Comparing Free And Total Psa
Comparing the results of total and free PSA tests can give doctors an idea of how likely it is that a person has prostate cancer.
Free PSA ranges can vary, but generally, a higher ratio of free PSA to total PSA indicates a lower risk of prostate cancer. On the other hand, a low ratio of free PSA to total PSA indicates a higher risk of having prostate cancer.
However, PSA tests alone will not confirm a diagnosis, as other factors can affect PSA levels. A digital rectal exam and prostate biopsy may also be necessary.
PSA kinetics can affect PSA levels.
PSA kinetics reflect how levels change over time, as can happen when a person has or is undergoing treatment for prostate cancer. The factors involved are PSA velocity and doubling time.
PSA velocity measures how rapidly levels are rising, and it can indicate that prostate cancer is recurring or progressing.
Doubling time is a calculation of how long it takes for PSA levels to double. It can give an idea about how quickly the cancer is progressing. For example, a faster doubling time can suggest a more aggressive cancer.
What Is Free/total Psa Ratio
Although prostate cancer cells do not produce more PSA than benign prostate tissue, the PSA produced from cancerous cells appears to escape an enzymatic processing that cleaves the bond between PSA and the protein that binds to it. Therefore, men with prostate cancer have a greater fraction of complexed, or bound, serum PSA and a lower amount of unbound PSA compared with men without prostate cancer. Therefore, the free/total PSA ratio can be additionally used in clinical practice to discriminate between PSA elevation secondary to benign prostatic disease and prostate cancers. This is particularly useful for patients with a total PSA level between 4.0 and 10.0 ng/mL and a negative normal rectal exam to help the health care provider to decide if a biopsy is necessary. In one study, prostate cancer was found in 56% of men with a free/total PSA less than 0.10 but in only 8% of men with free/total PSA greater than 0.25 . Nevertheless, the concept of free PSA must be used with caution as several factors may influence the free/total PSA ratio such as temperature and prostate size. Furthermore, the free PSA measurement is not clinically useful for patients with total serum PSA values less than 10.0 ng/mL or in the follow-up of patients with known prostate cancer.
Normal Psa Levels By Age Chart
We mentioned earlier in this article that PSA levels increase with age due to age related growth of the prostate gland. A doctor will therefore take into account an age-adjusted PSA level when discussing your prostate health:
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Age Range |
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0 to 6.5 |
Although there are normal PSA levels by age range, it is still important to screen routinely to ensure these normal levels are not rising.
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What Do My Test Results Mean
Your doctor will look at your test results to find out if the cancer has spread and how quickly it might be growing.
How far has my cancer spread?
The stage of your cancer tells you whether it has spread outside the prostate and how far it has spread. You might need scans, such as an MRI, CT or bone scan, to find out the stage of your cancer.
Depending on the results, your cancer may be treated as:
- localised prostate cancer it’s contained inside the prostate
- locally advanced prostate cancer its started to break out of the prostate or has spread to the area just outside it
- advanced prostate cancer its spread from the prostate to other parts of the body.
Is my cancer likely to spread?
Your doctor may talk to you about the risk of your cancer spreading outside the prostate or coming back after treatment.
Your prostate biopsy results will show how aggressive the cancer is in other words, how likely it is to spread outside the prostate. You might hear this called your Gleason grade, Gleason score, or grade group.
To work out your risk, your doctor will look at your PSA level, your Gleason score and the T stage of your cancer.
Low risk
Your cancer may be low risk if:
- your PSA level is less than 10 ng/ml, and
- your Gleason score is 6 or less , and
- the stage of your cancer is T1 to T2a.
Medium risk
Your cancer may be medium risk if:
- your PSA level is between 10 and 20 ng/ml, or
- your Gleason score is 7 , or
- the stage of your cancer is T2b.
High risk
What happens next?
High Psa Levels From A Urinary Tract Infection
“Any infection near the prostate gland, including a urinary tract infection, can irritate and inflame prostate cells and cause PSA to go up,” says Milner.
If youve been diagnosed with a urinary tract infection, be sure to wait until after the infection has cleared up before you get a PSA test. In men, most urinary tract infections are caused by bacteria and respond well to antibiotics.
Having BPH increases your risk for a urinary tract infection.
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How Is The Psa Test Used In Men Who Have Been Treated For Prostate Cancer
The PSA test is often used to monitor patients who have a history of prostate cancer to see if their cancer has recurred . If a mans PSA level begins to rise after prostate cancer treatment, it may be the first sign of a recurrence. Such a biochemical relapse typically appears months or years before other clinical signs and symptoms of prostate cancer recurrence.
However, a single elevated PSA measurement in a patient who has a history of prostate cancer does not always mean that the cancer has come back. A man who has been treated for prostate cancer should discuss an elevated PSA level with his doctor. The doctor may recommend repeating the PSA test or performing other tests to check for evidence of a recurrence. The doctor may look for a trend of rising PSA level over time rather than a single elevated PSA level.
Who Should Have Regular Screening Tests For High Psa
The PSA test was first developed to observe prostate changes in men who had a history of prostate cancer. Then it became more widely used in the general population as a way to detect and prevent prostate cancer before symptoms developed. But routine screening can find prostate cancers that grow slowly and do not need treatment. Talk to your healthcare provider to see if you should have regular PSA tests.
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What Can Lower The Psa Test Results
Medications commonly taken to treat benign enlargement of the prostate such as finasteride , dutasteride , and a combination of dutasteride and tamsulosin can decrease the PSA by about 50% within six to 12 months of starting their use. Another medication used to treat fungal infections, ketoconazole, can also lower PSA levels. Lastly, herbal supplements such as saw palmetto and those containing phytoestrogens, which are plant-derived chemicals with estrogen-like effects, can also lower the PSA level. It is important to tell your health care provider all the medications, both prescription and nonprescription, as well as any herbal preparations or health supplements that you are taking.
What Is The 4k Biomarker
The 4kscore test measures free and total PSA, human kallikrein 2 , and intact PSA and considers age, digital rectal exam results, and prior biopsy status. The test result reports the percent likelihood of finding high-grade prostate cancer on a prostate biopsy result. This test is not approved by the FDA, rather it is regulated as a laboratory-developed test. No cutoff threshold has been established for this test. Currently, the NCCN recommendations are that this test can be considered in patients prior to biopsy and for those with a prior negative prostate biopsy who are thought to be at higher risk for a high grade prostate cancer.
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What Are The Limitations Of The Psa Test
The level of PSA is a continuous parameter the higher the value, the higher the probability of having prostate cancer. On the other hand, men may have prostate cancer despite low levels of PSA. In a U.S. prevention study, 6.6% of the men whose PSA level was less than 0.5 ng/mL had prostate cancer. Thus, although age and ethnicity-based normal reference ranges exist, they have limitations. Furthermore, PSA does not allow one to predict the likelihood of clinically significant prostate cancer being present, thus subjecting men to potentially unnecessary biopsy and treatment and the morbidity associated with these.
Getting The Results Of The Biopsy
Your biopsy samples will be sent to a lab, where they will be looked at with a microscope to see if they contain cancer cells. Getting the results usually takes at least 1 to 3 days, but it can sometimes take longer. The results might be reported as:
- Positive for cancer: Cancer cells were seen in the biopsy samples.
- Negative for cancer: No cancer cells were seen in the biopsy samples.
- Suspicious: Something abnormal was seen, but it might not be cancer.
If the biopsy is negative
If the prostate biopsy results are negative , and the chance that you have prostate cancer isnt very high based on your PSA level and other tests, you might not need any more tests, other than repeat PSA tests sometime later.
But even if many samples are taken, biopsies can still sometimes miss a cancer if none of the biopsy needles pass through it. This is known as a false-negative result. If your doctor still strongly suspects you have prostate cancer , your doctor might suggest:
- Getting other lab tests to help get a better idea of whether or not you might have prostate cancer. Examples of such tests include the Prostate Health Index , 4Kscore test, PCA3 tests , and ConfirmMDx. These tests are discussed in Whats New in Prostate Cancer Research?
- Getting a repeat prostate biopsy. This might include getting additional samples of parts of the prostate not biopsied the first time, or using imaging tests such as MRI to look more closely for abnormal areas to target.
Prostate cancer grade
Gleason score
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According To Dr Samadi Psa Test Results Should Be Interpreted By Taking Into Consideration That:
Prostate cancer is not the only cause of an elevated PSA PSA level can increase with prostatitis, BPH , or even recent sexual activity Antibiotics can be used to address an elevated PSA when no physical irregularity is noticed during physical exam Prostate biopsy should be performed only when a prostate nodule is present, the PSA level is non-responsive to antibiotics, and/or repeatedly high PSA test results are obtained
Highly specialized oncologic urologists who spend their days analyzing PSA results and treating prostate cancer are only a consult away. Men of all ages are encouraged to see the opinions of these experts for the most effective and targeted prostate cancer analysis.
Dr. Samadi advises: PSA stands for Prostate Specific Antigen, not Prostate Cancer Secific Antigen. Affections such as enlarged prostate, inflammation of prostate and prostate cancer can elevate the PSA. If your PSA test is elevated, make sure that you talk to a doctor and find out if you are at risk. According to many factors, one person may be at risk and the other one is not. Not every elevated PSA means biopsy, not every positive biopsy means surgery.
What Is A Correct Psa Interpretation
Over time, scientists have placed the baseline value of the PSA at different levels. The upper limit was first set at 4 ng/mL and doctors used to recommend biopsies for values higher than this. The standard has changed and the medical world has a different understanding on the PSA test results. An elevated value does not necessarily mean prostate cancer. However, the standard values have now been lowered at 2.53 ng/mL for patients below 65 years old, with the recommendation that the frequency of screening should be discussed between the doctor and the patient. The PSA alone is not an instrument in detecting prostate cancer and it should be interpreted in conjunction with other tests and risk factors such as family history, genetics, race, obesity, heart conditions, symptomatology .
One thing is certain. After the introduction of the PSA test in a clinical practice, the cases of early diagnosis of prostate cancer have gone up significantly. According to studies, about 70-80% of the diagnosed cancer are organ confined. Doctors are now able to learn more information about the staging of prostate cancer by interpreting the PSA test results.
- a PSA value between 04 ng/mL can suggest that the cancer is confined in the prostate
- a PSA level between 410 ng/mL suggests that the cancer is 70% organ based
- a PSA level above 10 ng/mL suggests that the cancer is 50% organ based
The measurement of the serum PSA level can also provide useful clues regarding the lymph node involvement:
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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.
An Abnormal Psa Test: What Comes Next
If your PSA score is in the abnormal range, your doctor may recommend yourepeat the PSA test. If your levels are still high, your doctor mightrecommend one of the newer prostate cancer screening tests available today.
These tests can help better assess your risk for prostate cancer anddetermine whether a biopsy is necessary. Only a prostate biopsy candefinitively diagnose prostate cancer.
For individualized recommendations that suit you, ask your doctor about:
- What age you should start prostate cancer screening
- New blood, urine and imaging tests that are available
- Improved biopsy techniques, if applicable
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Positron Emission Tomography Scan
A PET scan is similar to a bone scan, in that a slightly radioactive substance is injected into the blood, which can then be detected with a special camera. But PET scans use different tracers that collect mainly in cancer cells. The most common tracer for standard PET scans is FDG, which is a type of sugar. Unfortunately, this type of PET scan isnt very useful in finding prostate cancer cells in the body.
However, newer tracers, such as fluciclovine F18, sodium fluoride F18, and choline C11, have been found to be better at detecting prostate cancer cells.
Other newer tracers, such as Ga 68 PSMA-11 and 18F-DCFPyl , attach to prostate-specific membrane antigen , a protein that is often found in large amounts on prostate cancer cells. Tests using these types of tracers are sometimes referred to as PSMA PET scans.
These newer types of PET scans are most often used if its not clear if prostate cancer has spread. For example, one of these tests might be done if the results of a bone scan arent clear, or if a man has a rising PSA level after initial treatment but its not clear where the cancer is in the body.
The pictures from a PET scan arent as detailed as MRI or CT scan images, but they can often show areas of cancer anywhere in the body. Some machines can do a PET scan and either an MRI or a CT scan at the same time, which can give more detail about areas that show up on the PET scan.
What Should My Free Psa Level Be
Free PSA is the form of prostate specific antigen that is produced by benign cells of prostate gland, finding 10% of total PSA as Free is acceptable for healthy men. The lower the riskier.Benign prostate tumors normally show Free PSA percentage higher than 10%.Carcinogen cells reducing free PSA percentage to less than 10% and raise the values of total PSA due to the increasing of complexed PSA by cancer cells, from PSA blood test explainedLow PSA level, what does it mean?The normal PSA level is 0 but it can rise to up 4 with infection or other minor issues.A PSA of 0.6 is good and would not normally need further blood tests.PSA 1.0 is lower than men limit of PSA but is still not a cancer marker.If you have prostate cancer already and have had treatment, then 0.5, 1.0, or 2.0 is still nothing serious to worry about.The same is applied for PSA 2.0 or 3.0: means youre a cancer free or have your treatment course succeeded and lowered the PSA percentage.A problem with prostate production of prostate specific antigen can lead to very low PSA level.Diminished free PSA with normal PSA total is not fully understood.
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