About this page. This is a plain English summary of how prostate cancer is usually first picked up in the community, before you see a urologist. It does not replace medical advice from your own doctor.
For full information and references, please read the detailed page.
The two starting tests
Prostate cancer in the community is usually picked up in one of two ways:
- A PSA blood test that comes back higher than expected.
- A digital rectal examination (DRE) of the prostate that feels different from normal.
Both tests are usually arranged by the GP.
The PSA blood test
PSA stands for prostate-specific antigen. It is a protein made by the prostate that leaks into the bloodstream. The higher the PSA, the higher the chance of prostate cancer, but a high PSA on its own does not mean cancer is definitely there.
There are a few different ways to use a PSA result:
- Absolute level. For many years, 4 was used as the upper limit of normal.
- Age-related levels. Because PSA tends to creep up with age, it can be more useful to compare your PSA with what is typical for your age group.
- Younger men, lower threshold. More recent evidence suggests that in younger men, a PSA above 2.5 may already raise the chance of cancer.
- PSA velocity. Even if the level is low, a PSA that is rising relatively quickly over time may prompt further tests.
- Free-to-total ratio. Some PSA in the blood is "free" and some is bound to other proteins. A low ratio suggests a higher chance of cancer for that PSA level.
The rectal examination
The DRE involves the GP gently feeling the prostate through the back passage. Many men are nervous about this, but it is usually painless and only takes a few seconds.
A normal prostate is roughly the size of a walnut and feels smooth, with no lumps or hard spots. It has been described as feeling like the tip of your nose. A firmer prostate, or a hard area, can be a sign of possible prostate cancer.
Why both tests are done
Around 1 in 10 prostate cancers do not raise the PSA at all. That is why the rectal examination still matters, even if the PSA is normal.
Important things to know
- A raised PSA does not always mean cancer. It can also be raised by an enlarged prostate, a urine infection, or recent activity such as cycling or sex.
- A normal PSA does not always mean no cancer. About 1 in 10 prostate cancers do not raise the PSA at all.
- One PSA result on its own rarely tells the whole story. The trend over time matters more than a single number.
- The decision about whether to have a PSA test, and how often, is a personal one. Talk it through with your GP, taking into account your age, family history, and what you would do with the result.
- Specialist opinion (and an MRI scan) may be needed before deciding on a biopsy. A high PSA does not always mean a biopsy is the next step.
What you can do next
- Read the full detailed page with references.
- Short version: PSA testing.
- Short version: the MRI scan, often the next step after a raised PSA.
- Short version overview of prostate cancer.
- Request a second opinion on a PSA result.
- Call 02 8382 6980 to make an appointment.