Prostate cancer screening PSA shared decision

Overview

This article explains the PSA screening test for prostate cancer and why it is important to discuss with your doctor before deciding whether to have the test. PSA stands for prostate-specific antigen, a protein made by the prostate gland. A high level can be a sign of cancer, but it can also be caused by other conditions like an enlarged prostate or infection.

Prostate cancer is one of the most common cancers in men, especially after age 50. About 1 in 6 men will be diagnosed with it at some point in their life.

Prostate cancer mainly affects men, particularly those over 50. Men of African or Caribbean descent and those with a close relative (father or brother) who had prostate cancer are at higher risk.

Symptoms

Common symptoms

• Early prostate cancer often has no symptoms.
• Needing to urinate more often, especially at night.
• Difficulty starting or stopping urination.
• Weak or interrupted flow of urine.
• Pain or burning during urination (less common).

Symptoms in children

• Not applicable to children.

Symptoms in older adults

• Same as common symptoms.
• Bone pain if the cancer has spread to the bones.
• Unexplained weight loss or fatigue.

Causes

Main causes

• The exact cause of prostate cancer is not known. It begins when cells in the prostate grow out of control.
• Changes (mutations) in DNA can cause normal cells to become cancerous.

Risk factors

• Age – risk increases after age 50.
• Family history – having a father or brother with prostate cancer.
• Ethnicity – being of African or Caribbean descent.
• Obesity – may increase the risk of more aggressive cancer.

When to see a doctor

See a doctor urgently if:

• If you cannot urinate at all.
• If you have severe pain in your lower back, hips, or pelvis.

Book a routine appointment if:

• If you have urinary symptoms that bother you, such as frequent or painful urination.
• If you are between 50 and 70 years old and want to discuss whether PSA screening is right for you.
• If you are at higher risk (e.g., family history) and want to consider screening earlier.

Diagnosis

Prostate cancer is often first suspected after a PSA blood test or a digital rectal exam (DRE). If either is abnormal, your doctor will discuss further tests, usually a biopsy, to confirm if cancer is present.

Tests that may be done

• PSA blood test – measures the amount of prostate-specific antigen in blood.
• Digital rectal exam (DRE) – doctor feels the prostate through the rectum to check for hard areas or lumps.
• Prostate biopsy – a needle takes small tissue samples from the prostate to look for cancer cells under a microscope.

What to expect at your appointment

If you have a PSA test, you will give a blood sample. An abnormal result does not mean you have cancer – it means more investigation is needed. Your doctor will explain the results and what they mean for you. If a biopsy is needed, you will likely be referred to a specialist. The biopsy is done with a local anesthetic and usually takes about 10–15 minutes.

Treatment

Treatment for prostate cancer depends on the stage (how far it has spread), the grade (how aggressive the cells look), your age, and your overall health. For many men, active surveillance (monitoring the cancer closely without immediate treatment) is a safe option. Other treatments include surgery, radiation, hormone therapy, and chemotherapy.

Self-care at home

• Stay physically active as your health allows.
• Eat a balanced diet with plenty of fruits, vegetables, and whole grains.
• Talk openly with your doctor about any side effects or concerns.

Medical treatments

If treatment is needed, options include surgery to remove the prostate (prostatectomy), radiation therapy (using high-energy rays to kill cancer cells), hormone therapy to lower testosterone levels (which can fuel cancer growth), and chemotherapy (drugs to kill cancer cells). Your doctor will explain which treatments are best for your situation. Some treatments are used in combination.

When is surgery considered?

Surgery (radical prostatectomy) is typically offered when the cancer is still confined to the prostate and the patient is in good health. It removes the entire prostate gland and some surrounding tissue.

Living with this condition

If you have prostate cancer, you will have regular check-ups to monitor your condition or the effects of treatment. Side effects from treatment can include urinary leakage (incontinence), erection problems (erectile dysfunction), or bowel changes. Many men manage these with the help of their healthcare team and support from loved ones.

Lifestyle tips

• Stay as active as you can – gentle walking can help.
• Avoid smoking and limit alcohol.
• Maintain a healthy weight through diet and exercise.

Diet and exercise

A diet rich in fruits, vegetables, fish, and whole grains may help your overall health. Talk to your doctor before starting any new exercise program, especially after surgery or radiation.

Mental health and emotional wellbeing

A cancer diagnosis can cause anxiety, sadness, or stress. It is normal to have these feelings. If they become overwhelming, speak to your doctor or a mental health professional. If you ever have thoughts of harming yourself, call your local emergency number immediately for help.

Prevention

There is no proven way to prevent prostate cancer. A healthy lifestyle – including a balanced diet, regular exercise, and maintaining a healthy weight – may lower your risk. Some studies suggest that certain foods (like tomatoes, broccoli, and green tea) might be helpful, but more research is needed.

Screening programmes

PSA screening is a personal choice. It can find cancer early, but it can also lead to false alarms and unnecessary biopsies or treatment for cancers that would never have caused harm. The best approach is to have a shared decision-making conversation with your doctor about your risks and preferences. For most men, this discussion is recommended starting at age 50, or earlier if you have higher risk factors.

Complications

If left untreated

• Cancer may spread to nearby tissues, lymph nodes, or bones (metastasis).
• Bone pain, fractures, or spinal cord compression if it spreads to the spine.
• Problems with urination or kidney function due to blockage.

Long-term outlook

Prostate cancer often grows very slowly, and many men live for many years without it causing problems. When caught early, treatment is very successful. Even for cancer that has spread, treatments can control the disease for a long time and maintain good quality of life. The outlook is generally hopeful, and your doctor will help you understand what to expect based on your specific situation.

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