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PSA test for prostate cancer

Why some men have had a PSA test - symptoms

Few men with early prostate cancer have any symptoms. Most urinary symptoms are caused by benign (non-cancerous) enlargement of the prostate. They are sometimes called Lower Urinary Tract Symptoms (LUTS), and include'

  • Pain or difficulty when passing urine
  • Poor urine stream 
  • Passing urine more frequently than usual, and especially at night
  • Rarely, blood in the urine or sperm 

When men consult a doctor with urinary symptoms they may be offered a PSA test to help to diagnose the problem. The PSA test is not a very accurate test but a raised PSA can be an early indication of prostate cancer (see 'What is the PSA test?' and 'Finding information about the PSA test').

 

A surgeon explains that when a man consults a doctor with symptoms, a PSA test might be done to...

A surgeon explains that when a man consults a doctor with symptoms, a PSA test might be done to...

Age at interview: 63
Sex: Male
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' I trained as a general surgeon and for a while in addition to general surgery I was looking after urological patients so I know a little bit about urology. And if a man, say over the age of 50 presents with symptoms, which suggest an enlarged prostate, then part of the work-up of that patient would be PSA testing to exclude the possibility of cancer of the prostate.

Do you think that at that stage the man should be given information if the tests were to come back positive about possible treatment options in the future or not?

This man has symptoms and if his PSA is very high and he has an enlarged prostate then it is very likely he's got cancer of the prostate and we're more concerned at that stage about the current status of his health and the treatment there and then rather than consider what might happen in the future.

So you wouldn't necessarily discuss the future about the possible options if it turned out to be cancer, you wouldn't discuss that before he had his PSA test?

No at this point, it's part of the work-up in the differential diagnosis of benign prostatic hypertrophy and malignant prostatic hypertrophy, this man has urinary tract outlet obstruction, we need to diagnose it and then treat it appropriately.

Are there any other circumstances in which a PSA test might be appropriate do you think?

With the current state of knowledge no.

Do you mind explaining why?

Perhaps I should qualify that. I've emphasised a gentleman above the age of 50 who has prostatic symptoms, there I suppose might be a rare occasion when a man like that presents with skeletal pain and bone scan or x-ray shows skeletal metastases then I suppose you could do a PSA to look for the source of the primary. It is quite uncommon but you can get metastatic prostatic cancer without the symptoms of prostatic enlargement. Beyond that I cannot think of an indication for PSA testing because we're then in the area of PSA screening and in my opinion PSA screening is as yet of unproven value.
 

If a man comes with symptoms some doctors routinely do a PSA test, but experts disagree on whether it should be routine or whether men should be counselled and encouraged to make an informed decision before being tested. This is because the main treatments for prostate cancer have important side effects and treatment may not be successful. Also, getting a positive PSA test result out of the blue can be very distressing. 

Some men hadn't been given much information before they had the PSA test (see also 'Deciding whether or not to have the test'). 

 

He had a PSA test because he had urinary symptoms but his doctor didn't explain exactly what the...

He had a PSA test because he had urinary symptoms but his doctor didn't explain exactly what the...

Age at interview: 67
Sex: Male
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Well I suppose it all started when I'm fortunate enough to have a, a fulltime job. I, I'm a teacher and my age is sixty-seven now and I, I started having to get up more and more in night time to go to the toilet. And it got to the stage where it was a, six or seven times a night. And my job was beginning to suffer because my sleep. I was getting sleep deprivation. And I thought to myself I ought to do something about it and went to the doctor who gave me some pills to try and cut down the number of times that my sleep was interrupted. Unfortunately it didn't work all that much although it temporarily it, it maybe cut it down to two or three times a night. It then it started to build up and build up and build up and I've had to take some more and more pills until eventually I got really frightened of it because I, I sat, I tried to urinate one night and I couldn't actually do it. I had to sit down and actually press my stomach in order to actually pass, pass urine. So then I really, [laugh] I did get frightened. Ok. And went to the doctor again whose a, who is now given me, asked me to do another, another test and go to a specialist.

Did the doctor at that stage discuss what the test might be or did they mention the PSA test?

Yes they did. At that stage they suggested I had it. There was very little explanation from the doctor although a wonderful doctor. I mean really I would go to nobody else but there was no explanation on the, on the test itself. They just said would you like one? And I presumed like all patients that that was the natural thing to do. And therefore it was like all tests if, if it was over certain percentage it would tell you whether you had cancer or it, if you were under a certain percentage it would tell you it wouldn't. So I felt it was, it was a thing you probably had to do.

Did the doctor at that stage say that the PSA test was a test to see whether or not you had prostate cancer or what? Can you remember in your own words the, how the conversation went?

No. She merely said, 'I advise you to have the, the test in so far as it's possible that if, you know, if it's above a certain limit then we would take one action. If it's below a certain limit we'd take another.' We avoided the actual word 'cancer' funnily enough at that particular stage.

Right.

But there was no, no analysis of how successful the test was, had proved. I mean how many people had, was above the limit but didn't have cancer and those below the limit but still had cancer. We didn't go into that kind of detail at all.

Urinary frequency is a common problem for men over 50 years old. Some men had to pass urine six or seven times a night, and felt they had to pee again within a few minutes. Some also had aches and pains. They had a PSA test which did not suggest cancer. 

One of these men said that he felt much better after taking an antibiotic and that his symptoms were probably due to an infection and to benign enlargement of the prostate (sometimes called prostatism). Having later learnt that the PSA test is unreliable he began to question the value of the test.

 

Urinary symptoms and pain were probably due to a urinary infection and to benign enlargement of...

Urinary symptoms and pain were probably due to a urinary infection and to benign enlargement of...

Age at interview: 68
Sex: Male
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I didn't know anything at all about PSA, I knew, didn't know anything at all about prostate, prostate, how it functioned, I didn't even know what it was or what it was or where it was in your body. And its only through that and having to go to doctors and seeing the specialist and stuff and getting clearance from them that I didn't have prostate cancer and the problem cleared up pretty well with antibiotics and it may have been just another infection I'd picked up I don't know.

So, so what exactly happened did you start having some symptoms?

Yes it was Christmas, Christmas, Christmas Day, Christmas Eve actually.

Yes

Or something and we went down to the local pub with my son-in-law and a couple of friends for a drink and I just found I had to start going to the toilet every two or three minutes you know in a lot of pain, it just suddenly, it all came on. And I came home and I felt quite, quite ill and sick and I felt really rough and was in bad form and as soon as I got a chance I went to see my GP and I was quite miserable for a few weeks you know. And I had some urine tests done and stuff like that and they find blood in my urine and stuff like that. And the signs were looking pretty bad you know then and I thought well this it you know this is curtains you know [laughs].

Oh

I did really you know I thought that's it you know. But then I had tests done and my doctor put me on some antibiotics, what he actually put me on I don't know I never really found out but it did seem to clear it up pretty well. And then I had to go back and have some more urine testing done and it showed some more, it hadn't quite cleared up but whatever it was it seemed to clear up so it may not have been prostatism, they diagnosed me with I think it's called prostatism

Mm

And I went was sent to see the specialist in the hospital and of course I'd got an enlarged prostate and they told me I'd had the symptoms but that I didn't have cancer.

Did they do a ...

I didn't have cancer but I had prostatism which I'll have to live with.

Yes. Was it at that stage they did a PSA test?

Yes I probably had a PSA test done before I'd seen the specialist.

The GP did it?

Well you know they send you to the hospital and test it yes.

Another man needed to pass urine four or five times an hour. He also had some backache. His PSA was slightly raised, but he was told that this and the symptoms were due to an infection.

 

He had to pass urine frequently, so consulted his GP and had a PSA test.

He had to pass urine frequently, so consulted his GP and had a PSA test.

Age at interview: 40
Sex: Male
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Okay I suppose my, working in the field of cancer you, one becomes very much aware of what's going on. I suppose there's also an element of paranoia sometimes as well [laughs] but I noticed I was going to the bathroom, you know quite a bit, quite frequently, I thought oh what could it be? I thought it might be my intake of caffeine because I, I must say I do enjoy the [laughs] copious amounts of coffee every now and again. so I actually went for a while without coffee just to, just did some little tests of my own just to find out, check what was going on. And I still presenting with some of the symptoms so I popped into my GP. And this was two years ago, I popped into my GP and explained what was going on and he initially was rather reluctant to proceed with the PSA test on account of I was too young, you know he didn't think it was that, that you know I should sort of give it a while and then we'd check it out again. And I went along with him for a while but then I kept on presenting with the symptoms and I thought mm I'm a bit concerned about this. I obviously spoke to my wife about it and I think I popped back into the GP about three months later and said, 'Look still presenting, what do I do now?' So he did the preliminary PSA test which was quite straight forward, no problems about it at all, I talk to people about it quite a bit through my work here so I had no reservations about that at all, I suppose it was just the wait for the results. 

The results came back and the PSA was a little bit high so obviously that kicked in the other bits and pieces which were to do with a referral to urological, urology department at my local hospital. 
 

Prostate cancers usually cause symptoms when they are large enough to press on the urinary tube (urethra). Some men we talked to had urinary symptoms, and after further investigations were diagnosed with cancer. One man admitted that he did not tell his GP that he had had symptoms for over six months. 

 

He noticed that his urine stream had become weaker so he consulted his GP.

He noticed that his urine stream had become weaker so he consulted his GP.

Age at interview: 70
Sex: Male
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I have a friend he had, had problems passing water and we used to talk about it and then that, in talking about it, it sort of jogged my brain and I said, to myself, 'Well, wait, this is something, I never had a problem passing water, but when you're younger and you're passing water it, it sort of spout out, to a distance like to this window there. But as time go by it started, the distance started to drop. Now, I put that down, when you're going in age and, you know, you're not as young as you used to be. But how wrong was I? 

So, I got a bit concerned and I rang my doctor for an appointment. And I saw him, the following day, which was a Friday. And he asked me, the doctor, my GP asked me, 'Well, how long this is been going on?' I had to admit now that I told him a lie. Because I noticed it about, 'Oh, dear, I'm going to get me into trouble this.' I told him about six months when in actual fact it was more than that. And he gave me a good telling off..

Hmm.

So he said to me, 'I want you to go and have blood tests and come back see me within two weeks time.' Which I did. And I went to the, when I had the blood tests I went back to see him in two weeks' time and he, he told me about this prostate, up until then I didn't know what he was talking about, It sound foreign to me. 
 
 

He went to his GP because he had to pass urine frequently.

He went to his GP because he had to pass urine frequently.

Age at interview: 72
Sex: Male
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Yes. I think perhaps my, the history of my father having a benign condition of prostate made me aware that I might have some problem with my prostate at some stage. And in the last ten years my inclination to urinate at frequent intervals in some cases made me aware that I might be getting this condition. And my doctor was not pushing the idea of a PSA test at any stage. I did mention it to him one time, but he said, 'When things get worse perhaps we can consider it'. And recently I m-, I approached his locum when he was away for a spell and mentioned it again. And she said, 'Well, it's not difficult to arrange. Quite happy to do it'. And I have two friends who just recently have had prostatectomies. And one is our local vicar, and he's been through it and is still recovering from it. And another is a, another friend I've known for thirty years and he seems to have come through that well. And by talking with them it made me aware that, you know, I might be getting to the stage where it wouldn't be a bad idea to, to have it checked up. Throughout our married life I've encouraged my wife to have mammograms because, you know, that's the problem which could affect, could have affected our families years back. And eventually I got round to the idea that I should perhaps have the PSA test. And at that stage approached the doctor and got it arranged.

Blood in the urine or sperm can also be a symptom of prostate cancer, though more often these symptoms are due to other problems. One man explained that previously he had had a trans-urethral resection (TURP) operation because his prostate was enlarged. Ten years later he started to pass blood in his urine. He didn't realise that he still had his prostate gland and that blood could be a symptom of cancer.

 

He started to pass blood in his urine so went to the doctor and had a PSA test.

He started to pass blood in his urine so went to the doctor and had a PSA test.

Age at interview: 72
Sex: Male
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Yes well ten years ago I started having problems passing urine and therefore I went to the doctors and arrangements were made and I had a TURPS regarding the prostate gland. And I was under the impression that I'd had a full prostatectomy, it was my fault I hadn't taken much notice, so ten years afterwards when I started having problems, waterworks problems again I didn't take a lot, I thought, Oh, this is just old age, it can't be my prostate because I've had it removed.' But then I started to pass blood so I took a sample of the urine to the doctor and he immediately, to my GP and he immediately had me admitted to the local hospital. And that's when on admission they did a blood test. Now they didn't tell me that they were doing a PSA, I didn't even know what that was. They did a PSA test on the blood and found that my PSA was very much higher than it should have been, they didn't tell me how much higher and if they did I've forgotten but they said it was very high and then they warned me that it did look very likely that this was prostate cancer. 'How can I have prostate cancer, I haven't got a prostate?' 'Oh yes, you have.' And then I realised that I hadn't had it removed. So I'd left it too late really and the tumour was quite well established. So then having had a biopsy then to confirm the fact that it was a tumour then I was offered the opportunity of having treatment which I took which was hormone treatment to start with and that's what I'm still on the hormone treatment.
 

Weight loss and impotence might suggest a physical problem and one man we talked to who had these symptoms was diagnosed with cancer.

 

He had lost weight and had mild erectile problems. His PSA test showed that it was raised, so the...

He had lost weight and had mild erectile problems. His PSA test showed that it was raised, so the...

Age at interview: 69
Sex: Male
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' and then last Autumn when they were doing the annual check-up and so on and took a bit of blood I noticed that they hadn't put PSA on it. She said, 'Oh no we don't, we don't like to frighten people because it gives false positives sometimes.' Well nowadays most of my pals have had prostate problems of one kind or another and the Big C, cancer, is not as petrifying as it used to be by any means, people talk about it so I asked her to put it on and she put it on in biro on the thing and it came back 7.3. So I thought well the doctor is going to ask for another PSA test and to my surprise he didn't, he put me in for the full biopsy which is not a very pleasant experience having a camera crew stuffed up your backside and so on. And full biopsy and it's also, you know you have to be on heavy antibiotics afterwards in case they've given you an infection and so on. And I would've thought a second PSA would've done but in fact he was absolutely right to panic, or not panic, to press the red button because I think it was partly because I'd lost 4' kilograms without intending to, my weight just dropped by that amount and also I was having erectile problems, I'd actually got some Viagra from him which was slightly unexpected I thought and so may be that triggered some worry in his mind and he sent me off. And he was absolutely right it was a Gleason score of I think 7 and they reckoned something like 40% of the, may be it's more than that, of the prostate was cancerous. And so that's what started the PSA thing. It's since gone down to 0.1 while I was on hormones and it's now 0.2, it's doubled, so it's still zero, still nothing. and I would certainly encourage people to have a PSA test but have it checked if it comes out positive, just have a second one, much cheaper than having this awful biopsy.
 

But symptoms such as impotence, weight loss, unexplained fatigue, and bone pain are usually due to something other than prostate cancer.

 

Last reviewed May 2016.

Last updated May 2016.

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