Prostate Specific Antigen (PSA) Testing

	of all new cancer cases in males (2016-18)[1]
	incidence in older men, Black men and those with family history[2]
	diagnosed via primary care, either through routine or urgent suspected referral (2018) [3]
	will survive for 5 years or more if they are diagnosed at stage 1[1]
	will survive for 5 years or more if they are diagnosed at stage 4[1]

References

1. Cancer Research UK, Prostate cancer statistics. Accessed October 2022
2. Delon, C., Brown, K.F., Payne, N.W.S. et al. Differences in cancer incidence by broad ethnic group in England, 2013–2017. Br J Cancer
126, 1765–1773 (2022).
3. For England, where route to diagnosis is known. CRUK, Early Diagnosis Data Hub. Accessed November 2022

NICE recommend providing the following information and advice prior to offering a PSA test to enable the person to make an informed choice. [1]

Benefits of PSA testing include:
Icon Tick	prostate cancer may be detected before symptoms develop and may extend life or facilitate a complete cure
Limitations and risks of PSA testing include:
Icon Cross	false-negative PSA tests – about 15% of asymptomatic people with a normal PSA level may have prostate cancer false-positive PSA tests –  about 75% of people with a raised PSA level have a negative prostate biopsy false-positive PSA test may lead to invasive investigations, such as prostate biopsy, and there may be adverse effects unnecessary treatment – slow growing tumours are common and may not cause any symptoms or shorten life

1. NICE. How should I assess a person with suspected prostate cancer. Accessed October 2022

Watch CRUK GP, Dr Joe Mays, discuss the benefits and limitations of PSA testing and the importance of discussing these with your patients:

Icon Warning	Act on clinical suspicion with consideration of risk factors such as family history and Black ethnicity
Icon Phone	Be aware of the potential challenges associated with remote consultation
Icon Investigations	Conduct face to face appointments/testing with patients if there is suspicion
Icon Lightbulb	Consider a Digital Rectal Examination (DRE) and a suspected cancer referral for patients with an abnormal DRE. A normal DRE does not rule out prostate cancer
Icon speech bubble	Consider a discussion with a urologist if you feel it would be helpful, take advantage of Advice and Guidance channels (available in England only)
Icon magnifying glass	Be aware of and feel confident discussing the benefits and limitations of the PSA test with patients
11.png	Be aware if multiparametric MRI (mpMRI) is available in your area as it can detect more clinically significant prostate cancers than the PSA test
Icon Safety	Safety-netting is vital for all patients, whether they’re being referred for tests or specialist advice, or not

The diagnostic pathway for prostate cancer has been changing with the implementation of multiparametric MRI (mpMRI). mpMRI is now widely available for use before biopsy.

There is some evidence to suggest multiparametric MRI (mpMRI) can detect more clinically significant prostate cancers than the PSA test, which could help mitigate some of the risks associated with the PSA test, such as biopsy complications, overdiagnosis, and overtreatment.

Research is ongoing to explore:

• optimising the PSA test, e.g. by combining with other patient factors or test results
• risk prediction models, including genetic risk scores
• using AI to support current diagnostics
• a screening trial to address current evidence gap

The following information and health professional resources are available to support the timely referral of suspected prostate cancer.

Recognition and referral of suspected prostate cancer

Our guide provides an overview of prostate cancer diagnosis and supports GPs to discuss the benefits and limitations of PSA testing with patients.

• CRUK guide to prostate cancer (UK version)
• CRUK guide to prostate cancer (Scotland version)

You can also watch CRUK GP, Dr Joe Mays, explain the importance of discussing PSA testing with patients.

Further information

•  Visit our Prostate cancer web pages for patient information.
• See CRUK’s Prostate cancer statistics for in-depth statistics on prostate cancer incidence, diagnosis, treatment and survival.