Understanding the PSA Test: Prostate Health and Screening in the UK

A Prostate Specific Antigen (PSA) test is a simple blood test used to help detect problems with the prostate gland. PSA is a protein made by both normal and cancerous prostate cells. While it is normal for all men to have a small amount of PSA in their blood, a high level can be a sign of an underlying condition.

In the United Kingdom, there is no national screening programme for prostate cancer because the PSA test is not always accurate. However, under the NHS Informed Choice (formerly Prostate Cancer Risk Management Programme), any man over the age of 50 who requests a PSA test is entitled to have one, provided they have discussed the benefits and risks with a healthcare professional.

It is a common misconception that a high PSA result automatically indicates prostate cancer. According to NICE guidance, several non-cancerous factors can cause PSA levels to rise:

• Benign Prostatic Hyperplasia (BPH): A common, non-cancerous enlargement of the prostate as men age.
• Prostatitis: Inflammation or infection of the prostate gland.
• Urinary Tract Infections (UTIs): Infections in the bladder or urethra can temporarily elevate PSA.
• Recent Ejaculation: Sexual activity within 48 hours of the test can affect the result.
• Vigorous Exercise: Cycling or heavy lifting can put pressure on the prostate and raise levels.

Because of these variables, GPs often recommend a repeat test or further investigations, such as an MRI or biopsy, if a result is borderline.

Many men seek a PSA test because they are experiencing urinary symptoms. While these are often due to an enlarged prostate (BPH) rather than cancer, they should always be reviewed by a GP. Symptoms to look out for include:

• Needing to urinate more frequently, especially at night (nocturia).
• A weak or interrupted flow of urine.
• Feeling that your bladder has not emptied completely.
• Sudden urgency to reach the toilet.
• Straining or taking a long time to start urinating.

If you are experiencing these symptoms, an online GP consultation is a convenient way to discuss your history and determine if a blood test or physical examination is required.

The Benefits

The primary benefit of the PSA test is that it can help detect prostate cancer at an early stage, often before symptoms develop. Early detection frequently leads to more successful treatment outcomes. For men with a strong family history of prostate cancer or those of African-Caribbean descent, who are at a higher statistical risk, the test provides a valuable baseline for monitoring.

The Risks

The test can lead to 'false positives,' where a high level is caused by something other than cancer, leading to unnecessary anxiety and invasive biopsies. Conversely, 'false negatives' can occur, where PSA levels remain low despite the presence of cancer. Furthermore, some prostate cancers grow so slowly that they would never cause problems in a man's lifetime; treating these can lead to side effects like erectile dysfunction or urinary incontinence.

If you are concerned about your prostate health or are considering a PSA test, you can speak to a GP online in the UK for a confidential discussion. An online GP can help by:

• Evaluating your urinary symptoms and family history.
• Explaining the PSA test results in plain English.
• Providing advice on how to prepare for a blood test to ensure accuracy.
• Referring you to a specialist (Urologist) if your symptoms or results warrant further investigation.
• Issuing private blood test referrals if you prefer to bypass local waiting times.

Our clinicians provide evidence-based advice following NICE guidelines, ensuring you have the information needed to make an informed choice about your sexual and urinary health.

To ensure the most accurate result, UK health guidelines suggest following specific steps before your blood is drawn. You should avoid ejaculation for at least 48 hours before the test. It is also recommended to avoid vigorous exercise, particularly cycling, as the pressure on the perineum can stimulate the prostate. If you have recently had a urinary tract infection or a procedure like a catheterisation, you should wait at least six weeks before having a PSA test to allow levels to return to normal.