Check your prostate

Prostate screening and early detection in New Zealand

• Early prostate cancer often has no symptoms

• If you have prostate symptoms or concerns, such as problems peeing or blood in your pee or semen, see your doctor to get checked

• Many conditions can cause these symptoms, not just prostate cancer, but they should not be ignored

• Checks for prostate cancer symptoms normally involve:

  • A blood test called the prostate-specific antigen (PSA) test

  • A digital rectal examination (DRE)

• Discussion about PSA testing and DRE with your doctor usually begins at around age 50 for people without symptoms or a family history

• A DRE is optional, and you can choose whether you want one or not

• If you have a family history of prostate cancer (a father or brother who has had prostate cancer), talk to your doctor. You may benefit from testing from around age 40 years

Prostate-specific antigen (PSA) testing

What is a PSA test?

• Prostate-specific antigen (PSA) is a protein normally produced by the prostate

• The PSA test measures the amount of PSA in a sample of blood

• In cancer, PSA levels may rise abnormally

• A high PSA level does not always mean there is cancer

Making a decision about PSA testing:

• It is recommended that men aged 50 and older should talk to their doctor about PSA testing.

• Before making a decision, it is important to understand the benefits and risks

• Talk to your doctor about PSA testing so you can make an informed decision based on your own preferences

Benefits:

• A PSA test may help find prostate cancer before you have any symptoms and allow early treatment

• Early treatment is often more successful

• If your PSA level is slightly high, it can continue to be monitored, in case cancer is developing

• If further tests show a fast-growing cancer, early treatment may cure it or help you live longer

Potential harms and limitations:

• The PSA test is not a perfect test and can miss cancer

• Many people with a raised PSA level do not have prostate cancer

• A raised PSA may lead to a biopsy, which can have side effects such as pain, bleeding and infection

• Some prostate cancers found through testing would never have caused problems, but treatment can cause serious side effects, including urinary incontinence and sexual problems

Who should get checked?

You should see your doctor if you have:

• problems or changes with peeing (urination), which may include: a frequent or sudden need to urinate (pee), especially at night, pain or burning while urinating, a weak stream of urine, difficulty urinating or blood in your pee

• blood in your semen

• painful ejaculation

You should also discuss prostate checks with your doctor if:

• you have a father or brother who has had prostate cancer

• you are concerned about your prostate health

Discussion about PSA testing usually begins around age 50 for people without symptoms or a family history.

People with a family history of prostate cancer may benefit from testing from around the age of 40 years.

A warning against at-home PSA tests

Getting your prostate checked can be difficult or embarrassing to bring up with your doctor. Many people want to look after their health so may choose a home PSA test to do privately. There are many home PSA test kits available now online and at pharmacies. However, these are not recommended for the following reasons.

• Many people have elevated PSA levels for a reason other than cancer – eg, benign prostatic hyperplasia or prostatitis. This can lead to unnecessary anxiety and maybe even unnecessary further tests.

• You need to know more than just the PSA levels to diagnose prostate cancer – other things a doctor will  consider are family history, a digital rectal exam, or a biopsy.

• Only a doctor with clinical expertise can diagnose prostate cancer. 

• Home PSA tests don’t have proper quality control or follow-up.

• Home PSA tests may miss prostate cancer and lead to false assurance.

If you have symptoms, make sure to bring them up with your doctor. If you used a home PSA test, discuss this  with your doctor too. They are used to dealing with prostate tests and can support you.