Editorial
Written byMen's Health Istanbul Editorial Team
Medical reviewAsst. Prof. Dr. Yusuf İlker Çömez
Last medical reviewAwaiting reviewer sign-off
Key takeaways
- PSA is a protein made by the prostate. Levels can rise for many reasons, not only cancer.
- Infection, an enlarged prostate and, in some men, recent ejaculation or vigorous cycling may raise PSA temporarily.
- A large European trial found that PSA screening reduced deaths from prostate cancer, but also led to some men being diagnosed and treated for cancers that would never have harmed them.
- Decisions about testing are best made with a doctor, taking into account age, family history and personal preferences.
What PSA is
Prostate-specific antigen (PSA) is a protein made by the prostate gland. A small amount normally passes into the blood, where a simple test can measure it. Higher levels can be a sign of prostate cancer, but they are often caused by something else.
Why PSA can be raised
- an enlarged prostate (benign prostatic enlargement), which is very common with age;
- infection or inflammation of the prostate or urinary tract;
- recent ejaculation or vigorous exercise such as long-distance cycling;
- some medical procedures on the prostate or bladder;
- prostate cancer.
Some medicines for an enlarged prostate lower PSA, which your doctor needs to know when interpreting the result.
The limits of the test
A raised PSA does not mean you have cancer, and a normal PSA does not guarantee that you do not. The test can also find slow-growing cancers that might never have caused problems in a man's lifetime. Diagnosing and treating these can lead to side effects, including erectile and urinary problems, without extending life.
The European Randomized Study of Screening for Prostate Cancer, published in the New England Journal of Medicine in 2009, found that PSA screening reduced deaths from prostate cancer. It also highlighted the problem of overdiagnosis. Modern pathways try to keep the benefit while reducing the harms, for example by using MRI scans before deciding on a biopsy.
Questions to ask before testing
- Given my age and family history, what are the likely benefits and harms of testing?
- Is there anything I should avoid before the test, such as ejaculation or cycling?
- If my result is raised, what happens next?
Symptoms are different
Testing a man without symptoms is a choice. Symptoms such as blood in the urine or semen, difficulty passing urine or new bone pain are not a choice: they need to be checked by a doctor promptly.
References
- Schröder FH, Hugosson J, Roobol MJ, et al. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med. 2009;360(13):1320–1328. Source
- European Association of Urology. EAU Guidelines on Prostate Cancer. Source
This article is general health information. It does not replace an individual medical consultation, examination or diagnosis. Read our editorial policy and medical review policy.
