When Should I Get A Psa Test
The guidelines below are adapted from the NCCN Clinical Practice Guidelines In Oncology for Prostate Cancer Early Detection. Please use these guidelines to have a discussion with your physician about your personal risk and make a plan for screening.
- If you are between ages 45 and 75:
- Discuss the risks and benefits of prostate cancer screening with your doctor, have a baseline PSA, and consider a baseline DRE
- If your PSA is below 1 ng/mL and your DRE is normal, repeat testing every 2-4 years
- If your PSA is between 1 and 3 ng/mL and your DRE is normal, repeat testing every 1-2 years
- If your PSA is greater than 3 ng/ML or your DRE is very suspicious, your doctor may suggest additional testing or a biopsy
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.
How To Get A Psa Test
Consult with your general practitioner or urologist about receiving a PSA test in their offices. PSA tests are typically covered without co-pay or deductible by Medicare once a year for men 50 years and older. Many states now have laws which require private health insurers to cover the costs for PSA testing. However, additional PSA test costs may need to be covered by the patient. For those without insurance, or for those with insurance that does not cover PSA testing, free tools are available through advocacy groups, such as ZERO.
Companies such asimawaretm also offer in-home PSA testing kits and telemedicine appointments to discuss your PSA test results with a licensed physician. All imaware test kits are easy to use. After registering the test kit online, results will populate in the secure patient portal within 5-7 business days. You can submit your receipt of this test to insurance for potential reimbursement.
At-Home testing is now at a point where results can be provided accurately and quickly within 5 business days, with real physicians providing telemedicine support through the entire testing process
Dr. Diamandis Lunenfeld-Tanenbaum Research Institute, Sinai Health System
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Getting A Prostate Biopsy
For some men, getting a prostate biopsy might be the best option, especially if the initial PSA level is high. A biopsy is a procedure in which small samples of the prostate are removed and then looked at under a microscope. This test is the only way to know for sure if a man has prostate cancer. If prostate cancer is found on a biopsy, this test can also help tell how likely it is that the cancer will grow and spread quickly.
For more details on the prostate biopsy and how it is done, see Tests to Diagnose and Stage Prostate Cancer.
For more information about the possible results of a prostate biopsy, see the Prostate Pathology section of our website.
Psa Test For Prostate Cancer
The prostate gland makes a protein called prostate specific antigen . This protein helps to nourish sperm. Normally, only tiny amounts of it enter the bloodstream.
Cancer cells in the prostate interfere with proper functioning and can cause large amounts of PSA to enter the bloodstream. Therefore, when high levels of PSA are detected in the bloodstream, this may indicate cancer.
Early prostate cancer often has no symptoms. However, high PSA levels can occur five to 10 years before the onset of prostate cancer symptoms. In such circumstances, the PSA test can help to indicate the presence of cancer at an early stage.
Other tests are needed to confirm a diagnosis because an abnormal PSA test can be due to non-cancerous causes. Equally, it is possible for a man to have a normal PSA level when cancer is present.
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What Is The Phi Test
The PHI or Prostate Health Index test is a blood test that is used to predict the risk of having prostate cancer in men. The PHI test is used instead of the traditional PSA test. The Prostate Health Index test is actually derived from the PSA test. The PHI test is a combination of the free PSA, total PSA, and the proPSA isoform of free PSA. These 3 tests are mathematically combined in a formula that results in a Prostate Health Index or PHI score. The PHI score is a better predictor of prostate cancer than the total PSA test alone or the free PSA test alone. The Prostate Health Index is also a better predictor of prostate cancer risk than the free PSA to total PSA ratio or the free PSA ratio.
The PHI test offers better sensitivity as well as better sensitivity for prostate cancer. This means that men with a low score are less likely to have prostate cancer and those with a higher score are much more likely to have prostate cancer.
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Psa Testing Isnt Perfect
The standard screening blood test for prostate cancer is the prostate-specific antigen . The American Cancer Society recommends men have a discussion with their primary care provider when they turn 50 about whether or not to start routine PSA testing.
PSA testing can be very valuable, but it often leads to unnecessary biopsies because results can be difficult to interpret as a stand-alone test. Many variables can skew a PSA level high or low, causing either concern or confusion when deciding what action to take next.
Oftentimes, a prostate biopsy will be recommended to further evaluate and try to create meaning from an abnormal PSA result. Unfortunately, a prostate biopsy is invasive and can cause adverse events. However, they are needed when prostate cancer is at risk.
We need a more sensitive, informative, non-invasive way to evaluate a mans risk of prostate cancer as well as their risk for developing an aggressive form of prostate cancer. This where the 4K score comes in.
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Repeating The Psa Test
A mans blood PSA level can vary over time , so some doctors recommend repeating the test after a month or so if the initial PSA result is abnormal. This is most likely to be a reasonable option if the PSA level is on the lower end of the borderline range . For higher PSA levels, doctors are more likely to recommend getting other tests, or going straight to a prostate biopsy.
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 screeningexternal icon 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.
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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.
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 55 to 69 . This rating has now been certified official by the task force.
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Need For This Guidance
New Zealand men currently receive conflicting advice about prostate cancer testing and treatment. Some men may benefit from early diagnosis and treatment, but have limited opportunity to access appropriate health services.
Unlike other cancers, prostate cancer often grows slowly. With routine prostate specific antigen testing, many men can be diagnosed with a cancer that is not going to progress during their lifetime. Such a diagnosis may increase mens exposure to unnecessary treatment-related harms.
On the other hand, some men will still develop aggressive and potentially life-threatening prostate cancer. These men may benefit from prompt diagnosis and treatment.
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What Happens If You Have A Likert Score Of 3 Or More
This result on its own doesnt mean that you definitely have prostate cancer. But its more likely that you do. Your doctor is likely to recommend for you to have a biopsy.
The MRI scan also helps doctors know where to take the biopsy from. You usually have tissue samples taken from the suspected area of cancer and also from the rest of the prostate. Doctors call these targeted biopsies and systematic biopsies. This is because not all cancers can be seen on an MRI scan.
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What’s A Raised Psa Level
The amount of PSA in your blood is measured in nanograms of PSA per millilitre of blood .
If you’re aged 50 to 69, raised PSA is 3ng/ml or higher.
A raised PSA level in your blood may be a sign of prostate cancer, but it can also be a sign of another condition that’s not cancer, such as:
Combination Of Psa Molecular Forms For Improved Cancer Detection
It is most unlikely that a single biomarker will have the single decision as to a diagnosis and/or a prognosis of a particular pathology. The future of cancer profiling relies on the combination of a panel of complimentary biomarkers that can give accurate molecular staging and indicate the likelihood of aggressive behavior.
The group of Vickers and Lilja has developed a statistical model that predicts prostate biopsy outcomes based on age, DRE and a panel of four kallikrein markers total PSA, free PSA, intact PSA and hK2. Using data from the randomized prostate cancer screening trial in Göteborg, Sweden , they estimated that for every 1000 previously unscreened men with elevated total PSA, use of the model to determine biopsy would reduce biopsy rates by 573, while missing only a small number of cancers . These findings were subsequently replicated in an independent cohort . These findings have also been verified in men who recently have undergone previous screening, with resultant improvements in predictive accuracy. Recently, Gupta et al. demonstrated that the panel of four kallikrein markers can predict the outcome of prostate biopsy in men who had previously undergone prostate biopsy during previous screening. This model in addition to age and DRE substantially improved the predictive accuracy of a base model , for both low- and high-grade cancers.
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Prostate Cancer: Advancements In Screenings
You may know thatprostate canceris one of the most common cancer types in men. The good news is that thereare many treatment and management options, even if the cancer is caught ata later stage.
What you may not know: There are several options when it comes toprostate cancer screening. After considering multiple factors, your doctor may recommend theprostate-specific antigen test, and/or one of the newer screeningtests that are now available.
Johns Hopkins urologistChristian Pavlovich, M.D., explains what you should know.
Prostate Cancer Urine Test
This test detects the gene PCA3 in your urine and can also help your doctorbetter assess your prostate cancer risk.
PCA3 is a prostate-specific noncoding RNA. Its a gene thats only in yourprostate. If the gene is overexpressed , then theres a greater chance you have prostate cancer.
Like PSA and PHI tests, this isnt definitive, either. But data suggestthat when cancer is present, the PCA3 will be positive 80 percent of thetime. This test can also help your doctor determine whether a biopsy isnecessary.
Both of these new tests are more accurate than the PSA test. Your doctormay recommend one or more than one, based on the specifics of your case.
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Who Gets A Psa Test
According to the guidelines outlined by the American Urological Association, shared decision-making for the early detection of prostate cancer is recommended for targeted groups of men with an increased risk of prostate cancer.
- 55 69 years old, all men of average risk.
- 40-54 years old for individuals with an immediate family member with a history of prostate cancer or Black/African American men.
Over the age of 70, men in exceptional health should have a discussion with their doctor about whether PSA testing makes sense for them.
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Psa Levels In Healthy Males
PSA production in the prostate gland is normal, and levels will increase as men age. Other contributing factors for an elevated PSA level involve benign causes such as infection, inflammation, or benign prostatic hyperplasia . Conversely, some factors, such as anti-inflammatory medications and obesity, may decrease PSA levels. In general, there is no standard range for PSA levels due to the variability of each individual. The test does not differentiate between advanced prostate cancer versus benign causes.
There are also non-aggressive types of prostate cancer that may not affect life expectancy and will only require active surveillance. Prostate cancer is generally slow growing some patients may only require observation, sometimes referred to as watchful waiting or active surveillance, instead of treatment. Patients in this group often visit their doctors every few months, receiving PSA tests, digital rectal exams , and symptom monitoring.
How Is Prostate Cancer Treated
Treatment options for prostate cancer include:
- Surgery to remove the prostate .
- High intensity focused ultrasound .
- Hormone treatment, also called androgen suppression therapy.
You may continue to have PSA level tests during and after prostate cancer treatment. These tests check that the treatment is working.
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What Are Normal Psa Levels
Thereâs no such thing as a normal PSA for any man at any given age, but most men with prostate cancer have a higher than normal level. In general:
If your PSA results are in the borderline range , the % free PSA can be useful in helping distinguish between prostate cancer or benign prostatic hyperplasia . The pattern is the opposite of that seen with PSA in that a high % free PSAâabove 20%âpoints to BPH, while a %- free PSA less than 10% indicates a greater likelihood of cancer.
What Is It Used For
A PSA test is used to screen for prostate cancer. Cancer screening means looking for signs of cancer before it causes symptoms. But screening tests can’t diagnose cancer. If a screening test finds signs of cancer, you’ll need other tests to find out if you have cancer and how serious it may be.
Most types of prostate cancer grow very slowly. They don’t spread beyond the prostate and may never cause health problems. In fact, you can live a long life with prostate cancer and never know you have it. The goal of prostate cancer screening is to help find cancers that may be more likely to spread so they can be treated early. But there are challenges and possible harms from using a PSA test to screen for prostate cancer:
- A PSA test can’t tell the different between abnormal PSA levels from prostate cancer and noncancerous conditions. If your PSA level is high, a prostate biopsy is the only way to find out if the cause is cancer. And prostate biopsies have possible harms.
- A PSA test may lead to finding and treating prostate cancer that would never have affected your health. If prostate cancer is found:
- It can be difficult to tell the difference between slow-growing cancers and those that are likely to grow faster and spread in your body.
- You could have prostate cancer treatment that you never really needed. And cancer treatment may cause serious harms, such as:
- Problems controlling your bowels
PSA testing may also be used to:
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