Hyperplastic Tissue And Epithelial
The interpretation of PSA may vary according to the amount of BPH tissue and the epithelial-stromal ratio. Most PSA is produced in the hyperplastic transitional zone of the prostate. A relatively small amount of PSA is produced in the peripheral zone, where 80% of prostate cancers originate. Cancers developing in the transitional zone tend to produce large amounts of PSA.
High-grade cancer cells tend to lose their ability to produce PSA. A Gleason grade 5 prostate cancer produces less PSA than a grade 3 cancer does. Some patients with advanced prostate cancer may have low or undetectable PSA levels.
How Should The Psa Test Be Used For The Early Detection Of Prostate Cancer
Ultimately, the decision to use PSA for the early detection of prostate cancer should be individualized. Men should be informed of the known risks and the potential benefits of early screening. Not all men are appropriate candidates for screening efforts. For instance, screening in men with less than a 10-year life expectancy, either due to age or other illness, is discouraged as there will be most likely no benefit for them.
If prostate cancer is detected on prostate biopsy, all treatment options should be discussed. The benefits and risks of the many treatment options should be reviewed and discussed with men found to have prostate cancer. The AUA recommends that this discussion include active surveillance in men with low-risk prostate cancer. The goal of active surveillance is to allow men to maintain their quality of life when the disease is slow-growing or inactive but still allow them to be cured of prostate cancer when the disease appears to become more aggressive or is fast-growing. Other novel biomarkers, such as PCA3 , may assist the clinician in these decisions.
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.
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.
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Understanding Psa Levels & The Psa Test
The prostate is a walnut-sized gland found between the bladder and the rectum in males. Its primary job is to produce seminal fluid. The prostate creates a protein, the prostate-specific antigen, or PSA. A PSA screening test is a blood test approved by the FDA in 1994 to measure the levels of PSA in a mans blood.
Small amounts of PSA ordinarily circulate in the bloodstream and can be measured by a PSA test to monitor the health of the prostate. This test is intended to screen for prostate cancer, find other prostate-related conditions, or monitor PSA levels in those in treatment for prostate cancer. This is a simple blood test which reports PSA levels as nanograms of PSA per milliliter of blood.
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 6-12 months of starting 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.
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What Do The Results Mean
There is no specific normal or abnormal level for PSA in blood. In general, the higher your PSA level, the more likely it is that you have cancer. But it’s possible to have a high PSA without prostate cancer, or a low PSA with prostate cancer.
If you had a PSA test for a prostate cancer screening or because you have prostate symptoms:
- High PSA levels can mean you have prostate cancer or a prostate condition that’s not cancer, such as an infection or an enlarged prostate. If your PSA levels are higher than normal, your provider may talk with you about having more tests to diagnose the cause. These tests may include:
- Another PSA test, more commonly if you don’t have any symptoms. PSA levels can go up and down, so it helpful to see if your PSA levels change over time.
- A digital rectal exam . For this test, your provider inserts a gloved, lubricated finger into your rectum to feel your prostate for lumps or anything unusual.
- A urine test. A sample of your urine is tested for infection.
- A prostate biopsy. A biopsy is minor surgery. A doctor removes samples of tissue from your prostate so it can be studied under a microscope to look for cancer cells. A biopsy is the only way to diagnose cancer. It may be recommended if your provider thinks you may have prostate cancer.
If you have questions about your results, talk with your provider.
Learn more about laboratory tests, reference ranges, and understanding results.
When Should I Get A Psa Test
As recommended by the U.S. Preventive Services Task Force, PSA testing is a routine screening done on men after age 55 until they are 69 years old. In some cases, doctors may recommend screening at an earlier age.
The test may be done as part of the annual physical but can be more or less frequent depending on your preference and family history. Any concerning results may warrant repeat testing.
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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 screening 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.
Who Should Get A Psa Test & When
Controversy over when to give a PSA test began in 2011 when the United States Preventive Service Task Force recommended reducing PSA screenings for men. This task force was comprised of 16 volunteer clinicians but no urologists were directly involved in the recommendation, which was to only conduct PSA tests when symptoms of prostate cancer are present.
Urology Associates believes that this recommendation is a disservice to all men. Prostate cancer is often slow growing and it is usually in its later stages when men start experiencing symptoms. Waiting until symptoms appear to do a PSA test risks missing diagnosis at an early stage, a large factor in successful treatment of prostate cancer. We also recommend that all men, no matter their risk of prostate cancer, should be under the treatment of a urologist, not a primary care provider, when it comes to prostate health.
Urology Associates and The American Urological Association say that no one should ever receive a PSA test until he has a clear understanding of the facts, limitations, benefits and risks of the PSA test. Men should speak with their urologist about the PSA test and whether it is suitable for them.
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What Have Randomized Trials Of Prostate Cancer Screening Found
Several large, randomized trials of prostate cancer screening have been carried out. One of the largest is the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial, which NCI conducted to determine whether certain screening tests can help reduce the numbers of deaths from several common cancers. In the prostate portion of the trial, the PSA test and digital rectal exam were evaluated for their ability to decrease a mans chances of dying from prostate cancer.
The PLCO investigators found that men who underwent annual prostate cancer screening had a higher incidence of prostate cancer than men in the control group but had about the same rate of deaths from the disease . Overall, the results suggest that many men were treated for prostate cancers that would not have been detected in their lifetime without screening. Consequently, these men were exposed unnecessarily to the potential harms of treatment.
A second large trial, the European Randomized Study of Screening for Prostate Cancer , compared prostate cancer deaths in men randomly assigned to PSA-based screening or no screening. As in the PLCO, men in ERSPC who were screened for prostate cancer had a higher incidence of the disease than control men. In contrast to the PLCO, however, men who were screened had a lower rate of death from prostate cancer .
The United States Preventive Services Task Force has estimated that, for every 1,000 men ages 55 to 69 years who are screened for 13 years :
What Is Psa Velocity And Psa Doubling Time
Change in PSA levels over time can be used to assess both cancer risk and aggressiveness of the particular tumor. Most urologists use these PSA metrics to help drive patient counseling and care.
- PSA velocity is defined as the rate of change in PSA over time.
- PSA doubling time is the time it takes the PSA value to increase by 100% .
Although these two measures do not appear to be useful in determining who is at risk for prostate cancer, they do appear to be useful in monitoring some individuals with prostate cancer.
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What Are The Risks Of A Psa Test
Drawing blood is considered safe. However, because veins and arteries vary in size and depth, getting a blood sample isnt always simple.
The healthcare provider who draws your blood may have to try several veins in multiple locations on your body before they find one that allows them to get enough blood.
Drawing blood also has several other risks. These include risk of:
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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.
- 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 A Psa Test Administered
A sample of your blood will be sent to a laboratory for further examination. To withdraw blood from a vein, a healthcare professional 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 a 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.
Sites Of Highest Concentrations
PSA is found primarily in prostate epithelial cells and in the seminal fluid. The exact mechanism by which PSA gains access to the serum is unknown, but a possible mechanism has been suggested.
The lumen of the prostate gland contains the highest concentration of PSA in the body. A number of barriers exist between the glandular lumen and the capillaries, including the basement membrane of the glands, the prostatic stroma, and the capillary endothelial cell. Diseases such as infection, inflammation, and cancer may produce a breakdown in these barriers, allowing more PSA to enter the circulation.
PSA levels can rise dramatically with a prostate infection, but they return to the reference range after the infection has healed. A vigorous prostate massage also can produce a brief elevation of the PSA level.
Low concentrations of PSA have been identified in urethral glands, endometrium, normal breast tissue, breast milk, salivary gland tissue, and the urine of males and females. PSA also is found in the serum of women with breast, lung, or uterine cancer and in some patients with renal cancer.
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If Screening Test Results Arent Normal
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.
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Special Types Of Psa Tests
The PSA level from a screening test is sometimes referred to as total PSA, because it includes the different forms of PSA . If you decide to get a PSA screening test and the result isnt normal, some doctors might consider using different types of PSA tests to help decide if you need a prostate biopsy, although not all doctors agree on how to use these tests. If your PSA test result isnt normal, ask your doctor to discuss your cancer risk and your need for further tests.
Percent-free PSA: PSA occurs in 2 major forms in the blood. One form is attached to blood proteins, while the other circulates free . The percent-free PSA is the ratio of how much PSA circulates free compared to the total PSA level. The percentage of free PSA is lower in men who have prostate cancer than in men who do not.
If your PSA test result is in the borderline range , the percent-free PSA might be used to help decide if you should have a prostate biopsy. A lower percent-free PSA means that your chance of having prostate cancer is higher and you should probably have a biopsy.
Many doctors recommend a prostate biopsy for men whose percent-free PSA is 10% or less, and advise that men consider a biopsy if it is between 10% and 25%. Using these cutoffs detects most cancers and helps some men avoid unnecessary biopsies. This test is widely used, but not all doctors agree that 25% is the best cutoff point to decide on a biopsy, and the cutoff may change depending on the overall PSA level.
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