Cancer-screening decisions
A PSA test is a blood test that screens for prostate cancer. It’s genuinely useful for some people and genuinely harmful for others — which is why it’s offered as a choice, not given automatically. This walks you through what to weigh, and hands you the four questions to take to your GP.
This is for anyone with a prostate. We say “men” in places because that’s how most people talk about it, but trans women and some non-binary and intersex people have a prostate too. Doing the homework for someone else? You’re in the right place — “you” just means the person deciding.
Please read this first
Just to check
A quick redirect — this isn’t a screening question for you
A PSA test is a screening tool for people without symptoms. Because you’ve told me you have symptoms, this isn’t a screening decision — your symptoms should be assessed by your GP, who may or may not use a PSA test as part of that. Book a GP appointment to get them looked at.
You can still take questions in. Here they are, reframed as “questions to bring to that appointment” — not as a screening calculation.
This tool helps you prepare to decide — it can’t tell if something is serious. If you’re worried it might be urgent, call 000 or your GP now.
The bit nobody explained
What it looks like for 1,000 people
1,000 people of average risk, screened with PSA over about 13 years
These are the numbers from the trial Australian guidelines rely on. They’re here so you can weigh them — not to tell you what to do.
Out of 1,000 people of average risk screened with PSA for about 13 years: about 1 has a death from prostate cancer prevented (shown as a filled diamond); about 27 are diagnosed with a prostate cancer that may never have harmed them (shown as ringed squares); and the remaining roughly 972 have their prostate-cancer outcome unchanged by the screening (shown as plain dots).
1 death prevented · ~27 over-diagnosed · per 1,000 screened ~13 yrs
Your own numbers depend on your age, family history and health — that’s the part only your GP can fill in for you.
Print or screenshot these. They’re what to ask — the answers are yours to work out together, then you decide.
The honest part
A raised PSA usually does NOT mean cancer — roughly 2 in 3 people who go on to have a biopsy after a high PSA turn out not to have prostate cancer (Cancer Council Australia). And finding a slow cancer that would never have caused trouble can lead to treatment with real side effects — including problems with continence and erections. This is exactly why Australia doesn’t run a national PSA screening program: for people with no symptoms, the experts judge the harms can outweigh the benefits at a population level (Australian PSA screening position statement). For YOU as an individual, it’s a genuine personal choice — which is the point of this card.
A clean printable with the numbers and your four questions, ready to put on the desk.
That doesn’t look like an email address — mind checking it?
I’ll also send the occasional drhblo email. Unsubscribe anytime.
If your PSA does come back raised, the next decision — repeat, MRI, biopsy, or watch — is a bigger one. The full prostate-decisions kit walks you through it with the real numbers for your situation. You can also read the plain-English explainer on the prostate and PSA, see how numbers like these work for other treatments with the NNT/NNH Visualiser, or get the four questions for any other decision with the BRAN Question Generator.