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Prostate Specific Antigen Blood Test

If Screening Test Results Arent Normal

The Prostate Specific Antigen (PSA) Test

If you are screened for prostate cancer and your initial blood PSA level is higher than normal, it doesnt always mean that you have prostate cancer. Many men with higher than normal PSA levels do not have cancer. Still, further testing will be needed to help find out what is going on. Your doctor may advise one of these options:

  • Waiting a while and having a second PSA test
  • Getting another type of test to get a better idea of if you might have cancer
  • Getting a prostate biopsy to find out if you have cancer

Its important to discuss your options, including their possible pros and cons, with your doctor to help you choose one you are comfortable with. Factors that might affect which option is best for you include:

  • Your age and overall health
  • The likelihood that you have prostate cancer
  • Your own comfort level with waiting or getting further tests

If your initial PSA test was ordered by your primary care provider, you may be referred to a urologist for this discussion or for further testing.

How Is A Psa Test Administered

A sample of your blood will be sent to a laboratory for further examination. To withdraw blood from an artery or vein, a healthcare provider will usually insert a needle into the inside of your elbow. You may feel a sharp, piercing pain or slight sting as the needle is inserted into your vein.

Once theyve collected enough blood for the sample, they will remove the needle and hold pressure on the area to stop the bleeding. Theyll then put an adhesive bandage over the insertion site in case you bleed more.

Your blood sample will be sent to a laboratory for testing and analysis. Ask your doctor if theyll follow up with you regarding your results, or if you should make an appointment to come in and discuss your results.

A PSA test can also be done with an at-home testing kit. You can purchase a test kit online from LetsGetChecked here.

What Is Considered A Normal Psa Blood Level

PSA blood test results are reported as nanograms per milliliter, or ng/ml. Normal levels usually range from 0 ng/ml to 4 ng/ml, although what is considered normal may vary by age and race. Mild to moderate increases in PSA between 4 and 10 are considered borderline, while levels over 10 are considered high. The higher the PSA, the more likely the presence of prostate cancer.

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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.

What Is A Normal Psa Test Result


There is no specific normal or abnormal level of PSA in the blood, and levels may vary over time in the same man. In the past, most doctors considered PSA levels of 4.0 ng/mL and lower as normal. Therefore, if a man had a PSA level above 4.0 ng/mL, doctors would often recommend a prostate biopsy to determine whether prostate cancer was present.

However, more recent studies have shown that some men with PSA levels below 4.0 ng/mL have prostate cancer and that many men with higher levels do not have prostate cancer . In addition, various factors can cause a mans PSA level to fluctuate. For example, a mans PSA level often rises if he has prostatitis or a urinary tract infection. Prostate biopsies and prostate surgery also increase PSA level. Conversely, some drugsincluding finasteride and dutasteride , which are used to treat BPHlower a mans PSA level. PSA level may also vary somewhat across testing laboratories.

Another complicating factor is that studies to establish the normal range of PSA levels have been conducted primarily in populations of White men. Although expert opinions vary, there is no clear consensus regarding the optimal PSA threshold for recommending a prostate biopsy for men of any racial or ethnic group.

In general, however, the higher a mans PSA level, the more likely it is that he has prostate cancer. Moreover, a continuous rise in a mans PSA level over time may also be a sign of prostate cancer.

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What Is The Psa Screening Controversy

The goal of measuring PSA in men with no symptoms of cancer as a screening test for prostate cancer is to reduce the mortality caused by this cancer. Although the advent of prostate cancer screening is associated with decreased prostate cancer deaths, concerns exist regarding risks of overtreatment and the associated risks of such treatments.

A substantial number of the cancers detected by PSA screening are early stage and low-risk, and these patients will likely never die from this disease. PSA screening, due to its low specificity, does not allow differentiating between low-risk and high-risk prostate cancer. Hence PSA systematic screening is inevitably associated with over-diagnosis and potentially overtreatment. Therefore, not only do these patients not benefit from early detection but they also carry the burden of a cancer diagnosis. In addition, a subset of these patients may suffer the side effects of an unnecessary treatment.

Another trial conducted in the United States recently concluded that there is no evidence of an improvement in death rate from prostate cancer with annual PSA screening compared with usual medical care. After 13 years of follow-up, the cumulative mortality rates from prostate cancer in the intervention and control groups were 3.7 and 3.4 deaths per 10,000 person-years, respectively, meaning that there was no significant difference between the two groups.

How Is Psa Testing Used For Pretreatment Staging Of Prostate Cancer

Once prostate cancer is diagnosed by the presence of cancer cells on prostate biopsy and assigned a cancer grade , PSA is used in combination with the grade of the prostate cancer to determine further medical studies needed for cancer staging. Staging determines if the cancer is localized or metastatic . Staging therefore drives the best management and appropriate treatment for the cancer. As mentioned earlier, serum PSA levels correlate with the risk of prostate cancer extension outside of the prostate including seminal vesicle invasion as well as metastasis to the pelvic lymph nodes.

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Risk Factors That May Raise Or Lower Psa Levels

There are many other risk factors that can raise PSA levels, including:

  • Enlarged prostate, also called benign prostatic hyperplasia , which is common in older men
  • Older age, which naturally results in higher PSA levels
  • Ejaculation within 1 to 2 days of the blood draw
  • Riding a bicycle, which may raise levels for a short time after
  • Certain urologic procedures, like cystoscopy
  • Certain medicines, such as male hormones

Factors that may specifically lower PSA levelseven among men with prostate cancerinclude:

  • 5-alpha reductase inhibitors, which treat BPH or other urinary symptoms
  • Some medications, such as aspirin or statins
  • Herbal mixtures or supplements, which could skew the results

In certain cases, a factor that lowers PSA does lower the risk of developing prostate cancer. In others, however, lowering the PSA level has no effect and could be harmful, as prostate cancer could go undetected if the level drops too far.

What Are Some Of The Limitations And Potential Harms Of The Psa Test For Prostate Cancer Screening

Prostate-specific Antigen (PSA) Tests for Prostate Cancer

Detecting prostate cancer early may not reduce the chance of dying from prostate cancer. When used in screening, the PSA test can help detect small tumors that do not cause symptoms. Finding a small tumor, however, may not necessarily reduce a mans chance of dying from prostate cancer. Many tumors found through PSA testing grow so slowly that they are unlikely to threaten a mans life. Detecting tumors that are not life-threatening

that requires treatment.

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What Do The Results Mean

High PSA levels can mean cancer or a noncancerous condition such as a prostate infection, which can be treated with antibiotics. If your PSA levels are higher than normal, your health care provider will probably order more tests, including:

  • A rectal exam. For this test, your health care provider will insert a gloved finger into your rectum to feel your prostate.
  • A biopsy. This is a minor surgical procedure, where a provider will take a small sample of prostate cells for testing.

If you have questions about your results, talk to your health care provider.

Learn more about laboratory tests, reference ranges, and understanding results.

Factors That Affect Psa Levels

It is important to note that PSA levels can rise naturally with age, and that a number of benign conditions can also affect PSA levels, such as prostatitis , benign prostatic hyperplasia , urinary tract infection , or even injury to the prostate.

Other factors such as sexual activity right before testing, certain exercises, or even diet can impact the PSA levels as well. It is essential to consult a doctor regarding the meaning and next steps of your PSA testing results.

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What Are The Risk Factors For Prostate Cancer

Men at higher risk for developing prostate cancer are candidates for PSA testing. Risk factors include:

  • Men under 40 rarely get prostate cancer but the risk rises steadily after age 50.
  • African-Americans and Caribbean men of African descent are more likely to have prostate cancer than any other race. Hispanic/Latino and Asian-American men are less likely to get prostate cancer than others.
  • Geographic area. North America, the Caribbean, northwest Europe and Australia have more cases of prostate cancer than other areas, and it is less common in South America, Central America, Asia and Africa.
  • Having a brother or father who has had prostate cancer more than doubles a mans chance of getting it. The more family members who have had it, the more the risk.
  • Gene changes. Men with Lynch syndrome and those with BRCA1 and BRCA2 mutations account for a small number of cases.

Other factors such as diet, obesity, smoking and toxin exposure are under study, with no positive links determined at this time.

How Are Researchers Trying To Improve The Psa Test


Scientists are investigating ways to improve the PSA test to give doctors the ability to better distinguish cancerous from benign conditions and slow-growing cancers from fast-growing, potentially lethal cancers. None has been proven to decrease the risk of death from prostate cancer. Some of the methods being studied include:

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Prostate Specific Antigen Test

can predict residual tumor in the post-operative phase of prostate cancer, For this test, Colorectal, The PSA test measures the level of PSA in a mans blood, cells of the prostate gland, some doctors and professional organizations encouraged yearly PSA screening for men beginning at age 50, or prostate cancer may increase circulating PSA levels.Prostate-Specific Antigen TestProstate-specific antigen, The PSA test can be useful for detecting prostate cancer, a blood sample is sent to a laboratory for analysis, several new biomarkers supplementing the role of prostate-specific antigen have become available for men with prostate cancer, his doctor will consider a number of factors before recommending further treatment, is a protein produced by normal, The results are usually reported as nanograms of PSA per milliliter of blood.What is the PSA test?Prostate-specific antigen, High PSA

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 Is The Controversy Surrounding Psa Screening

In recent years, there has been some controversy surrounding the PSA test. In 2012, the U.S. Preventive Services Task Force assigned the PSA test a D rating. This meant that the USPSTF concluded the harms that resulted from PSA testing, such as unnecessary biopsies and negative treatment side effects, outweighed the benefits of finding and managing the disease early. This recommendation did not include exceptions for men at increased risk of developing the disease, such as African American men, those with a family history of the disease, and those with BRCA gene mutations. The USPSTF recommendation is important as it guides primary care physicians in preventive care and can impact insurance coverage and reimbursement for screening. Prior to its D rating, the PSA test had an I rating, meaning the USPSTF concluded there was insufficient evidence to assess the pros and cons of testing.

In May 2018, the USPSTF updated their recommendation on PSA screening. In response to new research demonstrating the benefits of PSA screening , an increase in the number of men choosing active surveillance, and advocacy efforts, the USPSTF released a draft recommendation in April 2017 that assigns the PSA test a C rating for men ages 55to 69 . This rating has now been certified official by the task force.

What Causes An Elevated Psa Level

Should Men Get the PSA (prostate specific antigen) blood test?

Prostate cancer is the main cause of an elevated PSA level. But PSA levels increase with age and can reflect different prostate conditions. Other factors that may raise a persons PSA level include:

Your healthcare provider will also consider whether your medications affect PSA levels. For example, 5-alpha reductase blockers treat enlarged prostates and will lower PSA levels.

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When Should I Have My Psa Levels Tested

The first thing to do is talk to your doctor about the pros and cons of prostate cancer screening before you decide whether to be tested. Donât get tested until you have that talk. Opinions differ about when you should do that.

The American Cancer Society says to get tested at age:

  • 40 or 45 if youâre at high risk
  • 50 if youâre at average risk

The American Urological Association suggests:

  • Under 40: No screening
  • 40 to 54: No screening if youâre at average risk. If youâre at a high risk, you and your doctor can decide.
  • 55 to 69: Screening if your doctor suggests
  • Over 70 or less than a 10-15 year life expectancy: No screening

The U.S. Preventive Services Task Force says:

If your doctor thinks you might have prostate cancer based on either a PSA level or a rectal exam, a biopsy is the next step. This is a test where the doctor takes a small amount of tissue from your prostate and sends it to a lab for tests. Itâs the only way to be sure you have cancer.

When Is A Psa Test Performed

PSA blood tests are recommended when men who are at risk for prostate cancer discuss screening options with their doctor. In general, the discussion should include men who are:

  • Age 50 and have an average risk for prostate cancer
  • Age 45 and have a high risk of developing prostate cancer, including black men and men who have first-degree family members with prostate cancer.
  • Age 40 and have a very high risk of developing prostate cancer

Men with enlarged or inflamed prostates may also undergo PSA blood tests.

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Understanding Your Psa Test Results

PSA is usually measured in nanograms per millilitre of blood . There is no one PSA reading that is considered normal. The reading varies from man to man and the level increases as you get older. Typically, most men have a PSA level of less than 3ng/ml.

Your doctor may refer you to a specialist if your PSA level is over what is consider normal for your age. Its important to remember that a PSA level higher than 3ng/ml may be normal in older men. Talk to your doctor about your PSA level and what this means for you.

Doctors usually follow guidelines that advise when to refer someone to a specialist. These guidelines vary slightly between the different UK nations. It’s important to know that your doctor also uses their own experience and judgment when deciding who needs to see a specialist.

Your doctor may refer you to a specialist if your PSA level is:


How Is The Psa Count Measured


PSA is measured by a simple blood test that does not require fasting or special preparation. Since the amount of PSA in the blood is very low, detection of it requires a very sensitive type of technology . The PSA protein can exist in the blood by itself or be bound with other substances . PSA is mostly bound to three substances: alpha-2-macroglobulin, alpha 1-antichymotrypsin , and albumin. Total PSA is the sum of the free and the bound forms. The total PSA is what is measured with the standard PSA test. More recently, a precursor of PSA, proenzyme PSA , has been identified, which may be helpful in determining prostate cancer risk in men with a PSA under 10 and a normal digital rectal examination. The prostate health index is a new approved test that measures the total PSA, free PSA, and proenzyme PSA. The National Comprehensive Cancer Network guidelines include use of PHI as a secondary test option for men making decisions about an initial or repeat biopsy. The 4K score test is another test that incorporates PSA. The 4K score uses a prediction model based on clinical variables and laboratory measurements of total PSA, free PSA, intact PSA, and a related protein known as hK2 .

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