PSA test for prostate cancer

Family history and other concerns about cancer

What causes prostate cancer is not known, but the chance of getting the disease increases as men get older, and having relatives (father, grandfather, uncle, brother) who have had prostate cancer increases the likelihood. It should be noted that other prostate problems associated with urinary symptoms, for which people also have treatment, would not place a family member at higher risk of prostate cancer.

Men of black African and black Caribbean descent are more likely to develop prostate cancer than other ethnic groups. Prostate cancer is also more common in the West, suggesting a possible link with western lifestyle factors, such as diet. (see the prostate cancer section for more about causes).

Men have PSA tests for many reasons, but some we talked to had asked their GPs for a PSA test mainly because of a history of prostate cancer in the family. Two relatively young men without urinary symptoms wanted a test just to make sure they didn't have an early cancer.

He asked for a PSA test because his father had prostate cancer. The result was normal.

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Age at interview: 42

Sex: Male

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The reason why I decided to have a PSA test was... two years ago following the death of my Mother, my Father decided to have a full medical check-up and he's aged seventy two and from the results or following the full check-up that he had it was identified that he had a very high PSA count and subsequently he did have prostate cancer, he-he had a prostatectomy.

And believe now that he's been given the all clear, so...

Oh good.

... so that's good but I thought from that it would be a sensible idea to have a PSA test, because it's a simple straight forward test so, I was actually at my GP's in June this year and I asked her if I could have one and she said yes, so I had a blood test and it was sent away and my result was low, zero point five.

But I aim to have the test every five years or so...

Right.

... from now.

So you'd never heard anyone talking about the PSA test on television or radio?

I've-I've...

Not that you're aware?

Not really sure, no not since my Father told me that he'd been diagnosed with prostate cancer. No, so in the last two years say.

Did he [your father] encourage you to have the PSA test?

Oh well no he suggested that at a convenient moment it might be a good idea.

Do you think the suggestion to have the test came from him in the first place? Or was it a joint decision with you and him [laughs]?

Well he put the idea in to my mind and the reason for that was, possibly to do with genes.

Right, so that comes back to the causes of prostate cancer?

Yes.

Have you, have you thought about that at all?

Well I suppose one possibility is genes from father to son.

Due to a family history of prostate cancer and pressure from a friend he asked for a PSA test to...

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Age at interview: 55

Sex: Male

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Yes, I'm 55 years of age and perhaps when I was about 50 I had a colleague who was having this test on a regular basis, perhaps once every twelve months and he put some pressure on me to, to go and have the test. He sort of stressed to me that he thought it was important that men of our age should be having this test, at least every twelve months. And I have some history within my family, I certainly know that my grandfather on my father's side died of prostate cancer, that's obviously many, many years ago and also my Uncle, my father's younger brother died, developed prostate cancer, was treated and successfully in his early to, early to mid 70s. So there was some family background of this particular illness. So on my next visit to my GP, I didn't particularly go for that reason, I mentioned it to him that I thought it might wise, what was his advice about me having the test and that I did notice there was some reluctance from the doctor that the test was even necessary. I had no symptoms as far as I was aware and he obviously asked me questions, I had no symptoms but I think he could see that I was perhaps determined to have it, if only for some peace of mind. So he agreed to give me the test which is only basically taking a sample of blood and it's sent away for analysis. He explained to me that sometimes the test, the result can be a little bit, well what he said sometimes the results could show that there might be some abnormality but then in effect it could turn out that there isn't so he said it wasn't altogether accurate. So but anyway I decided I would have it, a blood sample was taken and a couple of weeks later I got a letter from the doctor to say everything was fine.

And as I said I would be about may be 50, 51 when I had that test and since then I've had a further test, probably eight or nine months ago, round about the end of 2004. On that occasion I actually saw the practice nurse and explained that I'd had the press, the test perhaps two years earlier and could I have another. She said she would have to speak to the doctor about it but she very quickly did that and we, we, she took the test, took the blood sample the same day and again I rang into the doctors some weeks later to find that the test was clear.

Other men, also symptom free, had asked their GPs for PSA tests because of a family history of prostate cancer. But further investigations found they had the disease.

His brother and father had had prostate cancer so he asked for a PSA test, and he was diagnosed...

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Age at interview: 70

Sex: Male

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Starting with my brother. He was very ill at the end of 1999 into 2000 and continued for a year up and down, had quite a lot of tests and investigation and one of these was a PSA test. This showed that he had a PSA of 16 but the outcome of the research was that in fact although he had a prostate infection it was quite independent of the cancer. Nonetheless the test score indicated treatment would be a good idea and he went into the hospital in [town] at the beginning of 2001 and had a prostatectomy. This persuaded me that I ought to get a PSA test, particularly as I remember my father had what I think was the same problem in the 1960s. So I came to see the doctor who was initially reluctant to do the test because he considered that it quite often gave false indications, particularly false positives which could be worrying without being helpful.

Nonetheless he agreed to do it because I asked for it and it gave a score just over 4 which was enough to persuade him that he should continue to monitor it and tests were done every 6 months up to August 2002 when the PSA test figure was over 6. And at that point he referred me to a specialist in a hospital in [town] and I had a test, which I've now forgotten the name of, a biopsy, which was really rather uncomfortable. And this indicated that there was cancer present in the prostate and surgery, and radiotherapy were both considered but eventually it transpired that in the biopsy some tissue had been taken from outside the prostate and that also showed signs of cancer which meant that a prostatectomy wouldn't in fact solve the problem and radiotherapy was indicated. So we went into radiotherapy in the summer of 2003, I think a month of daily visits every working day and although it was tiresome it was not in any sense unpleasant and after that I was referred back after three months when we had another PSA and then every six months. And following the last meeting with the specialist, the PSA was still below 1 and in his opinion it wouldn't be necessary to have another review for a year so the next review is at the end of 2005.

When you said he [the GP] was reluctant to give it to you your feelings at that time were, perhaps you can explain why you persisted?

Well because it seemed to me possible that there was a hereditary tendency and that as my brother's health hadn't been affected by the cancer, that his illness was due to a separate prostate infection, it seemed to me not surprising that I didn't have any symptoms and that the sooner the problem was discovered the better, if there was a problem. And of course it would've set my mind at rest if there had been no problem.

Having seen his father die of prostate cancer he wanted a PSA test so that if cancer were diagnosed he could start aggressive treatment.

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Age at interview: 52

Sex: Male

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As far as the PSA test is concerned I had some knowledge beforehand. The knowledge was that A) my father had prostate cancer, and working in the pharmaceutical industry I get a lot of chance to talk about medical things. And I've had debates on, with, you know, friends who are GPs and consultants about the merits of PSA tests. And also I'd had a couple of friends who'd also had prostate cancer. And my father-in-law had also had prostate cancer. So I had a good, I had a good idea what PSA tests were and also the unreliability of prostate tests. So when I was 50 I decided that I'd go to my GP and debate to have a PSA test. And I had a PSA test when I was 50. And that PSA test came out at roughly 2, of which was normal. And the GP reassured me that that was normal, but he said, 'We must repeat that'. I probably should have gone back and had it repeated after one year, but time lapsed and things, I was busy. And I actually went back after about eighteen months and I had a PSA test done a second time. And that came out at 7.2, which was obviously abnormal. I was called back to the GP. We debated on what to do next and we'd agreed that he would do a rectal examination. Which he did, which he couldn't feel anything wrong. And we took a second PSA test. That second PSA test came out at 6.2, which was, also abnormal. And at that stage I was referred to the local hospital, where I saw a specialist registrar, who again repeated the PSA test and did a second rectal examination.

Can I just interrupt? You're quite young. What made you decide to have that PSA test?

The only reason I decided to have the PSA test done in the first place was the h-, family history, my family history of my father having prostate cancer. And I knew that there was a greater increased risk of prostate cancer. But at that moment in time when I had the PSA test done I had no symptoms at all.

Would you mind just going over a little bit about what might have influenced you to have the test?

Well, I think the biggest influence was that my father did have prostate cancer. He had a number of other medical conditions at the time, but the end condition which he died of in, in a hospice was, was cancer, and that was, that was prostate cancer that had spread to the bones. And I suppose having seen my father die and been there nearly at the end of his death, then I wanted to make sure that, you know, if I could have treatment I'd have aggressive treatment to start with.

One man found that he was passing urine more frequently than previously, and since his father had had prostate cancer he asked for a PSA test as part of his private medical care. Two tests have been 'normal'. He plans to have another one soon.

He decided to have a PSA test because of a family history of prostate cancer and mild urinary...

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My father died of prostate cancer and the interesting part was that a sort of nowadays he wouldn't have been allowed by his doctor to have the symptoms that he had for so long. My, my father you know, constantly had difficulty in passing water. I remember sort of going to hotels and things like that and my, my father would be sort of standing there endlessly trying to pass water. And once when he was on holiday he had to go and have something which in those days they called a boogie put up in, in order to enable him to pass water. And I suppose that and then sort of subsequently he was diagnosed with something wrong with his prostate. He had the operation and had the prostate removed but it was far too late and the cancer had spread all over the place. And fifteen months later he died. And I suppose I think to myself coming up to the kind of age that he was. In fact I've passed the age that he was when I think he first had symptoms. Because I think he had symptoms, quite bad symptoms, probably for seven or eight years even ten years before any doctor came along and said, 'Now look' you know, 'That is quite serious. Let me give you some sort of test.'

And so therefore now things have moved on. I mean I, I always when I went for a private medical always, you know, asked the doctor even when I was in my thirty and forties to pay some attention to see whether the gland was enlarged or not. And I suppose since I heard about PSA I've had the test twice and I'm going to have one again. I had the test twice over four or five years with sort of two or three year interval. And I'm having a full medical privately in the month coming up and you know, I'm going to ask for a PSA test there as part of it.

But in the last probably five, six years my stream hasn't been as good as it was when I was a lot younger. And I get up in the night perhaps a couple of times which is, is unfortunate because I sleep incredibly well so I'm up and I'm back in bed asleep literally within a minute. And so therefore I, it's come to me that right. I've never had any real pain or anything like that. It just is that sometimes my stream is not that good and I'm passing water a lot. I think probably part of the reason I'm passing water a lot is I'm, I drink a lot of liquid but nonetheless that isn't the reason why my stream is poor perhaps in the morning. And so hence, thought to myself well certainly I'd like to be reassured I haven't got a cancer problem there.

Some men had specific concerns about cancer even though there wasn't a family history of the disease. One young man, for example, began to worry about prostate cancer when his father-in-law was diagnosed.

He decided to have a PSA test when his father-in-law developed prostate cancer.

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Age at interview: 49

Sex: Male

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Okay basically it was brought about as far as I'm concerned because, well the impetus was from my father-in-law, who actually has prostate cancer. Before I'd had a conversation with him I was actually not really aware of what it was or what the problems were and how it would exhibit etc. So I actually decided, well I mulled it over for a long time as to whether I should actually go and have a test and could I face hearing the result, whether it was you know positive or negative, did I actually want to know, and then trying to weigh up what the implications were of finding out. So I went to the GP and asked the GP if I could have a test and they were actually perfectly receptive to providing a test which, which I then did. And that takes us to now, essentially because as it stands, and this is not going to be very good for your interview, I haven't heard back from the GP in terms of whether it's positive or negative, and this is some time ago I did the test so I can only assume that it's negative [laughs]. That does concern me slightly and in fact I have rung the doctors just to, just to chase up and try and get the result. But it was a specific PSA test and it was at my request.

Did you say it was your father-in-law who had prostate cancer?

My father-in-law has prostate cancer yes so not directly related to me obviously. It was just that he's always been a very healthy guy, never really been ill with anything and suddenly discovered that he had prostate cancer, which I understand is a fairly common thing in men as they get older and in fact as you, well I don't know what the term is, contract it or develop prostate cancer as you get older it's not a life threatening thing, usually because although it is a cancer, at the age that they, they develop it tends not to be a problem.

So there's no prostate cancer in your direct family?

Not as far as I'm aware.

So just knowing about him made you start thinking about it?

Yeah it was just, yeah, essentially that's what happened. It just set the ball rolling in my head and I thought well actually okay [my father-in-law] is not old, he's only, he's 73 and I'm just coming up to 50 and it just struck me that if there was going to be something there and there was a test available then it would be better to know than not know and therefore you know face up the problem if there was one. And as the test was available then I decided to go for it.

Another man had had testicular cancer in the past and wondered if this made him more susceptible to other cancers. He had repeated PSA tests and was eventually diagnosed with prostate cancer.

He worried about prostate cancer because he had had testicular cancer in the past.

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Age at interview: 60

Sex: Male

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Well basically it starts 10 years ago I had testicular cancer and I suppose ever since then I've had it in the back of my mind that I've thought that there might be a problem. You tend to push it to the back of your mind as much as you can but it's always been there. And now I've just been signed off with the testicular cancer, that's all clear, and then my brother had a heart attack, who is somewhat older than me, he's about 15 years older than me. I'm coming up 60 and I thought I must have the MOT now to see how things are going. So I went and had the MOT at the surgery and asked, while I was there, for the PSA test, which they did, and from then they first of all picked up that I had a high PSA count, so I had to go and have the biopsy. They took the biopsy and they couldn't find anything with that test at all so we waited 3 months and I took, they took another blood test for the PSA and that one showed that it was slightly higher so I had to have another PSA test then which they did actually find some. Basically that's, that's it really as far as we've got to date. Now I have to have the, the operation.

They did another biopsy?

That's right.

You said they did another PSA test, they did another biopsy?

That's right yes and well that's it as far as we've got really and that is, that is the whole story.

There is no evidence that testicular cancer leads to prostate cancer, but another man was also worried about prostate cancer because he had been born with an undescended testicle and had been told that this meant he had a slightly higher risk of developing testicular cancer (also see testicular cancer section).

Testicular problems in the past made him worry that he might develop testicular cancer or prostate cancer.

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Age at interview: 58

Sex: Male

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About the PSA test, yes, well the reason for asking for a PSA test was more immediately connected with worries about testicular than about prostate cancer although my GP explained that having a higher risk for the one didn't mean necessarily a higher risk for prostate but I still wanted the assurance. And the GP did explain that you don't necessarily get the assurance because there can be errors either way, in the jargon false positive and false negative which was explained to me. But, so my personal story goes back well to birth because I had an undescended testicle and this was not dealt with until I think my mid 20s or 30s and then it was discovered that I had no sperm production in the other one, I have a prosthesis, an artificial one, so at later times in life various GPs explained to me that this did carry a slightly higher risk of testicular cancer in the other one, in the surviving natural one and so I can't remember the occasion, I think it may have just been a routine check up but my GP said would I like to take the PSA test in view of the anxieties I'd expressed. But she did explain that there was no necessary connection between testicular cancer and prostate cancer. She explained the risks of getting a raised PSA and then not having prostate cancer but I was happy to accept the risks.

So I decided to have a PSA test for two reasons. One was that I have had testicular problems in the past and although the GP told me that there was no particular connection between having testicular problems and having prostate cancer still that was, it was a concern. And the other was that I'd noticed needing to go the toilet slightly more frequently and I'd heard that that was, or could be a sign of prostate problems, enlargement or whatever. And so for those two reasons when the GP invited me to consider having a prostate PSA test then I decided that I wanted one.

(For more discussion about whether or not to have a PSA test see 'The pros and cons of a national screening programme for prostate cancer'.)

Last reviewed May 2016.
Last updated May 2016.