• Age
• Urine infection
• Your GP will test for this and treat any infection. They will give you the PSA test in four to six weeks time.
• BPH
• Prostatitis
• Prostate cancer
• Vigorous exercise
  Exercise such as cycling may raise the PSA level. You might be asked to avoid vigorous exercise for 48 hours before the test.
• Ejaculation
  You may be asked to avoid sexual activity for 48 hours before the PSA test.
• Biopsy
  Prostate biopsy in the six weeks before a PSA test could affect the result.
  A catheter or investigations or operations on your bladder or prostate You may need to wait up to six weeks before having a PSA test.
• Medicines
  Tell your GP if you are taking any prescription or over-the-counter medicines.

A PSA test alone cannot diagnose prostate cancer. PSA naturally rises as men get older and the prostate gland gets bigger. A high PSA level for your age can be a sign of prostate cancer, but it can be caused by other things. PSA levels can range from 1ng/ml to up into the 100s and further. 'Normal' PSA levels may be up to:

• 3 ng/ml for men in their 50s
• 4 ng/ml for men in their 60s
• 5 ng/ml for men in their 70s and over

A very high PSA level (in the 100s) normally means that a man has prostate cancer. If your PSA level is only slightly raised, then your doctor would do other tests to find out if there is a problem.

Your GP will consider your PSA level together with your DRE result, any risk factors or other health problems and any previous biopsy results before discussing the next step with you.

If your test results are within the normal range you may not need any further tests or your GP may advise you to have another PSA test in the near future. If they think that you may have a prostate problem then they might refer you to the hospital. You can also ask your GP to refer you to a hospital specialist.

Advantages

• It may help pick up a significant prostate cancer before you get any symptoms
• It could help to monitor men who have a higher risk of developing prostate cancer
• It may help pick up a more aggressive cancer at an early stage when treatment may prevent the cancer from becoming more advanced
• Repeat PSA tests can identify changes to your PSA level that may show that there is a problem with your prostate
• It may help to pick up a non-cancerous prostate problem such as BPH or prostatitis

Disadvantages

• Around two thirds of men with a raised PSA do not have prostate cancer
• It will not pick up all prostate cancers. Some men with prostate cancer have a normal PSA level
• It cannot tell you whether a prostate cancer is likely to be fast or slow growing (high or low risk). A slow growing cancer may not cause any symptoms or shorten your life
• If your PSA is raised, you may need a biopsy which some men find uncomfortable and has some risks
• Treatment for prostate cancer may cause significant side effects which can affect your daily life

To help you decide, ask yourself:

• Are you more at risk of prostate cancer?
• If the result of your PSA test was normal, would this reassure you?
• If your PSA was high, what would you do?
• If you went on to be diagnosed with slow growing prostate cancer that might not cause you any problems in your lifetime, would you want to have treatment that may cause side effects?

Speak to your GP about any concerns before making a decision or contact the specialist nurses on our Helpline.

After some men have had their first PSA test, they may choose to have regular tests, particularly if they are more at risk of prostate cancer. This might be a good way to spot any changes in your PSA levels. At the moment there is no research to show how often men should have tests, but this could be every one or two years. You could discuss this further with your GP or contact our confidential Helpline.

Screening programmes aim to spot early signs of cancer in people who do not have any symptoms. There is no screening programme for prostate cancer because the PSA test is not reliable enough.

Screening using the PSA test could reduce the number of deaths from fast growing prostate cancer but it could also increase the number of men having unnecessary treatment for slow growing prostate cancer. Treatment can cause significant side effects so screening could lead to many men having worse side effects from treatment than they would have had from the cancer.

Early detection is still important for men at a higher risk of getting prostate cancer or who have advanced disease but no symptoms. If you are concerned about prostate cancer you can talk to your GP about your individual risk and talk through the advantages and disadvantages of the PSA test. If you then decide that you want a PSA test, you can ask your GP for one.

• What are the pros and cons of having a PSA test?
• Do I have an increased risk of developing prostate cancer?
• How long will I have to wait for the results?
• If I have a PSA test and the result is normal, will I need to have regular tests in the future?
• What is my PSA level?
• Do I need a DRE?