Prostate cancer is the most common cancer in men in the UK, with around 48,000 new cases diagnosed and 11,600 men dying from the disease each year.
The prostate gland lies just below your bladder and helps produce healthy sperm. Prostate cancer is caused when some cells in the gland start to grow out of control.
It usually develops slowly, so someone with prostate cancer may have it for many years before symptoms start to show. They can include an increased need to pee, straining while you pee and a feeling that your bladder has not fully emptied.
Early diagnosis of prostate cancer can affect what treatment is chosen and how effective it is, although if it is slow-growing it might need no treatment other than monitoring. While there is no single test for prostate cancer, men over 50 (the age group most vulnerable to the disease) can request a blood test – called a ‘PSA test’ – from their GP.
Now GPs are being issued with an information sheet to give out to men aged 50 and over who display no obvious symptoms of prostate cancer but proactively request a PSA test. It gives concise, clear and balanced information on the potential benefits and risks of having the test, including information about prostate cancer, the PSA test, and options after it depending on the results.
Backed by Cancer Research UK and Prostate Cancer UK, the information sheet stresses that the PSA (Prostate Specific Antigen) test is not perfect. It is a simple blood test which measures the amount of PSA molecules in a patient’s blood. A raised level can be a sign of prostate cancer, but it can also indicate other things, including a urinary tract infection, an enlarged prostate or that the person has had recent vigorous exercise. In short, the PSA test alone doesn’t prove a patient has prostate cancer, but it might indicate if further investigation is warranted.
Prostate cancer is rare in men under 50 and the most common age of diagnosis is between 65 and 69, the risk increasing with age. However, someone diagnosed in their sixties may have had the condition for many years without any symptoms, which is why the PSA test is available on request to men over 50. You’re also more likely to develop prostate cancer if a close relative (such as your father or brother) has it, or if you’re of black ethnic origin, which doubles the risk.
Before deciding whether to have the test, you should talk to your GP as there are both advantages and disadvantages to consider. The main advantages are that a PSA test might detect prostate cancer before you have any symptoms, and if it’s fast-growing then early treatment could prevent it spreading or shortening your life. Some disadvantages to having the test include:
- It is not definitive; many men with a raised PSA level do not have prostate cancer.
- It can also miss prostate cancer. One in seven men with a normal PSA level could have prostate cancer and one in 50 could have a fast-growing cancer.
- If your PSA level is raised you might need a biopsy (not all men do), which is a surgical procedure to harvest small samples of your prostate for further testing. Side effects of a biopsy can include pain, infection and bleeding.
- You might be diagnosed with a slow-growing cancer that would never have caused any problems or shortened your life, but the diagnosis could cause you to worry and opt for treatment that you don’t need and which could have unwanted side-effects.
If you decide to have a PSA test and it shows a raised level, your GP will discuss what happens next, which will usually be referral to a specialist for further investigations. This could mean an MRI scan and a biopsy. If prostate cancer is confirmed, the specialist will discuss treatment options.
Many men with a slow-growing cancer will be safely offered active surveillance, which is a ‘watch and wait’ approach. This involves regular testing to monitor the cancer, but no other treatment unless it starts to progress. Other treatments – including surgery, radiotherapy or chemotherapy – might be offered depending on how advanced the cancer is or how fast it is growing.