PSA Blood Test or Digital Rectal Examination?

With prostate cancer  predicted to be the most common cancer in South Africa (SA) by 2030, more men are choosing to screen for if detected early the cancer is potentially curable. The Prostate Cancer Foundation (PCF) recommends informed patient-based screening in men with a life expectancy more than 10 years in the following situations:

– From the age of 40 in black African men and in men who have a family history of prostate and/or breast cancer in a first degree relative. The reason for recommending screening in black males at a younger age, is that they have a 60% greater risk for prostate cancer and are more than twice as likely to die from the disease.

– From the age of 45 years for all other men

In addition, patients with a history of lower urinary tract symptoms (LUTS) and/or clinical suspicion of prostate cancer, regardless of age group, should be tested, usually with prostate specific antigen (PSA) and a digital rectal examination (DRE).

When looking at these tests it is important to recognize that a positive screening test does not always mean the presence of prostate cancer  but rather gives an indication that there may be a problem. There are two factors used to determine the accuracy of a test in medicine:

Sensitivity– the ability to correctly identify patients with the disease (positive predictive value)

Specificity– the ability to correctly identify patients without the disease (negative predictive value)

So let us look at how PSA test DRE shape up as screening tools.

Prostate Specific Antigen (PSA)  is a blood test of a protein normally made in the prostate. PSA levels can increase when there are cancer cells in the prostate. PSA also increases with age as men have natural enlargement of the gland called benign prostatic hyperplasia (BPH) and certain other conditions, such as obesity, and some drugs can lower the PSA which is the reason age reference ranges decide individual management decisions.

Other common conditions that can raise PSA level include:

  • inflammation of the prostate (prostatitis)
  • urinary tract infection
  • prostate cancer
  • recent ejaculation

Accuracy of PSA:

The PSA test is far from perfect but at present it is the best we have. Using a cut-off of ≥4.0 ng/ml the PSA has a sensitivity of about 21% and a specificity of about 91%. If the cut-off is reduced to 3.0 ng/ml the sensitivity is about 32% for detection of any prostate cancer and for the detection of a high-grade cancer about 68%. One of the advantages of the PSA test is its ability to pick up prostate cancer 5 to 10 years before it causes symptoms. Because the test is not perfect, even if your PSA is normal there is still a chance that you have prostate cancer.

A Digital Rectal Rectal Examination (DRE) – During a DRE the doctor inserts a gloved, lubricated finger into the rectum to feel the back section of the prostate for enlargement, lumps, or irregularities. The DRE can only detect tumours that are in the area that can be felt by the doctor’s finger, although this is the area where most cancers occur. It may not detect small tumours in the early stages of the disease that the PSA will pick up.

Sensitivity is about 52% and specificity about 59% which are relatively low, which is why some guidelines no longer recommend DRE as a primary screening test for prostate cancer.

Athough PSA is the best screening test we currently have, for optimal detection it should be done together with a DRE. In one large multicentre screening study of 6630 men, the prostate cancer detection rate was 3.2% with DRE as opposed to 4.6% for PSA, and 5.8% when using both tests. So, if you want to be extra sure, have both tests.


Book our Prostate Cancer Foundation Stand for your company wellness event

Educating men about the importance of age and risk appropriate screening for prostate cancer can help to ensue that prostate cancer is detected in the early stages of the disease when treatment is potentially curable.

Our prostate cancer nurses and educators provide important basic information about prostate cancer that can help save lives. We are also able to do onsite PSA blood tests for men over the age of 40. The PSA blood test is the best test we currently have to detect problems with the prostate. An elevated PSA level could mean that the prostate is enlarged, or that there is an infection, or that there is prostate cancer.

With prostate cancer predicted to be the most common cancer by 2030 you should consider having our specially trained nurses and prostate cancer educators at your wellness day.

The 2022 Hollard Daredevil Run – A great success!

The 2022 Hollard Daredevil Run was was another huge success. The event takes place annually in September, which is prostate cancer awareness month. Thousands of men and boys, wearing their purple Daredevil speedos, run through peak hour trafc in
Johannesburg to raise awareness about prostate and testicular cancer. The funds raised are donated to The Prostate Cancer Foundation and CANSA.
After a two-year, lockdown-induced hiatus, the in-person event once again took place in September at Zoo Lake Sports Club, Johannesburg with over 2 300 men running through rush-hour trafc. The advent of Covid 19 meant that the event had to be held virtually for the past 2 years. Happily, this has actually increased participation by 1500 with neighbourhoods, schools, corporates and sports clubs arranging over 260 satellite runs around the country.

The Start at Zoo Lake Sports Club in Johannesburg

“We are blown away by the support we have received from around the country. The act of stripping down to nothing but a speedo is not only daunting for runners, but also challenges stereotypical male behaviour, which often stops men from tackling health issues,” says Heidi Brauer, Chief Marketing Ofcer at Hollard. “With this event, we are asking South African men to confront male cancers head-on by showing that they’re not afraid to run in a speedo, not afraid to talk about cancer and not afraid to get checked. Because catching these cancers early means better futures for those men unlucky enough to contract them, better futures for their families, and, ultimately, better futures for communities around the country.”

Patient Affairs Board vice-chairman, Thulani Sibisi with CEO Andrew Oberholzer 

“Running in just a speedo is something that asks a lot of men, more than most people understand. But dealing with cancer asks a great deal more. And that’s part of why this platform works so well in helping people understand the importance of catching these
cancers early”, says Warwick Bloom, Head of Group PR at Hollard.

Delegates at the South African Urology Association Congress in Bloemfontein warming up for an early morning Daredevil Run in Bloemfontein.