The lowdown on men’s PSA testing

Canadian men get prostate cancer more than any other cancer, and 1 in 9 men are diagnosed with it during their life. Most cases are discovered in their early stages, which is part of the reason there’s a 93% probability of surviving prostate cancer in Canada. Despite this, population-wide prostate-specific antigen (PSA) screening for prostate cancer isn’t recommended. That doesn’t mean PSA screening is wrong for you, however. If you’re wondering whether you should get your prostate tested, or simply feel confused about it, you’re not alone. Here’s how to know if you should go for prostate screening.

What is the prostate and where can I find it?

Your prostate is a gland that sits below your bladder and in front of your rectum. It makes a protein called prostate-specific antigen (PSA) that makes up part of your seminal fluid and is also found in your blood. Your prostate is typically the size of a walnut, but can sometimes swell to the proportions of a tennis ball, and even a grapefruit.

What is PSA testing?

While all prostates make PSA, cancerous prostate tissue generally makes more PSA than healthy prostate tissue does. Since PSA circulates in the blood, labs measure it in units of nanograms per millilitre of blood. Your doctor will generally consider your PSA levels normal if your blood test shows around 4ng/mL. Higher levels of PSA might indicate an abnormality. The higher your PSA levels, the more likely your healthcare provider is to recommend follow-up testing.

Why is PSA testing controversial?

The benefits of prostate testing can be significant, but it’s considered controversial for a couple of reasons. While high PSA levels are a possible indication of prostate cancer, they can also be caused by other things. About 1 in 4 abnormal PSA tests are a result of cancer — which means that three-quarters aren’t. Getting an abnormal result can cause the stress of thinking you might have cancer when you don’t. Beyond that, it may also spur you to request more invasive procedures — like a prostate biopsy.

Not only can a PSA test scare you into thinking you have cancer when you don’t, it’s also possible that screening might not detect cancerous cells. Not all cancers produce high levels of PSA. That makes it possible to have prostate cancer but show normal PSA levels, giving you a false negative.

Prostate cancer doesn’t always need treatment

Even if your investigation turns up cancer, it might not require treatment. Some men have aggressive forms of prostate cancer which metastasize (spread) quickly. In these cases, early diagnosis and treatment is key to averting severe illness and sometimes death. Data suggests, however, that as many as 67% of men with a prostate cancer diagnosis have clinically insignificant levels of disease. It sounds abnormal to call cancer clinically insignificant, but these cancers are typically slow-growing, don’t spread beyond the prostate, and are unlikely to shorten your life. 

Hearing that you have cancer — even one that’s supposedly harmless — is understandably distressing, and many men with low-risk prostate cancer choose to treat it. Treatment usually means radiation, chemotherapy, or surgery, which may cause side effects like erectile dysfunction and bowel and urinary issues — sometimes resulting in more complications than the actual cancer. Active surveillance through more frequent PSA testing may be a better choice for those with low-risk prostate cancer.

Who needs PSA testing?

Not everyone needs prostate testing, but that doesn’t mean screening is wrong for you. A family history of prostate cancer puts you at a higher risk of developing it. A number of other factors such as a BRCA gene mutation, obesity, diet, and occupational exposure to certain substances play a role as well. Research also shows that Black men have higher rates of prostate cancer, though researchers aren’t clear why.

PSA testing may also be valuable even if you’re not at higher risk of developing prostate cancer. Since most prostate cancers develop after age 50, offering PSA testing to men in their 40s can help to establish a baseline for future prostate cancer risk. These tests can provide a benchmark, alerting you to rising PSA levels as you age that may signal cancer or other issues. At this time, however, screening isn’t supported by the Canadian Urological Association until at least age 45, which means that it may not be covered by your local healthcare plan. If you have risk factors for prostate cancer, or want to learn more about your baseline PSA levels, speak to your healthcare provider about your PSA testing options.

What are the symptoms of prostate cancer?

Personal risk factors aren’t the only reason for prostate screening. Prostate cancer symptoms aren’t specific and can apply to other conditions as well. Most men with prostate cancer have no symptoms at all. Still, any of the following require medical follow-up:

• Pain or burning during urination
• Painful ejaculation
• Blood in your semen or urine
• Difficulty getting an erection
• Frequent, strong, and/or sudden urge to urinate
• Interrupted urine flow, dribbling, or feeling like you have to push to urinate
• Feeling like your bladder isn’t fully empty
• Pain, fatigue, and weight loss

Establishing a prostate cancer diagnosis early can offer a higher chance of a cure if your cancer requires treatment. Without proper guidance from a medical professional, however, testing your PSA levels can cause stress and confusion. Talk to our oncology navigation team if you have further questions around prostate cancer screening or have been given a prostate cancer diagnosis.