Prostate Cancer Screening Ages 40 To 54
The PSA test is a blood test that measures how much of a particular protein is in your blood. Its been the standardfor prostate cancer screening for 30 years.
Your doctor will consider many factors before suggesting when to startprostate cancer screening. But hell probably start by recommending the PSAtest.
While the general guidelines recommend starting at age 55, you may need PSAscreening between the ages of 40 and 54 if you:
- Have at least one first-degree relative who has had prostate cancer
- Have at least two extended family members who have had prostate cancer
- Are African-American, an ethnicity that has a higher risk of developing more aggressive cancers
How Often Do I Need A Psa Test
The American Cancer Society recommends annual PSA testing for:
- Men 50 and older with a life expectancy of at least 10 years.
- Men over 40 with blood relatives who have had prostate cancer.
- Men over 40 who are in high-risk groups, such as African Americans.
The Prostate Cancer pages of this website are part of the Comprehensive Prostate Cancer Awareness Program , a major regional effort to reduce the rates of death and illness caused by prostate cancer in southwestern Pennsylvania. Funding for CPCAP is provided by a grant from the Commonwealth of Pennsylvania.
Screening For Early Disease
The purpose of any screening test is to detect disease before it becomes clinically evident. Routine measurements of blood pressure and cholesterol are examples of screening tests that have proved their worth. In the realm of cancer screening, Pap tests for cancer of the cervix, mammograms for breast cancer, and various tests for colon cancer have gained widespread acceptance.
A screening test is successful if it meets several goals:
It has a high sensitivity that is, it detects a high percentage of cases while missing few
It has a high specificity that is, it doesn’t falsely diagnose disease when none is present
The test is reliable and reproducible and also safe, convenient, and inexpensive enough to gain widespread acceptance
Above all, the test must lead to a treatment that will improve the patient’s quality of life, extend the duration of his life, or both. In a word, the test should do more good than harm.
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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.
What Causes An Elevated Psa Level
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:
- Prostate enlargement and inflammation .
- Urinary tract infection.
- Urinary catheter placement.
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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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.
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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Factors That Might Affect Psa Levels
One reason its hard to use a set cutoff point with the PSA test when looking for prostate cancer is that a number of factors other than cancer can also affect PSA levels.
Factors that might raise PSA levels include:
- An enlarged prostate: Conditions such as benign prostatic hyperplasia, a non-cancerous enlargement of the prostate that affects many men as they grow older, can raise PSA levels.
- Older age: PSA levels normally go up slowly as you get older, even if you have no prostate abnormality.
- Prostatitis: This is an infection or inflammation of the prostate gland, which can raise PSA levels.
- Ejaculation: Thiscan make the PSA go up for a short time. This is why some doctors suggest that men abstain from ejaculation for a day or two before testing.
- Riding a bicycle: Some studies have suggested that cycling may raise PSA levels for a short time , although not all studies have found this.
- Certain urologic procedures: Some procedures done in a doctors office that affect the prostate, such as a prostate biopsy or cystoscopy, can raise PSA levels for a short time. Some studies have suggested that a digital rectal exam might raise PSA levels slightly, although other studies have not found this. Still, if both a PSA test and a DRE are being done during a doctor visit, some doctors advise having the blood drawn for the PSA before having the DRE, just in case.
- Certain medicines: Taking male hormones like testosterone may cause a rise in PSA.
Some things might lower PSA levels :
When Should I Get A Psa Test
The guidelines below are adapted from the NCCN Clinical Practice Guidelines In Oncology for Prostate Cancer Early Detection. Please use these guidelines to have a discussion with your physician about your personal risk and make a plan for screening.
- If you are between ages 45 and 75:
- Discuss the risks and benefits of prostate cancer screening with your doctor, have a baseline PSA, and consider a baseline DRE
- If your PSA is below 1 ng/mL and your DRE is normal, repeat testing every 2-4 years
- If your PSA is between 1 and 3 ng/mL and your DRE is normal, repeat testing every 1-2 years
- If your PSA is greater than 3 ng/ML or your DRE is very suspicious, your doctor may suggest additional testing or a biopsy
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Serum Insulinlike Growth Factor
Insulinlike growth factor -1, its binding protein , and its receptor have been implicated in the development of prostate cancer. PSA cleaves IGF-1 from its binding protein, allowing this potent growth factor to act on prostate epithelial cells.
Plasma concentrations of IGF-1 have been associated with an increased risk of prostate cancer. In the Physiciansâ Health Study, 152 cases of prostate cancer were matched with 152 controls from the population of 14,916 physicians. Serum samples assayed for IGF-1 at the outset of the study found a positive association with the subsequent development of prostate cancer. Men in the highest quartile for IGF-1 had a relative risk of 2.4 as compared with men in the lowest quartile.
The predominant IGF-1 binding protein, IGFBP-3, has growth-inhibiting properties that diminish the effect of IGF-1. After correcting for IGFBP-3 levels, the risk of developing prostate cancer was 4.5 times greater for the highest quartile than for the lowest quartile.
The clinical usefulness of this assay has yet to be demonstrated, because alternative explanations for these findings may exist. Prostate size and a large overlap in actual values limit the utility of the test but do provide additional information regarding the biology of prostate cancer.
What Is Prostate Intraepithelial Neoplasia Or Atypical Or Suspicious Cells On Biopsy
In about 10% of prostate needle biopsy reports, the pathologist will tell us that the final diagnosis is neither benign nor malignant. They describe this condition as
- High Grade Intraepithelial Neoplasia
- A premalignant condition
- Biopsy should be repeated soon
- 25% risk of cancer on repeat biopsy
- Low Grade Intraepithelial Neoplasia
- Repeat biopsy is not indicated unless there is a rise in PSA
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How Psa Results Are Used For Diagnosis
In the past, many doctors wanted men with elevated PSA and/or an abnormal digital rectal examination to undergo a prostate biopsy. Today, this is not a course of action recommended by the American Urological Association. In such cases, multiparametric prostate MRI is now recommended as the best front-line test to detector rule outprostate cancer.
If a mpMRI shows a suspicious finding, a MRI-guided biopsy is the most accurate way to perform a biopsy of the prostate. If this is not possible, an MRI can be used with an ultrasound-guided biopsy. This is referred to as a fusion biopsy, and is more accurate than an ultrasound biopsy alone.
Variations On A Theme
Even before the PLCO and ERSPC results were unveiled in the spring of 2009, researchers were aware of limitations of PSA screening. Several modifications have been proposed, but none has proved superior to the PSA itself. One approach relies on measurements of both the total PSA and the free PSA. Cancer is more likely when the free PSA constitutes less than 25% of the total PSA the lower the percentage of free PSA, the more likely the diagnosis of cancer. Another refinement depends on serial measurements of the PSA, typically at yearly intervals. The PSA velocity reflects the rate of change researchers suggest that a rise of more than 0.75 ng/mL over the course of a year increases the likelihood of cancer. A similar modification, the PSA doubling time, helps doctors establish the prognosis for patients with prostate cancer the shorter the doubling time, the worse the outlook.
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If I Have Elevated Psa Levels What Should I Ask My Healthcare Provider
If you have any symptoms of prostate cancer, or if it runs in your family, ask your provider:
- Should I have regular tests to check my PSA level?
- What can I do to lower my risk for prostate cancer?
- What other tests or monitoring do I need?
- What are my treatment options if I get prostate cancer?
- What other signs or symptoms should I look out for?
A note from Cleveland Clinic
An elevated PSA level can be a sign of prostate cancer, but it doesnt always mean you have cancer. Your healthcare provider will watch you and do more tests to arrive at a diagnosis. Prostate cancer is often slow-growing and may never become life-threatening. If you have symptoms of prostate problems, such as difficulty urinating, don’t hesitate to let your provider know.
Last reviewed by a Cleveland Clinic medical professional on 04/06/2021.
Table : A Proposed Age
Unfortunately, however, there is no clear-cut threshold for “normal” at any age. The likelihood that a man has prostate cancer increases as PSA levels rise, but even men with low PSAs face some risk. An important study shows how the risk rises as the PSA increases, even within the normal range . At higher PSA levels, the risk is even greater according to some estimates, it may exceed 50% at PSAs above 10.
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Psa Levels By Age Chart
The main difference between the PSA scores of prostatitis and an enlarged prostate, compared to prostate cancer, is the ratio of free vs bound PSA within your test sample.
- Prostate Cancer will have a higher bound PSA ratio.
- An enlarged prostate and prostatitis will have a higher free PSA ratio.
- If your free PSA results are less than 25%, your risk for developing prostate cancer is between 10% to 20%.
- If your free PSA results are less than 10%, your risk for developing prostate cancer jumps to around 50%.
The Case Against Psa Screening
The Canadian Task Force on Preventive Health Care and the Canadian Urological Association recommend against PSA testing in men who seem healthy. The U.S. Preventive Services Task Force recommends against testing for men age 75 or older as well as for men with life expectancies of 10 years or less. For other men, the task force notes that the “potential harms of screening for prostate cancer can be established, the presence or magnitude of potential benefits cannot.” The American College of Physicians and American Academy of Family Physicians agree that men should be counseled about “the known risks and uncertain benefits of screening for prostate cancer” before they undergo any testing.
They, too, have a point. Even at an average cost of $40, the annual testing of all American men over 50 would cost billions of dollars. Still, it might save money if early diagnosis could reduce the need for even more expensive treatment of advanced cancer. But critics go beyond economics to consider the problem of overdiagnosis. The PSAgnostics have long argued that screening might produce more harm than good if it leads to unnecessary treatment in men who would never be harmed by their prostate cancers.
For all their differences, the PSAdvocates and PSAgnostics have agreed on one point: the only way to resolve the issue is with high-quality randomized clinical trials. And that’s just why the two studies are so important.
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What Is The Accuracy Of The Psa Test
One of the limitations of the PSA test is that PSA is not specific to prostate cancer and that it can be affected by several common conditions such as benign enlargement of the prostate, inflammation, and infection of the prostate. Furthermore, there is some variability in PSA results when using different testing equipment. One study showed that 25% men who had an initial PSA result between 4 ng/mL and 10 ng/mL had a normal test result when it was repeated.
Limitations of PSA testing include a high false-positive rate . In fact, only about 25% of men who have an elevated PSA between 4 ng/mL and 10 ng/mL will have prostate cancer identified on prostate biopsy and 75% will not. If one uses a lower cutoff of 3.1 ng/mL, PSA had a sensitivity of 32% and specificity of 87% for identifying prostate cancer.
Another concern in addition to the low specificity in detecting the presence of prostate cancer is the inability of the test to discriminate between a more aggressive, high-risk, prostate cancer from one that is less likely to cause harm, or a low-risk prostate cancer. This is thought to lead to overtreatment in up to 50% of men with prostate cancer.
Other Uses For Prostate Specific Antigen Testing
Outside of prostate cancer screening, there are other uses for PSA testing. If you have had a biopsy that shows a slow growing prostate cancer, your doctor may advise watchful waiting. In this case, PSA testing may be done periodically to see if your cancer becomes more active. Any increase in PSA could be considered abnormal. If you have been treated for prostate cancer, periodic PSA testing may be done to see if there are any signs of cancer coming back. Any increase would be abnormal.
If you have symptoms of prostate cancer, PSA testing may be done to find out if you have prostate cancer. When you already have symptoms, PSA is no longer considered a screening test. It is a diagnostic test. Let your doctor know if you have any of these prostate cancer symptoms:
- Problems passing urine, like slow flow, increased frequency, or loss of control
- Blood in your semen or urine
- Trouble getting or keeping an erection
- Weakness or numbness in your legs or feet
- Bone pain in your hips, back, or ribs
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Does Normal Psa Vary By Race
Studies have shown that African American men, with and without prostate cancer, have higher PSA levels than other racial groups. African American men in their 50s and 60s, without cancer, have average PSA levels approximately one point higher than their Caucasian counterparts. The reasons for this are still under investigation.
What Does Psa Mean
PSA is a single chain glycopeptide produced almost exclusively in the prostatic secretory epithelium. Normally, PSA is secreted into the prostatic ducts however, in some diseases increased amounts of PSA are diffused into the blood where they are quickly inactivated by protease inhibitors. PSA is also known as kallikrein-3.
The main function of PSA is the liquefaction of seminal coagulum to allow sperm to become more motile.
PSA is also produced at very low levels in the paraurethral and perianal glands, placenta, breast, and thyroid. However, except for breast cancer, these tissues do not secrete a significant amount of PSA into the blood.
The prostate specific antigen may be present in the blood in two different ways:
- Free PSA: The PSA remains free in the blood unbound to any carrier protein.
- Conjugated PSA: The PSA is bound to other proteins.
Total PSA is the sum of free PSA and conjugated PSA.
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