Prostate health and PSA testing explained

What the prostate does

The prostate is a gland about the size of a walnut, sitting just below the bladder and surrounding the tube (urethra) that carries urine out of the body. Its main job is to help make some of the fluid in semen. Because of where it sits, wrapped around the urine tube, any swelling or growth of the prostate can press on that tube and affect how you pass urine. The prostate tends to enlarge naturally with age, which is why urinary symptoms become more common in older men. Understanding this anatomy explains why so many prostate problems first show up as changes in urinating rather than pain.

Common prostate problems

Three conditions dominate. Benign prostatic enlargement is a non-cancerous growth of the gland that is very common with age and can cause a weaker stream, needing to go more often, urgency, dribbling, or getting up at night. Prostatitis is inflammation of the prostate, sometimes from infection, which can cause pain around the groin or when passing urine and sometimes fever. Prostate cancer is common but often slow-growing, and in its early stages it frequently causes no symptoms at all — which is precisely why testing is discussed. Importantly, having urinary symptoms does not mean you have cancer; most urinary symptoms in older men come from benign enlargement, not cancer.

What the PSA test is

PSA stands for prostate-specific antigen, a protein made by the prostate that can be measured in a simple blood test. A raised PSA level can be a sign of prostate cancer, but it is far from specific: levels also rise with benign enlargement, infection or inflammation, recent vigorous exercise, ejaculation, and even a recent examination. So a high PSA does not confirm cancer, and a normal PSA does not completely rule it out. In the UK there is no national screening programme for prostate cancer, but men over 50 can request a PSA test after a discussion with their GP about the pros and cons. The test is a starting point, not an answer.

Weighing up the benefits and harms

The value of PSA testing is a real balance. On the benefit side, it can help detect some prostate cancers earlier, and finding an aggressive cancer early can be life-saving. On the harm side, PSA can flag cancers that would never have caused problems, leading to worry, further tests such as an MRI scan or biopsy, and sometimes treatment with side effects like urinary or erectile problems — so-called overdiagnosis and overtreatment. It can also miss some cancers or raise false alarms. Because of this, the UK approach is informed choice: your GP helps you weigh your age, family history, ethnicity and personal preferences, and you decide together whether testing is right for you.

Making an informed choice

Some men are at higher risk and may particularly want to consider testing: those over 50, men with a father or brother who had prostate cancer, and Black men, who have a higher risk. If your PSA is raised, the modern NHS pathway usually involves an MRI scan of the prostate before deciding whether a biopsy is needed, which helps avoid unnecessary procedures. If cancer is found, not every case needs immediate treatment — slow-growing cancers may be safely monitored through active surveillance. The key message is that there is no single right answer for everyone. A conversation with your GP, understanding both what the test can and cannot tell you, is the best way to decide.