 

Information from a website helped him understand the results of the PSA test.

Information from a website helped him understand the results of the PSA test.

Age at interview: 69
Sex: Male
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To go back to the PSA levels, did you understand what the different readings meant?

Yes, by then I'd got a leaflet on it from somewhere. In fact I may have had stuff passed on from a friend of mine who'd had a cancer operation I think, and also you get it instantly off the Net. When he said 7.3, you know it should be 4.3 or something like that, and so immediately go home, press the buttons on the computer and it's all there. And you can, in fact I printed it out at that stage and then they [Prostate Cancer Charity] sent me a load of stuff through the, through the post. So yes I was well aware of that.

Men who had a 'normal' PSA result, were usually quite satisfied with the information and advice they received from their GP or practice nurse, though one said he was uncertain whether or not he should return for another PSA test at a later date (see 'The pros and cons of a national screening programme for prostate cancer'). 

 

The practice nurse reassured him that his PSA result was normal.

The practice nurse reassured him that his PSA result was normal.

Age at interview: 42
Sex: Male
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And how long did you have to wait for the result?

Well they would have been available the following tea-time but so it was a Monday I went, had the blood test and then I actually I phoned the surgery on the Wednesday, was given the results over the phone.

What did she say? Did the Doctor speak to you with the results?

No I spoke to the, well I mean initially it was the receptionist when she gave me the result and I obviously wanted to question her to find out a bit more about my score.

Mmm.

Because well I just wanted to [Laughs] have a bit more information, so she put me through to the practice nurse.

Mmm and what did the nurse say?

I spoke to her and she said that was my result was zero point five and that was you know quite normal and nothing to be worried about.

So what was your feeling having got that result?

Well I was pleased I wasn't expecting to have an untowards or a high count but...

Mmm.

Who knows, I mean my Father didn't he had no, as far as I know no symptoms of prostate cancer.

Mmm.

And he said he'd never felt better so,

Mmm.

You know it's one of those things that you don't know, know what you might have really.

Have you had any urinary symptoms at all?

No.

And then did the practice nurse know enough to explain to you?

Yes, yes, well she explained the-the range and the what the range and also the what's described as normal,

Mmm.

Well the normal range and as my result was right at the bottom of that I was quite happy.

 

The GP told him that his PSA result was in the middle of the normal range.

The GP told him that his PSA result was in the middle of the normal range.

Age at interview: 57
Sex: Male
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How were the results of the PSA test given to you?

Well they were given to me in a very, how could I say it, informally. I mean it was in a GP consultation but it wasn't, I never had them in writing if you see what I mean. I might have done if I hadn't been making an appointment to go in for them.

But you went to see the GP and talked face to face?

Yeah and it was just a quite straightforward piece of information. 'Oh yes and your result was,' you know whatever he told me, 2.1 or something, 'And that's very good, that's fine.' He explained a bit about the range that one you know finds in healthy people and that that was kind of smack in the middle of that so that was just fine and that was really the end of it. We didn't, he didn't particularly suggest a follow-up, you know I mean presumably he'll leave that to me, you know it was my idea in the first place so may be in another five years time he'll think, or I'll think well may be I should have another one.

And some of those who were later diagnosed with cancer spoke highly of the way in which their GPs had given them their PSA results. 

 

When he heard that his PSA level was slightly raised his GP was sympathetic and explained that...

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When he heard that his PSA level was slightly raised his GP was sympathetic and explained that...

Age at interview: 62
Sex: Male
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And then when you went back to the GP for the results of the PSA test how did he present the results, in what way?

I think again in 3 or 4 years it's a bit foggy but I certainly felt I didn't come away with any feelings that he'd particularly mishandled it or hadn't you know done it in an unsympathetic way. I mean however he did it he left me certainly with a feeling that there was a problem, he was in some ways ahead, and I didn't, certainly didn't come out of the surgery feeling well that had been mishandled you know.

No and did he tell you what the normal range of a PSA test was, did he explain what the figures meant?

Yes and in fact he was very much of the view that this was a pretty low score and I can remember coming away thinking that certainly one of the options very clearly in his mind was to do nothing. But you know he very much saw well this, this has highlighted something but it's not a big issue.

 

His GP explained that his PSA level was slightly high for a man of his age.

His GP explained that his PSA level was slightly high for a man of his age.

Age at interview: 57
Sex: Male
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When I had my second PSA test and it came out with a reading of 8 then I started looking quite seriously and I wanted to know what was going on. 

How did the GP present the result of 8 to you, did she present it explaining what a normal PSA test result might be etc?

She was very good, she's a friend anyway so we have a, a good relationship in terms of she can speak directly to me, she knows the kind of person I am and I found her very, very helpful and very, very sympathetic, almost too sympathetic you know, I prefer to deal in the facts. Other people need a lot of sympathy, I prefer to know the bottom line all the time and if, if it's 5 years or 2 years or you've got to have an operation or you're in trouble I want to know.   

But did she explain what the normal range would be or did you find that out yourself?

Oh yes she explained, she explained. When the first tame, test came up as 4 she said, 'You're slightly high for a man of your age,' I think the, at 54-55 you're supposed to have a reading of about 3.2 and my reading was 4 and she explained that it didn't necessarily mean anything, that it could be other reasons and that we should test again in a year. So I think she, looking at it I can't fault her in any way at all.

However, other men felt confused about their PSA results and some thought that doctors should provide much more information. Some men had not received information about the 'normal range' for a PSA test result. A few seemed unconcerned about this but others would have liked more clarity. Men who thought that the PSA test would be 'positive' or 'negative' in detecting cancer were surprised to find that further tests were needed before prostate cancer could be diagnosed. 

 

When he got his PSA result his GP reassured him that everything was alright but he wanted more...

When he got his PSA result his GP reassured him that everything was alright but he wanted more...

Age at interview: 77
Sex: Male
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How long did you have to wait to get the results?

Usually about three or four days.

Oh very quick. 

Very quick and he would normally ring me up and tell me 'I have the result of your PSA,' and he would tell me over the phone what the result was except I've never recorded it you see only on, only on the last one I had.

So you recorded the last one, that was this year 2005?

That was February this year yes.

And what did you say the result was for that one?

6.9

And did he tell you what that meant at all?

No, no I've never questioned him on that because I've foolishly not asked what that is or how much higher that goes, how much higher can it go before some action has got to be taken?

Did he say at all what that meant in any way at all, how did the conversation go?

He wasn't concerned about that figure at all.

Right oh that's good.

No he reassured me everything was alright and there was no need for any action at that time.

 

Doesn't know what the PSA results mean or what result he should expect for a man of his age.

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Doesn't know what the PSA results mean or what result he should expect for a man of his age.

Age at interview: 72
Sex: Male
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And you say you didn't really know what the different levels were or what is normal for your age or anything?

No I don't, I still don't really, and I don't really know what the units mean and what a unit is a unit of. So, and I still don't know. I suppose it's strange in a way that, I should've talked to my brother a bit more, he's a very reticent person but I don't know what medication he's on, he's on some sort of medication and his levels don't seem to be increasing at all. Whatever his medication is seems to be working so, but medication has never been discussed in my case.

One man was aware that his PSA level had risen while he waited for treatment for his cancer, but he wasn't sure if this was something to worry about. The significance of a single PSA rise is uncertain. It may have no significance because PSA appears to fluctuate naturally. The relevance of a raised PSA only becomes apparent over time, with several PSA results available to compare. Clearly a rising PSA could represent disease progression but alternatively may reflect the presence of some sub-clinical infection or inflammation in the prostate.  

 

Comments that PSA results are confusing and that they aren't widely explained to patients.

Comments that PSA results are confusing and that they aren't widely explained to patients.

Age at interview: 72
Sex: Male
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To date so far have you just had the one PSA test, or has it been repeated?

No, I've had a PSA test just recently. And I have to say that, not very alarming, but it was raised to 10.6, on the most recent one I've had, which was when I agreed to, to the HIFU [High Intensity Focused Ultrasound treatment]. And I phoned one of the doctors who's on the, the HIFU scheme and asked him whether I should be bothered by it in respect of the fact that from the time of the test to the time of my treatment it's a period of two and a half months. And he wasn't alarmist and he wasn't quite totally clear to me as to whether I should be worried. He said the PSA tests have a, a factor of 10 per cent, where they can be inaccurate. And I put the point that my PSA was raised by 50 per cent. And when he said that I said, 'You can read that two ways. It's risen by 30 per cent or it's risen by 70 per cent, because the PSAs can be both, wrong in both ways either way.' So I don't know whether that's a worry. And I don't think I'm quite clear in my mind yet.

I have to say any information I've had about PSA tests has not been as it were explaining to the uninitiated what it means. If I wanted to make it clear to the general population what to worry about with a PSA test, if I could be told that the levels you ought to have are 4, the levels you should be slightly concerned at are 6, and the levels you should be very concerned at are 15 to 30, I'd be better informed about it than I am. I don't think it's something which is widely explained to patients.

I don't really know on what basis doctors read the information from a PSA test. And one's, one's in their hands to say, 'You need something done' or, 'You could very well not need something done'. There's a certain sort of mystique about it [laugh].
 

Last reviewed May 2016.

Last updated May 2016.

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