The PSA Test

The PSA test is a key step in early diagnosis. It is important for you to discuss the test and your personal risk factors with your doctor to make an informed decision about whether the PSA test is right for you.

Recommendations on PSA testing

Prostate Cancer Canada endorses the Canadian Urological Association’s (CUA) recommendations on prostate cancer screening and early diagnosis.
 
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Questions to ask your doctor

  1. What is my risk of developing prostate cancer?
    • Be sure to understand your own risk: Are you a black man? Do you have a family history of prostate cancer? Your risk also increases as you get older. Be sure to discuss this with your doctor.
  2. What are the advantages and disadvantages of being tested for prostate cancer? How can I reduce the risks?
  3. Should I have a PSA test and a DRE?
  4. What happens if my PSA levels are high? Do I have another PSA test or go for other tests?
  5. What happens if my PSA levels are normal? When should I get tested again?

Answering your questions about testing

 
What is PSA?

Prostate specific antigen (PSA) is a protein produced by cells in the prostate. It is normal for PSA to be found in the blood in small concentrations. The amount of PSA can rise as you age or if you have a problem with your prostate.

What is the PSA test?

The PSA test is a blood test that measures the amount of PSA in the blood. Higher levels of PSA should not be an immediate cause for alarm. It may indicate the presence of cancer, but can also signal other prostate conditions.

Some other reasons you may have a high PSA level:
  • PSA levels naturally increase with age as your prostate enlarges
  • You have an enlarged prostate (BPE or BPH)
  • Infection
  • Vigorous exercise
  • Recent ejaculation or prostate stimulation (from a DRE or anal sex)
  • Certain medicine or medical procedures

In addition to being a valuable tool to help detect prostate cancer, the PSA test is often used to monitor how men respond to treatment, or to monitor prostate cancer recurrence or progression.

What are the advantages and disadvantages of the PSA test?

Advantages

  1. Identifies prostate issues one of which could be cancer
  2. Currently best test we have to detect prostate cancer at an early stage before symptoms appear, when the survival rate is close to 100%
  3. Simple blood test
Disadvantages
  1. A man can have a high PSA level even if he doesn’t have prostate cancer. This can create anxiety and may lead to other potentially harmful tests, like a biopsy
  2. Some men will be diagnosed with slow growing tumours that are unlikely to be life-threatening. However this cancer diagnosis can lead to anxiety and the decision to choose treatments that can cause side effects.

Being informed about your options after knowing your PSA value will help you make informed decisions with your doctor about further testing and next steps.

Learn more about whether you should get tested.

What happens if my PSA value is high?
  • A higher than normal PSA level can mean that you have a problem with your prostate, which could be prostate cancer. If your PSA level is high your doctor will consider a number of factors including your prostate health, results from your digital rectal exam (DRE), previous PSA tests, your age, health and risk factors before deciding what to do next. Depending on these factors, your doctor may recommend that you have another PSA test in the future to see if your PSA level changes, or may recommend you see a specialist for further tests like a biopsy or MRI.
Do I have to pay for the PSA test?
  • Coverage of the PSA test is regulated by provincial and territorial governments. The cost of the PSA test is currently covered in all provinces and territories except British Columbia and Ontario. In these two provinces men who do not have symptoms and want the PSA can pay out of pocket for between $30-$50. Prostate Cancer Canada is currently advocating with these governments to cover testing costs. Learn more.
Is the PSA test the same as the digital rectal exam (DRE)?
  • Some confuse the PSA test with the Digital Rectal Exam (DRE). The PSA test is a blood test 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.
What is shared decision making?
  • Shared decision making means having a discussion with your doctor about PSA testing so that you understand the advantages and disadvantages of the test.
  • Determining your risk of developing prostate cancer includes discussing your family history with your doctor and understanding if you are at higher risk based on your age or race.
My doctor doesn’t believe I should get a PSA test, but I do. What should I do?
  • The decision to have your PSA tested is based on your needs and 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. If you are still uncomfortable with your doctor’s recommendation, we suggest getting a second opinion.
What else is PCC doing to improve diagnosis and make sure prostate cancer is detected early?
  • Lobbying for equal access and coverage to the PSA test:
    • Currently, British Columbia and Ontario are the only provinces that do not fund the test. Out-of-pocket costs can be a barrier to many, which means men may not be accessing potentially life-saving information about their health. We’re working to change that.
  • Leading awareness and education programs:
    • We regularly connect with clinicians to educate them on the importance of early detection so they have the most current information to best care for their patients. Public awareness and education are a top priority for PCC. Each year, we release public campaigns that appear on television, in print, online and radio.
    • We also provide health education materials online and in doctor’s offices across the country so patients feel supported and informed throughout their journey.
  • Funding research to improve sensitivity and precision of diagnosis
    • We are funding a clinical trial to determine if using an imaging technique, MRI, before a biopsy can improve the precision of prostate cancer diagnosis and reduce the number of biopsies and slow-growing cancers detected.
    • We are also funding a number of studies that are identifying biomarkers that may help  distinguish slow growing tumours that can be simply monitored, from tumours that are more aggressive and need to be treated. 

For more information and support:

Did you know?

Ontario is one of only two provinces that do not cover the PSA test for men who do not exhibit any symptoms. Learn how we’re working to change that and join us to take action.

Tell Ontario to fund PSA tests


Last Reviewed: January 2019

 

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