‘I was doing a regular health check and my doctor said, ‘oh, we’ll toss in a PSA test’ … I had no idea what he was talking about.’
A blood test and physical examination are usually the first step a doctor will take to check the health of the prostate and for possible prostate cancer.
Doctors are required to inform and get permission from their patients before they do any testing. Make sure you understand the tests before agreeing to them because the test results can lead to actions that may be life-changing.
- Blood test (prostate specific antigen (PSA) test): PSA is a protein that is made in the prostate and can be found in the blood. The result from the PSA test shows whether or not there is an increased amount of this protein in your blood. Depending on the result, you may need further investigation by a specialist. A high PSA result does not always mean you have cancer. Prostatic diseases such as prostatitis can also cause a higher than normal PSA result.
- Physical examination (digital rectal examination): The prostate is located in front of the rectum. One way of checking the health of the prostate is for the doctor to insert a gloved, lubricated finger through the anus and into the rectum to check the size and texture of the prostate and feel if there are any abnormalities. This is called a digital rectal examination (DRE). A normal DRE exam does not rule out prostate cancer, but it is an important part of the assessment. The DRE is usually done in combination with a PSA test.
PCFA advises men over age 50, or 40 with a family history of prostate cancer, to talk to their doctor about testing for prostate cancer using the PSA test and DRE as part of their annual health check-up. Men should make an individual informed decision about testing based on the latest available evidence on the benefits and potential harms of testing and subsequent treatment for prostate cancer.
Ejaculation can cause an increase in PSA in the blood. It is recommended that men do not ejaculate for 48 hours before a PSA test to make sure the result is accurate. Also, manipulation of the prostate through a DRE, or other forms of prostate stimulation during sex, can cause the PSA to rise. These activities should be avoided before a PSA test.
Depending on the results of the PSA test and DRE, your doctor may request repeat tests and refer you to a urologist, a doctor who specialises in the urinary and reproductive area.
After doing these tests, and depending on the results, a biopsy may be done. This is the only way a firm diagnosis of prostate cancer can be made. The urologist removes small samples of tissue from your prostate using a very thin, hollow needle, guided by an ultrasound. The prostate is either accessed through the rectum (transrectal) or the perineum (transperineal), which is the area between the anus and scrotum.
A biopsy is usually done as an outpatient procedure and the doctor will likely advise a short course of antibiotics starting just before the biopsy and also afterwards to reduce the chance of infection. The tissue is sent to a pathologist to identify whether the cells are malignant (cancerous) or benign (non-cancerous).