The PSA Test and What It Means?

What is PSA?

Prostate Specific Antigen (PSA) is a prostate-produced protein which holds semen in a liquid state, facilitating the proper swimming function of sperm. PSA can penetrate the bloodstream from damaged prostates leading to increased levels of PSA in the blood. This may be an indicator of cancer, but due to other potential causes for these increases, cancer isn’t confirmed.

The PSA test

PSA tests are basic blood tests that measure levels in the blood and serve as a starting point for many a patient’s diagnosis; though these tests can’t confirm the presence of cancer alone, a patient’s risk levels and treatment needs can be assessed sooner, and factors such as age, family history and the results of any previous PSA tests will be accounted for.

Together with diagnostic innovations such as the PCA3 test and pre-biopsy prostate MRI scanning, PSA tests eradicate needless biopsies and provide accurate assessments, whilst identifying and treating cancer. Due to their complexity, PSA test results are best explained by healthcare specialists, along with any proposed future treatment.

PSA tests are also used to monitor the impact of treatment such as chemotherapy, surgery, hormone or radiation therapy, by gauging significant post-treatment changes in PSA levels. Importantly, cancer cells can also continue to produce PSA after prostate cancer treatment; this “biochemical recurrence” generally requires extra testing and further assessment.

Going for a PSA test

Should I have a PSA test?

Expert guidelines suggest that the early detection of cancer should begin with a visit to your doctor or urologist to discuss personal risk and the pros and cons of assessment and diagnosis. Also note that those with close relatives who have had prostate cancer are more prone to the disease, as are African American men or those with BRCA gene mutations.
The new, recently approved Prostate Health Index (PHI) is another blood test that incorporates three separate tests, when detecting a patient’s cancer cells, and predicting it’s future development via ongoing monitoring. Whilst PSA tests, Digital Rectal Exams (DREs) or biopsies are inconclusive by themselves, together they can improve diagnosis and dictate treatment pathways.

Those aged 45-75 should discuss prostate cancer screening with their doctor or urologist to have a baseline PSA test and perhaps a baseline DRE test. However, PSA/DRE tests may prove unreliable for those aged 75+ and will require in-depth discussion. The PSA level often increases with maturity, so further tests or biopsies may be required. General PSA guidance states¹:
A PSA level of 0-2.5ng/mL is considered safe. Between 2.6-4ng/mL is safe, but risk factors should be discussed with your doctor. Between 4-10ng/mL is suspicious and suggests a 25% chance of prostate cancer. 10ng/mL or above is also dangerous, suggesting a 50% chance of prostate cancer. You should discuss any results with your doctor, as soon as possible.

What else should I know?

PSA testing is controversial, it’s proven to involve sometimes unnecessary negative side effects or invasive procedures such as biopsies, which some say, outweigh the benefits of quickly identifying and treating the disease.

Both high and low test results can also be affected by the following factors…

LOW PSA: Anti-inflammatory medication, cholesterol-reducing statins and obesity (body fat lowers PSA levels circulating in the blood) can all affect results.
HIGH PSA: Mature ageing, catheters, recent surgical procedures (such as biopsies), Prostatitis or prostate and pelvic injuries, testosterone supplements, urinary tract infections, cycling or having sexual intercourse 24 hours prior to testing, are all causes for PSA test result inaccuracy.

Finally, PSA velocity is the rate that the PSA level increases annually; when monitored, it serves as an early risk indicator for men who have seen a quick rise in their PSA level. Critically, this measurement can help identify early stage prostate cancer before it leaves the capsule of the prostate.

¹Guidelines adapted from the NCCN Clinical Practice Guidelines in Oncology, November 2020

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