Who should have a PSA Test?
PSA testing is a little controversial. Not all men who have an elevated PSA have prostate cancer and not all men with prostate cancer need treatment.
In general, however, a young, otherwise healthy man is likely to benefit from the finding of prostate cancer.
We recommend annual PSA testing from the age of 45 or even 40 if there is a history of prostate cancer in the family. A family history of prostate cancer is a significant risk factor which is more important the greater the number of affected family members.
In older, or less healthy men (say, with a life expectancy of less than 10-12 years), it is not so important to pick up early prostate cancer because non-curative treatments are probably just as good as curative ones over this timespan. This does not mean that a PSA should not be done, it just means that the triggers for biopsy and intervention are at higher PSA levels.
Digital rectal examination (DRE)
Is it important to have a digital rectal examination (DRE)?
Many men are concerned about this. If your PSA is persistently elevated and if you are otherwise healthy then you are likely to need a prostate biopsy and as such the DRE can wait until you see your urologist. If your PSA is normal, then because a small proportion of prostate cancers are missed by the PSA test alone, a DRE is required.
If both the DRE and PSA are normal then you can be pretty reassured that there is nothing going on. However, just because you are OK this year, doesn't mean that you are not going to develop something next year.
We recommend annual testing until around 70 years of age.