The Prostate

The prostate is a gland that forms part of the male reproductive system. It is located below the bladder and surrounds the first section of the urethra, which is the tube that carries urine out of the body. In adults, it is usually about the size of a walnut, although it commonly enlarges with age.

The prostate's main function is to produce part of the seminal fluid that protects and transports sperm. It also produces a protein known as prostate-specific antigen (PSA), which is found mainly in semen, although small amounts naturally enter the bloodstream.

Several conditions can increase PSA levels in the blood, including:

  • Benign prostatic hyperplasia (non-cancerous enlargement of the prostate).
  • Prostatitis (inflammation or infection of the prostate).
  • Prostate cancer.
  • Recent manipulation or examination of the prostate.
  • Certain activities, such as recent ejaculation or vigorous exercise affecting the perineal area.

What Is the PSA Test?

The PSA test is a blood test that measures the level of prostate-specific antigen circulating in the bloodstream.

It is a useful tool for detecting prostate-related conditions, including prostate cancer, but it cannot by itself diagnose or rule out prostate cancer. An elevated PSA level may be caused by benign conditions, and some men with prostate cancer may have PSA levels within the normal range.

For this reason, PSA results should always be interpreted in the context of:

  • Age.
  • Urinary symptoms.
  • Family history.
  • Physical examination findings.
  • Other complementary diagnostic tests.

Is Routine PSA Screening Recommended?

Current international guidelines do not recommend universal PSA screening for prostate cancer in all men. Instead, they promote shared and informed decision-making between the individual and their healthcare professional.

Before having the test, it is important for men to understand both its potential benefits and its limitations.

The decision may be particularly relevant for people at increased risk, including:

  • Men with a family history of prostate cancer.
  • Carriers of certain inherited genetic mutations (for example, BRCA2).
  • People with other risk factors identified by their healthcare specialist.

Potential Benefits of PSA Testing

The PSA test may help to:

  • Detect some prostate cancers before symptoms develop.
  • Identify potentially curable tumours at an early stage.
  • Monitor patients who have already been diagnosed with or treated for prostate cancer.

Potential Limitations and Risks

False-Positive Results

An elevated PSA level does not necessarily mean that cancer is present. Many elevated results are caused by benign prostate conditions. This may lead to anxiety and additional investigations that ultimately do not confirm cancer.

False-Negative Results

Some men with prostate cancer may have PSA levels within ranges considered normal.

Overdiagnosis

Some prostate cancers grow so slowly that they would never cause symptoms or health problems during a person's lifetime. Screening may detect these tumours and lead to interventions that might never have been necessary.

Overtreatment

Treatments for prostate cancer can be associated with side effects such as erectile dysfunction, urinary incontinence and bowel problems. For this reason, the potential risks and benefits should be carefully considered before proceeding with further investigations or treatment.

What Happens If My PSA Level Is Elevated?

A raised PSA result does not automatically mean that cancer is present.

Depending on the PSA level, age and other clinical factors, your doctor may recommend:

  • Repeating the test after a period of time.
  • A physical examination, including a digital rectal examination (DRE).
  • A multiparametric MRI scan of the prostate.
  • Additional diagnostic investigations.
  • A prostate biopsy if clinically indicated.

Current international guidelines recommend that many patients undergo multiparametric MRI before a prostate biopsy is considered, as this improves the selection of candidates for biopsy and helps reduce unnecessary procedures.