When it comes to the PSA test, context is everything.
Anyone with a passing interest in prostate health - and that should be all of us - could be forgiven a moment of disappointment when the UK National Screening Committee (UKNSC) recently advised the government against introducing broad population PSA screening on the NHS. Many prostate cancer charities certainly voiced their discontent.
However, when viewed from the UKNSC’s perspective, the decision is understandable. Their rationale focused on two main concerns:
Cost versus the projected benefit.
The risk that people could be over investigated following a positive test, or conversely become ill advisedly complacent after a negative result.
The bottom line is this: interpreting a single PSA test result is a nuanced business. An isolated high PSA reading can be caused by a wide range of factors, the vast majority of which are not cancerous. These include normal age related prostate enlargement, prostatitis, cysts, recent trauma, recent ejaculation (yes indeed- within the previous 24 to 48 hours), epididymitis, sexually transmitted infections, urinary tract infections, or even sitting on a bike or horse for a couple of hours! Very quickly we see the enormity of the sifting challenge that an NHS screening programme would be faced with.
In addition, even when a raised PSA is caused by cancer, many prostate cancers grow so slowly that they require little more than careful observation and periodic monitoring.
So given all of this, why bother with a PSA test at all? Certainly, our doctors still order it, pretty frequently as it happens...
The answer is simple. Prostate cancer is the most common male cancer in the UK, and so far, the prostate specific antigen test remains the best chemical marker we have for its presence. To ensure it is used appropriately, our doctors at Winchester GP would generally request it in one of two broad circumstances.
First, when clinically indicated following a full consultation, based on specific symptoms or risk factors, and with full ongoing doctor support to interpret and act on the results. Symptoms your doctor would want to be aware of include frequent urination, especially at night, difficulty starting or stopping urination, weak or interrupted urine flow, a feeling that the bladder is not empty, dribbling after urinating, blood in urine or semen, pain or burning during urination or ejaculation, and erectile dysfunction.
The second circumstances is as part of a broader and more holistic health assessment, such as our Enhanced Wellness screen at Winchester GP. This includes the PSA blood test alongside multiple other tests to provide context and, most importantly, at least 40 minutes of discussion with one of our doctors. This ensures that any response to a raised PSA, or indeed any other abnormal result, is considered, proportionate, and fully tailored to you.
If you would like to learn more about incorporating PSA monitoring into your general healthcare routine, or if you are experiencing any of the symptoms listed above, please do not hesitate to get in touch.
Wishing you all a wonderful week!
Gemma, Tom and all at Winchester GP