There is still much controversy about the PSA test. One of the men we talked to recalled that he had heard GPs talking on the golf course, and that they completely disagreed about the value of the test. 

Discovered that GPs have very different views about the value of the PSA test, but decided to have one anyway.

If a man has symptoms some doctors do a PSA test as routine, but experts differ on whether it should be routine or whether men should be counselled and encouraged to make an informed decision beforehand.

Most of the men we talked to had consulted their GP either because they had symptoms or because they had heard about the test and thought it might be a good idea to have one. Although we have no evidence that screening for prostate cancer at any age reduces mortality (see 'The pros and cons of a national screening programme for prostate cancer'), reaching 50 years of age prompted some men to ask for a test, and some said that their GPs thought it reasonable to consider prostate cancer checks at this age. 

Because the test is of uncertain benefit doctors are supposed to inform their patients about the benefits and limitations of the PSA test before one is done. Some of the men said that their GPs had discussed the test and had offered them a useful information leaflet (see NHS Cancer Screening).

The NHS Screening programme has developed the Prostate Cancer Risk Management Programme:

“The aim of Prostate Cancer Risk Management is to ensure that men who are concerned about the risk of prostate cancer receive clear and balanced information about the advantages and disadvantages of the PSA test and treatment for prostate cancer. This will help men to decide whether they want to have the test.

Information packs have been sent to General Practitioners to assist them in the counselling of men who enquire about testing. The pack will help the primary care team to provide men with information on the benefits and limitations of the PSA test. It comprises a reference booklet and summary sheet for the primary care team and a book of tear off patient information sheets.”

His GP discussed the advantages and disadvantages of having a PSA test. He decided not to have one now.

However, some men recalled little discussion about the PSA test before being tested. A young man, for example, who had recently requested a PSA test, was given no written information or advice.

He asked for a PSA test. He had no symptoms but was tested without getting written information or advice.

When doctors feel that a test is an important part of investigating symptoms they may not present it as a matter of choice. An elderly man who consulted his GP with symptoms was told it was 'crucial' that he had the test, but he knew very little about it. Another man, in the same situation had been tested for 'prostate problems', but knew little about the test itself. 

He did not remember receiving much information about the PSA test. His GP said it was 'crucial' that he had one.

He consulted his GP with symptoms. The GP did a PSA test without explaining much about it.

A man who asked a urologist in the USA for advice about mild impotence, regretted that he had had a PSA test without understanding the implications. 

He had the PSA test primarily to humour his urologist. The result left him feeling extremely anxious.

He wished he had talked to a trained counsellor before he had the PSA test.

Suggests that having a PSA test requires very informed consent, in the same way that patients have to give informed consent to an HIV test.

Other men we talked to felt much better informed. They knew about the PSA test and some of them had asked for it. They felt that the decision to have the test was entirely driven by them.

He decided that he wanted a PSA test and requested one from his practice nurse.

His GP agreed to his request for a PSA test without much discussion.

Some men said that the decision to have a PSA test was very much a shared decision, involving themselves, their GPs and their wives. 

The decision to have a PSA test was made with the help of his wife and GP. He knew the test might lead to further investigations.

Decision-making can be difficult, particularly if GPs seem to give conflicting advice. One man was told about the pros and cons of having a test but advised by his GP not to have one. When he consulted another GP in the practice, having seen a nurse about a suspected urinary infection, he was dismayed to find that this GP had decided that he should have a PSA test and had asked a nurse to do one. He wondered if this was due to defensive medicine. 

His GP advised him not to have a PSA test unless there were clear reasons for suspecting prostate cancer.

A breakdown in communication led to him having the PSA test against his will.

Men's experiences of making decisions about the PSA test reflect the uncertainty about the benefits of the test. Some saw it as a routine test, as 'responsible health behaviour', akin to cervical and breast screening, and recommended that other men their age should consider it, but others emphasised that it is less straightforward than a cholesterol or blood pressure check and that men need to be fully informed and prepared for the consequences if their results are 'abnormal'.

Last reviewed October 2010.

Last updated October 2010.