Counselling for PSA

1. There is currently no screening programme for prostate cancer in the UK. This is because it
has not been proved that the benefits would outweigh the risks.
2. Routinely screening all men to check their prostate-specific antigen (PSA) levels is a
controversial subject in the international medical community.
a. PSA tests are unreliable and can suggest a false-positive result. This means that
many men often have invasive and sometimes painful biopsies for no reason. Also,
up to 15% of men with prostate cancer have normal PSA levels (a false-negative
result), so many cases may be missed.
b. The PSA test can find aggressive prostate cancer that needs treatment, but it can
also find slow-growing cancer that may never cause symptoms or shorten life. Some
men may therefore face difficult decisions about treatment.
3. However it can provide benefits: Evidence suggests PSA screening could reduce prostate-
cancer related mortality by 21%.
4. If you are thinking about asking for a PSA test, it is important that you first discuss whether it
is right for you with your GP so you understand what the results might mean.

 Ask patient do they know what it is

o Prostate cancer is a cancer which develops from cells in the prostate gland. It is the
most common cancer in men in the UK. Each year, about 40,000 men are diagnosed
with prostate cancer in the UK. It affects about 1 in 9 men in the UK at some point in
their lives. Most cases develop in men over the age of 65.

o The prostate specific antigen (PSA) test is a blood test to see if you might have
prostate cancer and to monitor treatment for prostate cancer.

o The PSA blood level is also increased in other conditions. So having an increased PSA
test result does not mean that you have prostate cancer.

 A raised PSA level may mean you have prostate cancer: About 3 in 4 men with a raised PSA
level (≥3ng/ml) will not have cancer.

 Other conditions may also cause a raised PSA level, including:

o Inability to pass urine, causing an enlarged bladder (acute retention of urine).
o Enlargement of the prostate that is non-cancerous (benign).
o Older age.
o Urine infection.

 Before a PSA test men should not have:

1. an active urinary infection
2. ejaculated in previous 48 hours
3. exercised vigorously in previous 48 hours
4. had a prostate biopsy in previous 6 weeks
 Test results and follow-up
 If you have a raised PSA level you might need further tests, including a biopsy.
• This involves taking small samples of your prostate through your back passage and
checking them for cancer. If you have prostate cancer, your specialist will discuss
options.
Men with slow-growing cancers may be offered active surveillance. This involves repeat PSA
tests to monitor the cancer, with treatment offered if the cancer starts to progress. Possible
treatments include surgery, radiotherapy and hormone therapy. Side effects of treatment
can include problems with erections, loss of fertility and incontinence.
 The 5-year survival rate tells you what percent of men live at least 5 years after the cancer is
found. Percent means how many out of 100. The 5-year survival rate for most men with local
or regional prostate cancer is almost 100%. Ninety-eight percent (98%) are alive after 10
years, and 96% live for at least 15 years. For men diagnosed with prostate cancer that has
spread to other parts of the body, the 5-year survival rate is 29%.