Use In Men Who Might Have Prostate Cancer
The PSA blood test is used mainly to screen for prostate cancer in men without symptoms. Its also one of the first tests done in men who have symptoms that might be caused by prostate cancer.
PSA in the blood is measured in units called nanograms per milliliter . The chance of having prostate cancer goes up as the PSA level goes up, but there is no set cutoff point that can tell for sure if a man does or doesnt have prostate cancer. Many doctors use a PSA cutoff point of 4 ng/mL or higher when deciding if a man might need further testing, while others might recommend it starting at a lower level, such as 2.5 or 3.
- Most men without prostate cancer have PSA levels under 4 ng/mL of blood. Still, a level below 4 is not a guarantee that a man doesnt have cancer.
- Men with a PSA level between 4 and 10 have about a 1 in 4 chance of having prostate cancer.
- If the PSA is more than 10, the chance of having prostate cancer is over 50%.
If your PSA level is high, you might need further tests to look for prostate cancer.
To learn more about how the PSA test is used to look for cancer, including factors that can affect PSA levels, special types of PSA tests, and what the next steps might be if you have an abnormal PSA level, see Screening Tests for Prostate Cancer.
How Accurate Are Prostate Cancer Tests
Prostate cancer testing is heavily reliant on measuring prostate specific antigen levels, which can give notoriously high false-positive results. But why is this and how can doctors diagnose the disease more accurately?
Reviewed byDr Sarah Jarvis MBE
24-Sep-19·6 mins read
Prostate cancer is one of the most common cancers in the UK, affecting one in eight men at some point in their lives. While survival rates are good overall , it’s really important for men to understand their risk.
The disease mostly affects men over 50, with the most common age at diagnosis being 65-69. It is twice as common in men of black ethnicity, and two and a half times as common in men with a family history of prostate cancer. Usually asymptomatic at the earliest, localised stage, it may eventually lead to urinary symptoms such as difficulty emptying your bladder, or needing to pee more than usual. If it has spread beyond the prostate, you may notice blood in the urine or semen, hip or pelvis pain, or unexplained weight loss.
It goes without saying that, if you do notice any changes of this kind, it’s essential to visit the GP. No one symptom is really a giveaway for prostate cancer – they can all be caused by other health problems, most commonly non-cancerous prostate gland enlargement – so it may be necessary to run some diagnostic tests. Typically, the GP would start by offering you a PSA test.
What Is Screening For Prostate Cancer
Some men get a PSA test to screen for prostate cancer. Talk to your doctor, learn what is involved, and decide if a PSA test is right for you.
Cancer screeningexternal icon means looking for cancer before it causes symptoms. The goal of screening for prostate cancer is to find cancers that may be at high risk for spreading if not treated, and to find them early before they spread.
If you are thinking about being screened, learn about the possible benefits and harms of screening, diagnosis, and treatment, and talk to your doctor about your personal risk factors.
There is no standard test to screen for prostate cancer. Two tests that are commonly used to screen for prostate cancer are described below.
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What Are Normal Psa Levels
Thereâs no such thing as a normal PSA for any man at any given age, but most men with prostate cancer have a higher than normal level. In general:
If your PSA results are in the borderline range , the % free PSA can be useful in helping distinguish between prostate cancer or benign prostatic hyperplasia . The pattern is the opposite of that seen with PSA in that a high % free PSAâabove 20%âpoints to BPH, while a %- free PSA less than 10% indicates a greater likelihood of cancer.
Discuss Prostate Cancer Testing With Your Doctor
Medical authorities do not recommend that all men should be tested for prostate cancer. In fact, most authorities suggest that men should make their own choice about whether or not to have a PSA test. If you decide to be tested, it is recommended that it should be done every two years from 50 to 69 years of age, and only if your health is such that you expect to live for at least another seven years.
Men at high risk of prostate cancer, such as men with a family history of prostate cancer , or men who have previously had an elevated test result, can start two-yearly testing from age 45. Your doctor can help you decide whether this is necessary.
While there is now some evidence that regular testing may prevent prostate cancer deaths, there are concerns that many men may be diagnosed and treated unnecessarily as a result of being screened, with a high cost to their health and quality of life .
However, the option of active surveillance, where a low-risk cancer is watched closely instead of being treated, helps to lower these risks. Active surveillance is now used quite commonly in Australia for men with low-risk prostate cancer.
If you are unsure whether or not to be tested after considering the benefits and uncertainties of testing and your own risk of prostate cancer, discuss it with your doctor.
In Australia, if you choose to be tested for prostate cancer the tests are covered by Medicare.
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How To Get A Psa Test
Consult with your general practitioner or urologist about receiving a PSA test in their offices. PSA tests are typically covered without co-pay or deductible by Medicare once a year for men 50 years and older. Many states now have laws which require private health insurers to cover the costs for PSA testing. However, additional PSA test costs may need to be covered by the patient. For those without insurance, or for those with insurance that does not cover PSA testing, free tools are available through advocacy groups, such as ZERO.
Companies such as imawaretm also offer in-home PSA testing kits and telemedicine appointments to discuss your PSA test results with a licensed physician. All imaware test kits are easy to use. After registering the test kit online, results will populate in the secure patient portal within 5-7 business days. You can submit your receipt of this test to insurance for potential reimbursement.
“At-Home testing is now at a point where results can be provided accurately and quickly within 5 business days, with real physicians providing telemedicine support through the entire testing process”
Dr. Diamandis – Lunenfeld-Tanenbaum Research Institute, Sinai Health System
HALO Dx
What Happens If My Psa Level Is Elevated
If you have a high PSA level, you will need ongoing PSA tests and DREs so your provider can look for any changes. If the PSA level continues to increase or if your healthcare provider finds a lump during a DRE, you may need other tests, including:
- Transrectal ultrasound and prostate biopsies.
- Prostate MRI.
- Iso PSA or 4Kscore® .
A biopsy can tell you definitively if you have prostate cancer. The biopsy results also affect your treatment. For example, if the biopsy shows a lot of cancer cells, you might need more aggressive treatment.
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How Is Prostate Cancer Treated
Treatment options for prostate cancer include:
- Surgery to remove the prostate .
- High intensity focused ultrasound .
- Cryotherapy .
- Hormone treatment, also called androgen suppression therapy.
- Chemotherapy.
You may continue to have PSA level tests during and after prostate cancer treatment. These tests check that the treatment is working.
Psa Testing Isnt Perfect
The standard screening blood test for prostate cancer is the prostate-specific antigen . The American Cancer Society recommends men have a discussion with their primary care provider when they turn 50 about whether or not to start routine PSA testing.
PSA testing can be very valuable, but it often leads to unnecessary biopsies because results can be difficult to interpret as a stand-alone test. Many variables can skew a PSA level high or low, causing either concern or confusion when deciding what action to take next.
Oftentimes, a prostate biopsy will be recommended to further evaluate and try to create meaning from an abnormal PSA result. Unfortunately, a prostate biopsy is invasive and can cause adverse events. However, they are needed when prostate cancer is at risk.
We need a more sensitive, informative, non-invasive way to evaluate a mans risk of prostate cancer as well as their risk for developing an aggressive form of prostate cancer. This where the 4K score comes in.
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What This Means For You
The Prostate Cancer UK spokesperson sounds a note of caution for now, pointing out that until these studies have been conducted, we don’t have enough information about its benefits.
“This innovative testing method is an interesting new approach, but there simply hasn’t been enough detailed research into its effectiveness for us to be able to recommend for its use at this stage,” he says. “Until then, we would not recommend that anyone use this test as a substitute for current standard methods.”
Of course, research in the field will be continuing apace.
“In order to save more lives from prostate cancer it is crucial that we create a diagnostic process that is robust enough to routinely diagnose men early and accurately,” says the spokesperson.
How Much Does The Test Cost
The price of a PSA test will vary based on where the test is conducted and whether you have health insurance. If you have health care coverage, you can reach out to your insurance provider directly to find out what a PSA test will cost under your plan. Depending on your plan, you may be responsible for out-of-pocket costs, such as copays and deductibles.
The cost of at-home PSA testing ranges from about $30 to $70.
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Average Psa Test Doubling Time
Another red flag. This calculation denotes the time it takes your PSA values to double.
Therefore it may signify the aggressiveness of any prostate abnormalities, whether it’s an enlarged prostate, prostatitis, or prostate cancer.
If your average PSA readings double in less than three years your doctor will most likely order a biopsy, to look in to the problem further and discuss possible prostate cancer treatment options.
Prostate Cancer Screening Ages 55 To 69
This is the age range where men will benefit the most from screening.Thats because this is the time when:
- Men are most likely to get cancer
- Treatment makes the most sense, meaning when treatment benefits outweigh any potential risk of treatment side effects
Most men will get prostate cancer if they live long enough. Some prostatecancers are more aggressive others can be slow-growing. Doctors will takeyour age and other factors into consideration before weighing the risks andbenefits of treatment.
You should ask your doctor how often he or she recommends you get screened.For most men, every two to three years is enough.
Depending on the results of your first PSA test, your doctor may recommendyou get screened less frequently.
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Can I Have False Psa Results And No Cancer In My Prostate
What are the reasons cause false PSA high levels and false low PSA results, which means you have no cancer in your prostate at all and your PSA level was relatively incorrect, come to know and tell your doctor youre a cancer Free.A matter of concern for whom deal with prostate cancer testing with PSA blood test as an early cancer marker, you must be aware of things can alter your PSA interpretation, however the professional lab tech must ask you about them before taking a blood sample for prostate specific antigen test.If you dont understand the PSA just read> what is the PSA blood test meaning?What do cause False positive PSA results?PSA false results mean thats unlikely you have a prostate cancer and may come from:
Dont miss interpretation of high PSA at: What does elevated PSA mean?Understanding False Low PSA ResultsIn general, a low PSA is a good result. However, there are several reasons a PSA test level may be artificially low including:
- Taking statins to lower cholesterol, anti-inflammatory drugs and obesity: thats because body fat decreases the amount of PSA circulating in the blood stream.
- Over doses of some chemotherapeutic drugs, for instance cyclophosphamide and methotrexate, can cause false PSA increase or false PSA levels decrease.
What to do when your results show false PSA results?
Other blood tests for cancer detection can help make decision:
Other Factors That Influence Psa Levels
The PSA blood test alone cannot diagnose prostate cancer. It is possible, although rare, to have prostate cancer without raised PSA levels in the blood. A higher-than-normal PSA level doesnt automatically indicate prostate cancer either. A high PSA level is due to cancer in around one in three cases.
PSA levels can be raised by other factors, including:
- , also known as benign prostatic enlargement .
For this reason, the PSA blood test isnt used in isolation when checking for prostate cancer.
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Atypical Small Acinar Proliferation
Another type of abnormal finding is cells that look like they may be cancerous, but there are too few of them to make a cancer diagnosis. This is called atypical small acinar proliferation , or atypical glandular proliferation. To rule out prostate cancer, your urologist may recommend a repeat biopsy in a few months.
Why The Test Is Performed
Reasons for a PSA test:
- This test may be done to screen for prostate cancer.
- It is also used to follow people after prostate cancer treatment to see if the cancer has come back.
- If a provider feels the prostate gland is not normal during physical exam.
MORE ABOUT SCREENING FOR PROSTATE CANCER
Measuring the PSA level can increase the chance of finding prostate cancer when it is very early. But there is debate over the value of the PSA test for detecting prostate cancer. No single answer fits all men.
For some men 55 through 69 years old, screening may help reduce the chance of death from prostate cancer. However, for many men, screening and treatment could potentially be harmful instead of beneficial.
Before having the test, talk to your provider about the pros and cons of having a PSA test. Ask about:
- Whether screening decreases your chance of dying from prostate cancer
- Whether there is any harm from prostate cancer screening, such as side-effects from testing or overtreatment of cancer when discovered
Men younger than age 55 have a higher chance of developing prostate cancer and should talk with their provider about PSA screening if they:
- Have a family history of prostate cancer
- Are African American
The PSA test result cannot diagnose prostate cancer. Only a prostate biopsy can diagnose this cancer.
A normal PSA level is considered to be 4.0 nanograms per milliliter of blood, but this varies by age:
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What’s A Raised Psa Level
The amount of PSA in your blood is measured in nanograms of PSA per millilitre of blood .
If you’re aged 50 to 69, raised PSA is 3ng/ml or higher.
A raised PSA level in your blood may be a sign of prostate cancer, but it can also be a sign of another condition that’s not cancer, such as:
Getting A Prostate Biopsy
For some men, getting a prostate biopsy might be the best option, especially if the initial PSA level is high. A biopsy is a procedure in which small samples of the prostate are removed and then looked at under a microscope. This test is the only way to know for sure if a man has prostate cancer. If prostate cancer is found on a biopsy, this test can also help tell how likely it is that the cancer will grow and spread quickly.
For more details on the prostate biopsy and how it is done, see Tests to Diagnose and Stage Prostate Cancer.
For more information about the possible results of a prostate biopsy, see the Prostate Pathology section of our website.
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The Test Is Often Not Needed
Most men with high PSAs dont have prostate cancer. Their high PSAs might be due to:
- An enlarged prostate gland.
- Recent sexual activity.
- A recent, long bike ride.
Up to 25% of men with high PSAs may have prostate cancer, depending on age and PSA level. But most of these cancers do not cause problems. It is common for older men to have some cancer cells in their prostate glands. These cancers are usually slow to grow. They are not likely to spread beyond the prostate. They usually dont cause symptoms, or death.
Studies show that routine PSA tests of 1,000 men ages 55 to 69 prevent one prostate cancer death. But the PSA also has risks.
Using The Psa Blood Test After Prostate Cancer Diagnosis
Although the PSA test is used mainly to check for prostate cancer, it can also help your doctor:
- Choose a treatment. Along with an exam and tumor stage, the PSA test can help determine how advanced a prostate cancer is. This may affect treatment options.
- Check treatment success. After surgery or radiation, the doctor can watch your PSA level to see if the treatment worked. PSA levels normally fall if all of the cancer cells were removed or destroyed. A rising PSA level can mean that prostate cancer cells are present and your cancer has returned.
If you choose a watchful waiting approach to treatment, your PSA level can tell your doctor if the disease is progressing. If so, youâll need to think about active treatment.
During hormone therapy, the PSA level can show how well the treatment is working and when itâs time to try another treatment.
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