PSA test: what it measures and when it makes sense

What is the prostate?

The prostate is a walnut-sized gland located just below the bladder. The gland produces fluid that forms part of semen. As men age, the prostate slowly grows, this is normal and proceeds without symptoms in most men. It is only when the gland becomes too large that pressure can develop on the urethra.

Prostate cancer is the most common cancer in men in the Netherlands, over 14,000 men are diagnosed annually. An important distinction: most prostate tumours grow slowly and will never cause symptoms during the patient's lifetime. A smaller group is fast-growing and requires active treatment.

What is PSA and what does the test measure?

PSA stands for Prostate-Specific Antigen, a protein produced exclusively by prostate cells. Small amounts of PSA normally enter the bloodstream. A blood test measures how high that concentration is.

An elevated PSA level can indicate prostate cancer, but also:

• benign prostatic enlargement
• prostatitis (inflammation)
• simply older age

The test is therefore sensitive but not specific: many men with an elevated level turn out to have no cancer on further investigation.

For whom is the PSA test worthwhile?

The PSA test is particularly worthwhile for men between 50 and 75 who want to know whether they have prostate cancer, regardless of whether they experience urinary symptoms. Urinary symptoms are not a reliable indicator of prostate cancer; they more commonly indicate benign prostatic enlargement or bladder problems.

Men with a strongly elevated family risk, three or more first-degree relatives with prostate cancer, are advised not to test independently but to discuss structured screening directly with their GP. A different guidance pathway applies to them.

Advantages of the PSA test

The test has a number of clear advantages:

• a normal result offers reassurance
• if the value is notably high, early detection provides the opportunity to discover cancer before symptoms occur
• if the tumour proves to be fast-growing, timely treatment can prevent metastasis and improve survival
• the test provides space to make considered decisions: about testing, about watchful waiting, or about treatment

Disadvantages and limitations of the PSA test

An elevated PSA value often leads to further investigation that ultimately shows no cancer, but uncertainty and burden are incurred along the way. Moreover, PSA screening regularly detects slow-growing cancer that would never have caused symptoms during the patient's lifetime.

Treating such a slow-growing tumour, surgery or radiation, carries risks including erectile dysfunction, incontinence, and bowel problems, without demonstrably extending life expectancy.

The decision is therefore personal: for one man, the certainty of knowing outweighs; for another, the risk of unnecessary treatment is a reason not to test.

What happens after an elevated PSA value?

With a notably high PSA value, the GP refers for further investigation. The process typically proceeds in steps:

1. 1a consultation with a urologist
2. 2an MRI scan of the prostate
3. 3if the scan gives grounds, a tissue biopsy

Only after biopsy can it be established with certainty whether cancer is present, and if so, of what type and growth rate.

Practical information: how does the measurement work?

PSA is measured via a simple blood draw, you do not need to fast. However, in the 48 hours before the blood draw, avoid:

• intensive cycling on a hard saddle
• a digital rectal examination
• ejaculation

These can temporarily raise the PSA level and cloud the result.

At Bloodworks, PSA is measured at one of 800+ blood draw locations in the Netherlands. Every result is assessed by a doctor and delivered as a personal PDF report, with an explanation of the value and, where applicable, advice to contact your GP.