Strong Men Get Checked: Your Guide to PSA Testing

PSA Testing: Who Should Be Tested, and Why

Prostate cancer is one of the most common cancers affecting men worldwide, and in South Africa, it ranks among the leading causes of cancer-related deaths in men. Fortunately, when detected early, prostate cancer is highly treatable, and survival rates are excellent. One of the most effective tools we have in detecting prostate cancer early is a simple blood test — the PSA test.

But PSA testing has also become a topic of debate. Some men wonder whether they should be tested at all or worry about false alarms. In this post, we will explain what PSA testing is, who should consider it, and why it remains an important part of men’s health.

What is PSA?

PSA stands for Prostate-Specific Antigen, a protein produced by both normal and cancerous cells of the prostate gland. It is found in small amounts in the bloodstream of all men, but when the prostate is enlarged, inflamed, or affected by cancer, PSA levels can rise.

A PSA test is a simple blood test that measures the amount of this protein in your blood. It doesn’t diagnose cancer directly, but it helps identify whether further investigation is needed.

Why PSA Testing Matters

Early-stage prostate cancer often causes no symptoms. By the time urinary difficulties, pain, or other symptoms appear, the disease may already be advanced. PSA testing gives doctors a chance to detect possible prostate cancer early, before symptoms appear and while treatment options are most effective.

When prostate cancer is found early, it is often curable, and treatments can be less invasive. The PSA test is therefore not just about cancer detection; it’s about giving men the best chance of long-term health and peace of mind.

Who Should Get Tested?

There is no single rule for every man, but the consensus among urologists and medical societies is that men should have an informed discussion with their doctor about PSA testing based on their age, risk factors, and family history.

Here’s a guide to help decide who should consider testing:

1. Men Aged 50 and Older

All men over 50 should speak to their doctor about PSA testing as part of a routine health check. At this age, the risk of developing prostate cancer increases significantly.

For healthy men with no family history and no symptoms, a baseline PSA test at age 50 is recommended. If levels are normal, testing every 1–2 years may be sufficient.

2. Men at Higher Risk (Age 40–45 and Up)

Some men are at higher risk of developing prostate cancer earlier in life. You should consider PSA testing from age 40 or 45 if:

• You have a father, brother, or uncle who was diagnosed with prostate cancer, especially before the age of 60.

• You are of African descent, as research shows men of African heritage are more likely to develop aggressive forms of prostate cancer.

• You have a family history of breast, ovarian, or other related cancers, as certain inherited genetic mutations (like BRCA) can also raise prostate cancer risk.

For these men, early and regular PSA testing can be lifesaving.

3. Men with Urinary or Related Symptoms

If you experience any of the following, speak to your doctor about a PSA test and further assessment:

• Difficulty starting or stopping urination

• A weak or interrupted urine stream

• Needing to urinate frequently, especially at night

• Blood in the urine or semen

• Persistent back, hip, or pelvic pain

These symptoms don’t always mean cancer — they could also indicate prostate enlargement (BPH) or infection, but they should never be ignored.

What Does a PSA Result Mean?

PSA levels are measured in nanograms per millilitre (ng/mL). Generally:

• A PSA below 4 ng/mL is considered normal for most men.

• PSA between 4–10 ng/mL suggests a moderate increase and may warrant further investigation.

• A PSA above 10 ng/mL raises the likelihood of cancer and usually requires further testing.

However, these numbers are not absolute. Age, prostate size, recent infections, and even sexual activity can affect PSA levels. This is why PSA testing should always be interpreted in context by a healthcare professional, ideally a urologist.

If your PSA is elevated, your doctor might repeat the test or recommend additional investigations, such as a digital rectal examination (DRE), MRI scan, or prostate biopsy, to determine the cause.

 

Balancing Benefits and Risks

One concern with PSA testing is the risk of overdiagnosis, finding cancers that may grow so slowly they would never cause harm. This has led to unnecessary anxiety or treatment in some cases.

However, the key is individualised screening. PSA testing is most effective when guided by a patient’s risk profile, age, and medical history. Discussing your results with a qualified urologist ensures you get a balanced approach, not too much, not too little.

The benefits of early detection often outweigh the risks. Men who are informed and proactive about screening typically have better outcomes if cancer is detected.

The Role of the Urologist

As a urologist, my goal isn’t only to detect cancer but to ensure that every patient’s care is personalised, evidence-based, and respectful of their values. PSA testing opens the door to early discussions about men’s health, not just prostate cancer, but urinary issues, sexual health, and lifestyle factors that affect wellbeing.

At Crestcare Malmesbury Hospital, we offer comprehensive urological services, including:

• Prostate screening and diagnostics

• PSA monitoring and follow-up

• Management of urinary tract and kidney conditions

• Surgical and non-surgical treatment options

Our approach is always patient-centred and discreet, ensuring that each man feels supported and informed through every step.

Takeaway: Knowledge is Power

Prostate cancer can be silent, but it’s also one of the most treatable cancers when caught early. The PSA test is not perfect, no screening tool is, but it remains a powerful first step in protecting men’s health.

The key is awareness and informed choice. Speak with your GP or urologist about your personal risk and whether PSA testing is right for you.

Early detection saves lives and peace of mind is priceless.