What Is Prostate Specific Antigen

What Happens If Psa Levels Are Elevated

What is Prostate Specific Antigen (PSA) Testing – Urology Specialists of the Carolinas

If an initial PSA test yields elevated results, your doctor may recommend another test at a later date to compare the numbers. Men who are experiencing symptoms of prostate cancer along with elevated PSA levels will likely be advised to undergo a digital rectal exam as well. The subsequent readings and findings help your doctor to discern whether prostate cancer is present or an unrelated or benign issue is causing antigen markers to spike.

Problems With The Psa Test

There are reasons doctors donât agree on whether you need this test:

Finding prostate cancer early doesnât always protect you. The PSA test often finds small, slow-growing tumors that arenât life-threatening. Treating them anyway, whether itâs with surgery or radiation, can expose you to harmful side effects and complications. Also, finding cancer early may not help if you have an aggressive tumor or if it spread to distant body parts before you found it.
The results arenât always accurate. If you have a high level but you donât have cancer, the test results can create a lot of worry and lead to medical procedures you donât need. A negative result if you really do have cancer can prevent you from getting treatment you do need.

Patient Guide To Prostate Specific Antigens

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Although rates of diagnosis and mortality have been declining in recent decades, prostate cancer remains the most common type of non-skin carcinoma among male populations. Monitoring levels of prostate specific antigen is an informative and largely effective way to keep tabs on the progression of prostate cancer.

Despite its importance in preventative medicine, not all patients may be familiar with PSA. In this guide from HIFU Prostate Services, we provide you with the information and answers needed to understand prostate specific antigen, from the bodily markers it tracks to its relationship with cancer treatment.

For more information on the research and case studies related to PSA, please contact one of our medical specialists at HIFU Prostate Services today! With treatment locations around the country, its easy to find a care center near you.

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What If My Psa Is High

PSA screening is just the first step, alerting you and your doctor that more testing may be needed. If PSA is only slightly elevated, your doctor may recommend repeating the test a couple of weeks later. From there, other types of tests can help with the decision on whether you need a biopsy, including:

Digital rectal exam , if not already done
Free PSA test
PSA velocity, or the rate of rise over time
PSA density, or the PSA per volume of prostate
PSA-based markers
Other markers, a urinary PCA3 or SelectMDx test
Magnetic resonance imaging of the prostate

Each time you see your doctor for a checkup, have a conversation about prostate health and prostate cancer screening. PCF recommends that you make a about PSA screening with your doctor, starting at age 45, or age 40 if you have a family history of prostate or other cancers or are Black.

Precision In The Diagnosis Of Prostate Cancer

An elevated PSA does not necessarily mean cancer since the PSA rises for manyreasons other than cancer.Since the facts listed above have often been ignored, many patients have beenunnecessarily subjected to a biopsy . Furthermore, cancer of the prostate has been detected in men with a PSAconcentration that is lower than 2.0 ng/ml. These cases account for at least 21% of thetotal diagnoses of prostate cancer. These data raise doubts about the use of anarbitrary PSA threshold to select the patients that will be subjected to a biopsy. We have been advising people not to have biopsies since 2004 even when they havehigh PSA levels.

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What Does Psa Mean

PSA, or prostate-specific antigen, is a protein produced by the prostate and found mostly in semen, with very small amounts released into the bloodstream. When theres a problem with the prostatesuch as the development and growth of prostate cancermore PSA is released. Sometimes, a mans prostate releases slightly high PSA for other reasons. Rising PSA eventually reaches a level where it can be easily detected by a blood test.

For more information on rising PSA, download or order your free copy of the Prostate Cancer Patient Guide.

Does Your Psa Indicate Cancer

Prostate Specific Antigen or PSA, is an enzyme found in a man’s blood produced exclusively by prostate cells. An abnormal rise in PSA, can indicate Prostate Cancer. Higher levels of PSA can be found in the blood as prostate cancer cells begin to proliferate in an uncontrolled way.

Normal PSA levels in the blood are very small amounts between 0-2.5 ng/ml. As a man ages his prostate can become larger, leading to slightly higher normal levels of PSA. It is important to have your PSA and prostate exam as part of your yearly physical.

Testing for PSA, requires that a man’s blood be drawn and sent to the lab for analysis. If higher than normal levels are discovered, action is recommended. Levels greater than 2.5 ng/ml, can have many different causes. Prostate Cancer is one cause. But elevated PSA levels doesn’t necessarily mean prostate cancer. PSA can also rise for benign, non-cancerous conditions such as enlarged prostate, prostate inflammation, infection, or trauma. Get checked by your doctor.

IMPORTANT: All elevated readings of PSA should be checked.

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How To Prepare For The Test

Make sure your health care provider knows all the medicines you are taking. Some drugs cause your PSA level to be falsely low.

In most cases, no other special steps are needed to prepare for this test. You should not have a PSA test soon after having a urinary tract infection or undergoing a procedure or surgery involving the urinary system. Ask your provider how long you should wait.

Variations On A Theme

The Prostate Specific Antigen (PSA) Test

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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What Is Digital Rectal Examination

Most prostate cancers are located in the peripheral zone of the prostate and may be detected by DRE. During this examination a doctor inserts a finger into the rectum to feel the prostate for lumps, size, shape, tenderness, and hardness. A suspect DRE is an absolute indication for prostate biopsy, regardless of the PSA level. In about 18% of patients with abnormal DRE, prostate cancer will be detected regardless of the PSA level.

Maximum Values Of Psa That Are Considered Normal

The tables have varied considerably as new factors that raise or reduce the PSA arediscovered. As mentioned above, it is also common to discover cancer in men whosePSA is below 2.0 ng/ml. Nor is it rare to find patients with no evidence of cancer of theprostate but with PSA levels that are above 70 ng/ml. In general, if the level is above 4ng/ml there is a greater possibility of finding one or more following diseases such as theones listed below:

Any surgery in the groin area such as hernia surgery, vasectomy, etc.

Mammary carcinoma

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.

What Does An Elevated Psa Level Mean If Ive Had Prostate Cancer In The Past

If youve ever had treatment for prostate cancer, youll have regular PSA screenings for the rest of your life. An increasing PSA level may mean the cancer has returned. Your care team may use other tests, including imaging scans and biopsies, to check for signs of cancer. If cancer returns, your team will discuss your treatment options with you.

What Are Normal Results For A Psa Test

The normal PSA serum concentration ranges between 1.0 and 4.0 ng/mL.

However, since the prostate gland generally increases in size and produces more PSA with increasing age, it is normal to have lower levels in young men and higher levels in older men.

The PSA level also depends on ethnicity and family history of prostate cancer.

Other than the single reading, the changes in PSA numbers on an annual basis also play a role in decision making about the PSA marker.

The normal increase of less than 0.75 ng/mL is used to help determine whether levels may be suggestive of disease and to counsel men on management.

A man 50 to 59 years of age with an increase in PSA levels from 0.5 ng/mL to 2.5 ng/mL may cause greater concern despite the “normal” value at that time.

What Is The Test To See If I Have Elevated Psa

Healthcare providers use a blood test to measure PSA levels.

You may have a digital rectal exam together with a PSA test to check for signs of prostate cancer. During a DRE, your provider inserts a gloved finger into the rectum to check for bumps or other irregularities.

Depending on the results of your initial test, your provider may want you to repeat the test. PSA levels can change. A second test gives your provider more details about your prostate health.

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.

What Should I Expect If Im Told I Have Elevated Psa

Prostate Cancer Screening: What is Prostate-Specific Antigen (PSA)?

If your provider finds an elevated PSA level, youll have repeat tests to check your prostate. Many men with elevated PSA levels even those who have prostate cancer live long, healthy lives. Prostate cancer may not need treatment, depending on how slowly the tumor is growing. Keep up with your regular appointments and tests so your care team can keep tabs on your health.

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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 :

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.

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What Is Considered An Elevated Prostate

Researchers havent settled on a single normal PSA level. Previously, a level of 4.0 ng/mL or higher would lead to more testing, usually a prostate biopsy. During the biopsy, a healthcare provider removes a small sample of prostate tissue to check it for cancer.

However, healthcare providers now consider other issues together with the PSA level to decide whether to perform a biopsy. Your age, general health, family history and health history factor into the decision.

Normal Psa Levels By Age

Electrochemiluminescence immunoassay for the prostate ...

For total PSA, the following values are considered normal

0-2.5 ng/mL for men aged 40-49 years
0-3.5 ng/mL for men aged 50- 65 years
0.0-4.5 ng/mL for men aged 60-69 years
0.0-6.5 ng/mL for men aged 70-79 years,

In women, total PSA should be under 0.002 ng/mL

Free PSA in the range of 0.2 to 5.0 ng/mL is normal in men with total PSA levels of 4.0-10.0 ng/mL. The following levels are considered normal by age in healthy men :

0.5 ng/mL for men 40-49 years old
0.7 ng/mL for men 50-59 years old
1.0 ng/mL for men 60-69 years old
1.2 ng/mL for men 70-79 years old

ThePSA Free/Total index should be > 25%

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One Test Several Roles

Doctors use blood PSA levels for several very different purposes. The test is an extremely important way to diagnose prostate cancer in men who have symptoms or laboratory abnormalities that raise suspicion of the disease. PSA levels are also used to evaluate the results of prostate cancer treatment. Some doctors even use PSA readings to estimate the severity of benign prostatic hyperplasia , non-malignant enlargement of the gland. There is no controversy about these PSA tests but there is controversy galore about the most widespread use of PSA testing: screening for prostate cancer in men who are free of signs and symptoms of the disease.

Psa Levels Are Not A Diagnostic Of Cancer

The standard for identifying prostate cancer is the prostate biopsy, collecting small samples of prostate tissue and identifying abnormal cells under the microscope. The total PSA test and digital rectal exam are used together to help determine the need for a prostate biopsy. The goal of screening is to minimize unnecessary biopsies and to detect clinically significant prostate cancer while it is still confined to the prostate.

A PSA blood test can detect prostate cancer early, but it may not save lives.

Many prostate cancers grow slowly, so a PSA test may save lives of some but cause others to have unnecessary surgeries or radiation treatment, which could cause lifelong problems such as erectile dysfunction or incontinence.

Men over 50 should talk to a doctor about their personal risk of developing prostate cancer and the benefits and risks of having a PSA test.

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