Frequently Asked Questions

What is Prostate Specific Antigen (PSA)?

Prostate Specific Antigen (PSA) is a protein produced within the prostate gland and is secreted into seminal fluid. There are two types of PSA; 1) free and 2) complex. Free PSA moves freely in the blood as it is unbound to other proteins. Complex PSA is attached to other proteins as it moves around the blood.

Free/total PSA ratios compare the amount of free PSA to the total amount of PSA in the blood. Free PSA comes from benign prostatic hyperplasia (BPH), an enlargement of the prostate. The higher the ratio of free PSA, the less likely PSA will be found as prostate cancer cells produce more complex PSA.

What is the PSA test?

The PSA test is a blood test that measures the amount of PSA protein in the blood. It is common for PSA to be found in the blood in very small concentrations. Prostate cancer cells produce more PSA than healthy prostate cells. Higher levels of PSA may indicate the presence of cancer, but can also be an indicator of other prostate conditions. While the PSA test is not currently used in Canada as a population-wide screening tool, it is used to monitor how someone responds to cancer treatment or to monitor disease recurrence or progression.

What are the potential risks associated with PSA testing?

Many studies and recommendations from other organizations often over-report the harms associated with getting a PSA test. The PSA test is a blood test. There is little or no risk associated with getting a blood test. The potential risks associated with PSA testing are the result of choices made based on the results obtained. These potential risks include undergoing further testing or procedures that carry their own risks, for example, having biopsies that may result in pain and infection. Additionally, knowing the results of a PSA test may result in worry and anxiety, even if cancer is not detected. Being informed about your options after knowing your PSA value will help you make informed decisions regarding further testing.

How do I know if I’m at higher risk for prostate cancer?

There is still much to learn about what causes prostate cancer. Without this information, it is difficult to assess how prostate cancer can be prevented. There are a number of factors that have been identified to increase a man’s chances of developing cancer in his lifetime. A number of risk factors can be found in the link below. If you are concerned about your risk, speak to your doctor.

What are the risk factors for prostate cancer?

While there is no known single cause for developing prostate cancer, there are some factors that increase the likelihood of certain men developing the disease. Some of these risk factors include4:
  1. Race: Prostate cancer is more common among men of African or Caribbean descent. Men of Asian descent have a lower risk of developing prostate cancer.
  2. Family History: A man’s risk of developing prostate cancer increases if a first degree relative has had prostate cancer.
  3. Age: While men under the age of 50 have been diagnosed with prostate cancer, a man’s chances of developing the disease increase after a man reaches age 50.
  4. Lifestyle: Maintaining a healthy weight, through good diet and exercise, reduces the risk of prostate cancer.

What is Shared Decision Making?

Deciding to get a PSA test should be determined after knowing the benefits and limitations of the test. The final decision to have a PSA test is your choice and your doctor can help you determine if this test is right for you. Determining your risk of developing prostate cancer includes discussing your family history with your doctor and reviewing other risk factors that may increase your chances of developing the disease. If after gathering all the information and knowledge regarding PSA testing you wish to get tested, discuss with your doctor how often you should return for follow-up PSA tests. Additionally, if after receiving all the information about PSA testing you feel this isn’t something for you, that’s your choice. While PSA testing may not be important to you now, as new research or new discoveries about your family history emerge, you may wish to revisit your decision to undergo testing.

When should I get my first PSA test?

The decision to begin PSA testing is an individual decision that you can make after having a discussion with your doctor. Discuss the benefits and limitations of the test with your health care provider to determine when to begin your individual screening program. Prostate Cancer Canada recommends that men in their 40s get a PSA test to establish their baseline. Men who have elevated risk factors should talk with their healthcare provider about prostate cancer before the age of 40.

When should I stop screening for prostate cancer, using the PSA test?

While a number of organizations recommend ending screening between ages 69-75, the decision to end screening will be based on individual factors. These individual factors should be discussed between you and your healthcare team.

What is active surveillance?

Active surveillance and watchful waiting are often used interchangeably. These two terms actually have different meanings. Active surveillance involves closely monitoring prostate cancer using PSA tests and DRE exams. Additionally, ultrasounds may be used regularly to determine if the cancer is growing. If the cancer becomes more aggressive, biopsies may also be used to determine treatment options. Watchful waiting often refers to less intense follow-up which may include fewer tests. Watchful waiting relies on tracking changes in symptoms to determine if treatment is, in fact, recommended.

How often should I get a PSA test?

Frequency of PSA testing will be dependent upon the result of your first PSA test. PSA tests do not distinguish between slow growing and aggressive forms of cancer but indicate that something may be wrong. Depending on your risk factors, your healthcare provider may recommend more frequent testing to monitor your PSA values or may suggest less frequent testing based on a number of factors.

I’ve heard the PSA test hurts, is this true?

Some confuse the PSA test with the Digital Rectal Exam (DRE) and a biopsy. The PSA test is a blood test, where blood is taken from your arm. In a DRE, your doctor will feel the size and shape of the prostate by inserting a gloved and lubricated finger into the rectum. A healthy prostate feels soft, rubbery, smooth, symmetrical, regular and even.

Should PSA testing only be used for men with a life expectancy of more than 10 years?

The decision to be tested for prostate cancer should be based on individual decisions/factors. While many organizations recommend PSA testing for men with a life expectancy of at least 10 years because of the possibility of over treatment which may result in complications later on in life, PCC recommends that the decision to be tested for prostate cancer using the PSA test be determined with a man and his healthcare team.

I’m over 70 and my doctor doesn’t think I should get the PSA test. What should I do?

Some organizations recommend against prostate cancer screening for men over the age of 69 or men with a life expectancy of less than 10 years. Just as the decision to begin PSA testing is based on your individual needs and preferences, the decision to end testing should also be based on individual preferences. If you are interested in having a PSA test and your doctor recommends against testing, ensure you have all the information that will allow you to make a decision you are comfortable with.

Do I have to pay for the PSA test?

Coverage of the PSA test is provincially and territorially regulated. The PSA test is currently not covered for asymptomatic men who live in Ontario and British Columbia. The cost of the PSA test ranges from $30-$50.

What research is currently being done into improvements on the PSA test?

A couple landmark trials are studying the effects of screening (using DRE and PSA in combination or alone) on prostate cancer.

For information about these studies visit the links below.

The Prostate, Lung, Colorectal & Ovarian Cancer (PLCO) Screening Trial

European Randomized study of Screening for Prostate Cancer (ERSPC) 

Prostate Cancer Canada has also funded research into improvements on the PSA. To learn more about these funded research studies and others, please click here.

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