- prostate specific antigen test
The PSA test is a test that measures the Prostate Specific Antigen (PSA) in the blood stream. PSA is specific to the prostate and is present in all normal prostate tissue. Most of the PSA produced by the prostate remains in the prostate gland. However, a small amount leaks into the bloodstream and this is what is measured by the blood test.
Who is a candidate for the test?
The American Cancer Society and the American Urological Association recommend that men over age 50 have a yearly PSA. They should also have a rectal examination of the prostate. High-risk groups should begin screening at age 40 to 45. Men with a family history of the disease and African Americans fall into this category.
How is the test performed?
A simple blood test is all that is needed.
What is involved in preparation for the test?
If possible, the patient should not ejaculate for 48 hours before a PSA test. If ejaculation has occurred and the PSA is elevated, it might be necessary to repeat the test.
Infections or inflammation of the prostate gland, called prostatitis, can also elevate PSA levels. Therefore, patients need to inform their doctors of any urinary symptoms that might exist. These may include pain with urination, urgency to urinate or discharge from the penis. The inflammation from prostatitis causes PSA to leak into the bloodstream. This causes the PSA level to be higher than normal.
Some patients will experience a rise in PSA if the test is taken after a simple rectal exam. If this is the case, the PSA test may have to be repeated.
The most common noncancerous cause of elevated PSA levels is benign prostate hyperplasia (BPH). As men age, the prostate normally enlarges. This becomes more apparent after age 50. The most common symptom with BPH is difficulty urinating. About 80% of men will develop some symptoms of BPH in their lifetime. BPH is not cancer and will not lead to cancer. However, BPH may cause a false elevation of PSA values.
What do the test results mean?
When evaluating PSA results, the doctor must also take into account the results of the rectal exam, the patient's age, previous PSA results, and prostatic size.
Many researchers now use the following levels rather than the 4.0 used in the past. However, more time is needed to assure that these levels are more accurate.
age 40 to 50, normal range is 0 to 2.5
age 50 to 60, normal range is 0 to 3.5
age 60 to 70, normal range is 0 to 4.5
- age 70 to 80, normal range is 0 to 6.5
If the rectal exam is normal then the following recommendations are suggested:
PSA of 4 or less. If the PSA level has been measured for the first time and is less than 4, repeat testing is recommended on a yearly basis. (This number may be dependent on age. See above for normal values).
PSA between 4 and 10. If the PSA level is greater than 4 but less than 10, another blood test, called the free PSA can be performed
Another option is a diagnostic ultrasound of the prostate. If the ultrasound shows no suspicious areas, the prostate can be monitored through regular testing and exams. If observation alone is used, the PSA should be repeated in 4 to 6 months and no later than a year.
If the ultrasound shows a suspicious area, then biopsy of the area needs to be performed. This can be done at the time of the ultrasound. The patient will need to take antibiotics ahead of time.
Another option is to take random biopsies from various parts of the prostate.
- PSA greater than 10. If the PSA is greater than 10, diagnostic ultrasound of the prostate with biopsies is the recommended course
If the ultrasound shows no suspicious areas, then random biopsies of the prostate are taken. If the ultrasound shows suspicious areas, then biopsies of the areas along with random biopsies need to be done.
If previous PSA values are available, test results will be evaluated differently. The PSA level almost always rises if cancer is growing. Any PSA level that is rising is suspicious.
However, a high PSA level may not mean that cancer is present. For example, a male with a stable PSA of 8 over a three-year period is probably at less risk than a male with a PSA of 2, 4, and 6 over the same time frame. This is because the second patient's rising levels suggest growth. This makes it suspicious for cancer.
If the first patient had a negative biopsy when the first high PSA value occurred, there may be no need to repeat the biopsies.
If the PSA level jumped to 10 or 15 for no apparent reason, then repeat ultrasound and biopsies would be called for. Recent studies suggest that either a 20% rise or a measurable rise of 0.75 in PSA in one year should prompt a closer look. Ultrasound and biopsy may be needed.