Prostate prostate-specific antigen (PSA) test is an important screening tool to detect prostate cancer in men. This blog article by healthcare nt sickcare will help you understand what is PSA test is, why it is done, when to get it done, and the procedure and preparation needed. We have also answered some frequently asked questions about the PSA test towards the end of the article.
What is PSA or Prostate Specific Antigen Test?
PSA stands for Prostate-Specific Antigen, which is a protein produced by the prostate gland in men. The levels of PSA in the blood can be detected through a simple blood test called the PSA test or assay.
PSA is a tissue kallikrein, a serine protease enzyme secreted by epithelial cells of the prostate gland. PSA acts to liquefy the seminal coagulum so sperm can swim freely. It is also believed to break down seminogelins in seminal fluid.
In healthy men, a small amount of PSA leaks into the bloodstream. But when the prostate gland is enlarged, inflamed, or cancerous, more PSA can leak into the blood. Thus, an elevated PSA level in the blood may indicate some problem with the prostate gland.
The PSA test measures the level of PSA in a man's blood in ng/mL (nanograms per millilitre). Doctors use the PSA test as a screening tool to detect prostate cancer or other prostate problems early on when treatment may be more effective.
Why Get a PSA Test Done?
There are a few important reasons why a PSA test may be recommended by your doctor:
- Screening for Prostate Cancer: The main goal of a PSA test is to screen for prostate cancer in men who have no symptoms of the disease. PSA levels tend to be elevated in men with prostate cancer, so an abnormal PSA result may lead to further testing and diagnosis.
- Determine Recurrence After Treatment: If you have been treated for prostate cancer in the past, your doctor may recommend regular PSA tests to monitor for recurrence or spread of the cancer. A rising PSA after treatment may indicate the cancer has returned.
- Evaluate Benign Prostatic Hyperplasia (BPH): An enlarged prostate gland called BPH is common in older men and can cause urinary symptoms. PSA levels may be used along with a physical exam to help diagnose and monitor BPH.
- Check Response to Treatment: If you are undergoing treatment for prostate cancer or BPH, the PSA test can help determine if the treatment is working effectively to lower PSA levels.
- Diagnose Prostatitis: This condition involves inflammation or infection of the prostate gland, which may cause high PSA levels. Testing PSA can help diagnose prostatitis and gauge how well antibiotics are working if it's an infectious form.
When Should Men Get Tested?
Medical organizations differ in their exact recommendations about PSA screening. Here are some general guidelines on when PSA testing may be advisable:
- Age 50: The American Cancer Society recommends men at average risk of prostate cancer consider getting yearly PSA tests starting at age 50. Men at higher risk, including African-Americans and those with a family history of prostate cancer, should start at age 45.
- Age 45: The American Urological Association recommends a baseline PSA test at age 45 for high-risk men, while average-risk men may start screening at age 55.
- Age 40: Starting annual PSA screening at age 40 is reasonable for men at high risk of developing prostate cancer. This includes African-American men and those with a first-degree relative diagnosed with prostate cancer before age 65.
- Before DRE: Many doctors will check PSA levels before performing a digital rectal exam (DRE) since this exam can temporarily raise PSA for up to 48 hours.
- If symptomatic: Testing should be done promptly if you experience any urinary symptoms that could signal prostate problems, like reduced flow or painful urination.
Discuss your risk factors and the pros and cons of PSA screening with your doctor to decide if and when you should get tested.
PSA Test Procedure and Preparation
The PSA blood test is a simple, quick procedure that requires no preparation:
- No fasting needed: You do not need to fast for a PSA test. You can eat and drink normally before the test.
- Have it anytime: A PSA test can be done any time of day.
- Blood draw: A health professional will collect a small blood sample, usually from a vein in your arm, and send it to a lab for analysis.
- Results in 1-3 days: PSA test results are generally available within a day or two after the blood draw.
- No discomfort: The blood draw is mildly uncomfortable but not painful for most patients. Applying pressure stops any minor bleeding afterwards.
Certain activities may need to be avoided before a PSA test:
- Avoid ejaculation: Refrain from ejaculation for at least 48 hours before the test, as this can inflate PSA levels temporarily.
- No prostate exams: Do not undergo a digital rectal exam (DRE) or prostate biopsy for a few days before the test, as these can also drive PSA higher short term.
- Stop testosterone supplements: Let your doctor know if you take testosterone replacements, as these may increase PSA levels. Time off testosterone may be needed before testing.
- Avoid certain medications: Discuss with your doctor if you take Proscar, Avodart, Propecia or other 5-alpha reductase inhibitors, as these can lower PSA levels. Stopping them briefly for pre-testing may be required.
Understanding PSA Test Results
PSA test reference ranges can vary slightly between labs but are generally:
- Normal PSA: 0 to 4 ng/mL
- Borderline: 4 to 10 ng/mL
- High: Above 10 ng/mL
Lower PSA levels are better, with levels above 4 ng/mL considered elevated and warranting further evaluation.
However, PSA levels alone do not diagnose prostate cancer. Some men may have cancer even with low PSA, while others may have benign prostate enlargement causing higher PSA.
Doctors consider the PSA result along with digital rectal exam findings, Gleason score if a biopsy was done, genetics, family history and other factors. PSA levels between 4-10 have about a 25% chance of signalling cancer.
Rising PSA over time, called PSA velocity, is also a concern even if the level remains in the normal range. For example, PSA increasing from 1.5 to 3.5 over 2 years may require investigation.
If PSA or other assessments indicate prostate cancer risk, your doctor will likely recommend additional tests such as an MRI or ultrasound and prostate biopsy to make a definitive diagnosis.
PSA Screening Limitations and Controversy
While the PSA test can effectively screen for early prostate cancer, there are some limitations and controversy around its routine use for screening healthy men:
- False positives: Only about 25% of men with elevated PSA are found to have prostate cancer. The rest have benign prostate enlargement which also increases PSA.
- False negatives: 15% of men with prostate cancer have PSA in the normal range, so maybe missed on screening.
- Unnecessary biopsies: Many men with mildly elevated PSA undergo a biopsy to rule out cancer, which has risks of pain, bleeding and infection.
- Unnecessary treatment: Since most prostate cancer grows slowly, many cases detected by PSA screening will not need immediate treatment. This can lead to overtreatment with risks of side effects.
- Does not assess aggressiveness: PSA does not indicate how aggressive or advanced cancer may be. Slow-growing tumours often don’t need intervention.
Due to these factors, several organizations caution against routine PSA screening for men at average risk. However, the decision to have PSA testing is highly individualized. Discuss with your doctor if PSA screening is right for you based on your personal risk factors and values.
Frequently Asked Questions About PSA Test
The PSA test measures prostate specific antigen levels in the blood to screen for prostate cancer in men.
Is the PSA test recommended for all men?
The PSA test remains controversial as a screening tool for prostate cancer when used routinely in all men. Currently, most major medical groups only recommend the PSA test for high-risk men, those over 50 years old, or those experiencing urinary symptoms. Men should consult their doctor about whether PSA testing is advisable based on their individual health status and risk factors.
What causes high PSA levels besides cancer?
While prostate cancer is a major cause of elevated PSA, other common benign prostate conditions can also lead to higher levels, including:
- Benign prostatic hyperplasia (BPH), an enlarged prostate
- Prostatitis, inflammation or infection of the prostate
- Recent digital rectal exam (DRE) or prostate biopsy
- Older age
- Urinary tract infection
Should I get a PSA test if I have no prostate symptoms?
For men at average risk with no prostate issues, the benefits of PSA screening are uncertain. However, the American Cancer Society now recommends men ages 50-70 talk with their doctor about the potential pros and cons of annual PSA testing. Early prostate cancer detection may save lives but also lead to overdiagnosis and overtreatment. High-risk men should start discussing PSA screening around age 45.
Does health insurance cover PSA testing?
Most private insurance plans, as well as Medicare and Medicaid, provide coverage for PSA testing when considered medically necessary. This usually includes testing for men over 50 years old based on current guidelines. Out-of-pocket costs may apply. If unsure, check with your insurer about coverage details for prostate cancer screening tests.
How often should PSA testing be repeated?
There is no definitive guideline on PSA screening frequency. For men ages 50-70 at average risk, the American Cancer Society suggests annual testing. Men with higher PSA may need more frequent monitoring such as every 6 months. Discuss with your doctor how often to repeat PSA testing based on your risk profile and previous PSA results.
- PSA (prostate-specific antigen) screening has benefits but also significant limitations in detecting prostate cancer.
- Current guidelines generally recommend PSA testing every 1-2 years for men over 50 or high-risk men over age 45, when the potential benefits may outweigh the risks of overtreatment.
- Work with your doctor to make an informed decision on if and when PSA testing may be appropriate for you as part of your overall prostate health evaluation.
- An elevated PSA does not definitively diagnose prostate cancer. Additional testing like a biopsy is usually needed to confirm the diagnosis if PSA is abnormal.
- Together with your doctor, use the PSA test as an aid, not the sole factor, in determining if you may have underlying prostate problems requiring further evaluation and management.
At healthcare nt sickcare, we hope this overview helped you better understand the PSA test and its current role in prostate cancer screening. Our lab provides PSA testing on doctor’s orders along with other cancer marker tests. Please contact us or book a PSA test online if we can be of assistance in monitoring your prostate health.
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