Prostate screening

Key points about screening for prostate cancer

  • Checks for prostate cancer include a blood test (PSA) and a digital rectal exam.
  • Routine testing for all men without symptoms is not currently recommended in Aotearoa New Zealand .
  • If you are aged 50 years or older and have urinary symptoms, talk to your healthcare provider.
  • They will discuss the pros and cons of screening for prostate cancer and can help guide you in deciding if it is the right course of action.
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Routine testing for prostate cancer in all men without symptoms is not recommended in New Zealand at present. Being tested for prostate cancer is your choice. Learning about the pros and cons of prostate testing can help you decide if it is right for you.

To help you decide if a prostate check is right for you, Health New Zealand | Te Whatu Ora has developed the Kupe(external link) website. It will help you understand the risks, benefits and implications of prostate testing, so you can have an informed conversation with your doctor. 

If you are unsure about whether you need to get tested for prostate cancer, contact your GP for a discussion on the risks and benefits of testing.

Checks for prostate cancer normally involve a blood test, called the prostate specific antigen (PSA) test, and a digital rectal examination (DRE).

If your test results suggest you are at high risk for cancer, you will be referred to a specialist, who may recommend another test called a prostate biopsy.

The prostate-specific antigen (PSA) test

This test measures the level of PSA in your blood. PSA is a protein made by your prostate. Higher than normal levels can occur when there is a problem with your prostate, such as an infection, an enlarged prostate or prostate cancer.

Most men with raised PSA levels don’t have prostate cancer and some men with prostate cancer have normal PSA levels. However, high PSA levels are a risk factor for prostate cancer.

Digital rectal examination

This is a quick way for your doctor to check for prostate problems. Your doctor will feel the size and shape of your prostate by inserting a gloved finger into your rectum (bottom). A prostate that is rough, irregular or hard is more likely to have cancer. Some cancers may be too small to be found by a rectal examination.

Specialist referral and biopsy

Your doctor will discuss your prostate check results with you. If the PSA and DRC results suggest you have a high risk for prostate cancer, your doctor will refer you to a urologist (specialist).

The specialist will discuss having a prostate biopsy, in which a small sample of your prostate gland cells are taken for examination.

The aim of the biopsy is to confirm whether or not you have prostate cancer and, if so, whether it needs treatment. The treatment options will then be discussed with you.

If the biopsy shows no evidence of cancer, you may be advised to attend future check-ups.

Generally, if you aged 50 years or older and have any bladder control problems, you should let your doctor know. They will discuss with you whether or not you should have a prostate check.

Symptoms include:

  • poor flow of urine (pee)
  • trouble stopping peeing
  • dribbling after you are done peeing
  • needing to pee more often, at night or urgently
  • trouble starting peeing
  • incontinence (starting to pee without wanting to)
  • pain when peeing
  • blood in your pee.

If you have no symptoms, it is recommended that you get checked if you:

  • you are a man aged 50–70 years old but don’t have any family history
  • you are a man aged 40–70 years old and your father or brother has had prostate cancer
  • you are a man aged more than 70 years old and you have family history of prostate cancer or you have had an abnormal PSA test previously, and you have a life expectancy of more than 10 years.

Having a prostate check is your decision. The tests for prostate cancer can be uncomfortable but they may reduce your chance of being harmed or dying from prostate cancer.

If your test results suggest you are at risk of cancer, you will need to decide whether to have further testing and possibly treatment. In making this decision, you will need to consider whether your quality of life will be better living with a slow growing cancer than having treatments, which may cause you more harm than the cancer ever will.

Your doctor can help you weigh up the benefits and risks of being tested, by taking into consideration factors such as your age and family history.

Video: The Prostate Specific Antigen (PSA) Test

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Video: The prostate specific antigen test: to test or not to test? Michael Evans and Reframe Health Films Inc, 2014

Visit the Option Grid website(external link) and use their interactive guide or pdf version to help you and your doctor decide whether or not you will have a PSA test.

Clinical guidelines

The following summary is from Prostate cancer management and referral guidance(external link) Prostate Cancer Working Group and Ministry of Health, NZ, 2015.

  • Every year 3000 men are found to have prostate cancer and 600 die from the disease. This publication will help primary care practitioners provide men and their family and whānau with consistent, culturally appropriate information on prostate cancer testing and treatment.
  • It includes an algorithm to help primary care practitioners have informed discussion with men who present with prostate-related concerns, and to support men to make informed decisions about prostate cancer testing. Explanatory notes provide more detailed information on each of the steps involved.
  • The guidance provides referral criteria including definitions of high suspicion of prostate cancer for the Faster Cancer Treatment Programme.

See our page Men's health for healthcare professionals

Continuing professional development

PSA – to test or not to test: that is the question(external link) (Goodfellow Unit Webinar, NZ, 2020)

PHARMAC resources

1. PSA and prostate screening(external link) – Prof Ross Lawrenson PHARMAC Seminars, NZ, 2016

2. Urology – diagnosis and management of prostate cancer(external link) – Mr Rod Studd PHARMAC Seminars, NZ, 2016

Clinical resources 

Testing for prostate cancer – helping patients to decide(external link) BPAC, NZ, 2020
Prostate cancer testing decision support tool for patients and their families(external link) BPAC, NZ, 2018
Prostate cancer awareness and quality improvement programme(external link) Ministry of Health, NZ
Guidance on using active surveillance to manage men with low-risk prostate cancer(external link) Prostate Cancer Working Group and Ministry of Health, NZ, 2015
Diagnosis and management of prostate cancer in NZ men – recommendations from the Prostate cancer taskforce(external link) Ministry of Health, NZ, 2013
Clinical practice guidelines on PSA testing(external link) Prostate Cancer Foundation Australia
PSA screening in asymptomatic men – the debate continues(external link) BPAC, NZ, 2010
Prostate specific antigen test – yes or no?(external link) Option Grid, US

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Credits: Healthify editorial team. Healthify is brought to you by Health Navigator Charitable Trust.

Reviewed by: Dr Jeremy Tuohy, Obstetrician & Researcher, University of Auckland

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