Prostate Cancer Screening in Singapore: A Simple Guide to the PSA Test

The PSA test is an essential preliminary screening tool for prostate cancer. Undergoing a PSA test is typically the first step in screening for prostate cancer. 

The PSA test is a blood test that measures levels of prostate-specific antigen (PSA), a protein that is produced by both healthy and abnormal prostate cells. PSA is naturally present in the blood at low levels. Hence, an elevated PSA level that shows up in test results may signal the presence of prostate cancer or other issues related to the prostate. A small amount of blood sample is taken from the patient’s arm, and the PSA levels are then analysed in a laboratory. 

Generally, PSA levels under four nanograms per millilitre (ng/mL) are considered within the normal range. PSA levels above the threshold may indicate an issue with the prostate gland and need to be evaluated further to understand the underlying cause. However, do not panic if your PSA levels are elevated, as this does not necessarily mean you have prostate cancer.

Why is the PSA Test Important?

Early prostate cancers are often without symptoms, and an elevated PSA level may be the only indication of cancer.. PSA test allows for early detection of prostate cancer and can ultimately lead to improved treatment outcomes and reduced chance of cancer spreading beyond the prostate gland. While the PSA test results might not be a definitive diagnosis of prostate cancer, it serves as a helpful initial step in identifying potential prostate conditions.

Who Should Get Tested?

Recommendations for PSA testing are made with consultation with your doctor and  based on the following individual risk factors:

• • Old Age: General guidelines suggest that men aged 50 and older can consider PSA testing, while those at higher risk may start earlier.

•  Family History: Men with a father, brother, or close male relative who has prostate cancer or a close female family member who has been diagnosed with breast cancer.

• Diet Rich in Animal Fat and Low in Fibre: Observational studies found that a “Western diet,” characterised by high consumption of animal fat and fried foods, may be linked to an increased risk of prostate cancer. paninigarilyo: Toxic chemicals in cigarettes can influence hormone levels in the body, potentially contributing to an elevated risk of prostate cancer.
• Cadmium Exposure: Individuals frequently exposed to cadmium in occupations such as metalworking or the manufacturing of batteries, electronics, and plastics face a higher risk of developing prostate cancer.
• Human Papillomavirus-16 (HPV-16): Studies have found that HPV-16 can cause gene mutations, increasing susceptibility to prostate cancer.

Consulting with a urologist can help determine the appropriate screening schedule depending on your risk factors. 

The Controversy Surrounding the PSA Test

PSA tests may lead to diagnosis of slow-growing prostate cancers that may not pose an immediate threat to the patient’s health. Many of these cancers remain asymptomatic and do not progress significantly during the patient’s lifetime.

Some organisations advocate for routine PSA screening, while others recommend against it for population-based screening of average-risk men due to concerns about overdiagnosis and overtreatment. The decision is now largely left to shared decision-making between patients and their urologists.

Preparing for the PSA Test