What Is It Used For
A PSA test is used to screen for prostate cancer. Screening is a test that looks for a disease, such as cancer, in its early stages, when itâs most treatable. Leading health organizations, such as the American Cancer Society and the Centers for Disease Control and Prevention , disagree on recommendations for using the PSA test for cancer screening. Reasons for disagreement include:
- Most types of prostate cancer grow very slowly. It can take decades before any symptoms show up.
- Treatment of slow-growing prostate cancer is often unnecessary. Many men with the disease live long, healthy lives without ever knowing they had cancer.
- Treatment can cause major side effects, including erectile dysfunction and urinary incontinence.
- Fast-growing prostate cancer is less common, but more serious and often life-threatening. Age, family history, and other factors can put you at higher risk. But the PSA test alone canât tell the difference between slow- and fast-growing prostate cancer.
To find out if PSA testing is right for you, talk to your health care provider.
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What If My Biopsy Results Are Positive
Following a positive biopsy result, the next step is to determine the cancers staging the extent to which cancer has developed by growing and possibly spreading. You will undergo a bone scan, an MRI of the pelvis, or a CT scan. In the near future, PET scanning specifically for prostate cancer will be widely available. Ruckle says you and your physician should customize your prostate cancer care based on your desires, fears, age, current health status, motivation, and lifestyle.
There is a wide spectrum of treatments, Ruckle says. It is really important that patients understand that it is not a one-size-fits-all treatment by any means. Different prostate cancer treatments bear various side effects from close observation with deferred treatment if necessary, focal therapy to radiation therapies to robotic surgical removal.
We have a lot of resources and options to help men get through this and not have it adversely affect their life or their lifestyle, Ruckle says.
Learn more about prostate cancer screening and treatment options online. Loma Linda University Health is committed to your health and safety. Visit MyChart to schedule a telehealth visit or in-person appointment, or call .
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What Is A Psa Test
The PSA, which stands for prostate-specific antigen, is a specific enzyme produced by prostate cells in men. A PSA blood test measures the level of prostate-specific antigen in the patients blood at that given moment and is a valuable screening tool for the early detection of prostate cancer. Because the PSA can go up and down in response to a number of factors and conditions, it is important to monitor your level with regular PSA tests over time.
When Should I Start Getting My Psa Checked
Most men are encouraged to have regular PSA tests performed starting at around age 45, though men with a positive family history of prostate cancer or certain prostate cancer risk factors, such as being African American, should start sooner. During your initial visit with Dr. Kasraeian, he will thoroughly review your previous records, discuss your health history and family history, perform any necessary lab work or imaging studies, and formulate a customized care schedule that best meets your needs.
If I Have Elevated Psa Levels What Should I Ask My Healthcare Provider
If you have any symptoms of prostate cancer, or if it runs in your family, ask your provider:
- Should I have regular tests to check my PSA level?
- What can I do to lower my risk for prostate cancer?
- What other tests or monitoring do I need?
- What are my treatment options if I get prostate cancer?
- What other signs or symptoms should I look out for?
A note from Cleveland Clinic
An elevated PSA level can be a sign of prostate cancer, but it doesnt always mean you have cancer. Your healthcare provider will watch you and do more tests to arrive at a diagnosis. Prostate cancer is often slow-growing and may never become life-threatening. If you have symptoms of prostate problems, such as difficulty urinating, don’t hesitate to let your provider know.
Last reviewed by a Cleveland Clinic medical professional on 04/06/2021.
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What Do The Dre Results Mean
A digital rectal examination is a test used to see if you might have a prostate problem or prostate cancer.
Your prostate may feel:
- normal a normal size for your age with a smooth surface
- larger than expected for your age this could be a sign of an enlarged prostate
- hard or lumpy this could be a sign of prostate cancer.
The DRE is not a completely accurate test. Your doctor or nurse cant feel the whole prostate. And a man with prostate cancer might have a prostate that feels normal.
What Kind Of Doctor Will I See For A Dre
A primary care doctor or a gynecologist usually does a DRE. A gynecologist is a doctor who specializes in the health of womens reproductive system. Other types of doctors, including gastroenterologists, surgeons, and oncologists may do DREs. A gastroenterologist is a doctor who specializes in the gastrointestinal tract. An oncologist is a doctor who treats cancer.
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Who Should Have The Test
Having a PCA3 test done in addition to a PSA test and digital rectal exam can more accurately assess your need for a biopsy of your prostate gland. The decision to have the PCA3 test is up to you and your doctor.
Generally, the test is given if you have elevated PSA levels but a biopsy found no cancer. Its also given if you and your doctor have decided that watchful waiting is the best strategy, but you want another method of monitoring your status.
High Psa Levels From A Urinary Tract Infection
“Any infection near the prostate gland, including a urinary tract infection, can irritate and inflame prostate cells and cause PSA to go up,” says Milner.
If youve been diagnosed with a urinary tract infection, be sure to wait until after the infection has cleared up before you get a PSA test. In men, most urinary tract infections are caused by bacteria and respond well to antibiotics.
Having BPH increases your risk for a urinary tract infection.
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Different Factors Increase Or Decrease The Risk Of Developing Prostate Cancer
Is The Psa Test Recommended For Prostate Cancer Screening
Until about 2008, some doctors and professional organizations encouraged yearly PSA screening for men beginning at age 50. Some organizations recommended that men who are at higher risk of prostate cancer, including African-American men and men whose father or brother had prostate cancer, begin screening at age 40 or 45. However, as more was learned about both the benefits and harms of prostate cancer screening, a number of organizations began to caution against routine population screening. Most organizations recommend that men who are considering PSA screening first discuss the risks and benefits with their doctors.
Currently, Medicare provides coverage for an annual PSA test for all Medicare-eligible men age 50 and older. Many private insurers cover PSA screening as well.
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What Is Psa And How Do Psa Tests Work
The prostate is a small, apricot sized gland that sits below the bladder in males and uniquely produces prostate-specific antigen, a protein that circulates in the bloodstream. A PSA test is a blood test that measures prostate activity, reporting results as nanograms of PSA per milliliter of blood . Prostate cancer screening is generally recommended for men 55-70 years old or as young as 40 years old for men with a family or racial history that places them in a high-risk group. To benefit from prostate cancer screening, a man should be generally be healthy enough to have a 10-year life expectancy.
The range generally accepted as a normal PSA level spans from zero to four nanograms of PSA per milliliter of blood, though there are exceptions based on age, race, and risk factors. You and your physician can discuss whether any such nuanced situations apply to you. Keep in mind although a PSA test can certainly detect high levels of PSA in the blood, it is not enough to diagnose a cancer because an elevated PSA is not a definitive sign of prostate cancer.
Medical Procedures Can Cause Psa To Rise
“Anything that traumatically interferes with the architecture around the prostate gland can make PSA go up,” says Dr. Milner. “One of the most common causes of significantly high PSA from this type of trauma is the placing of a catheter into the bladder.”
Another cause is a prostate or bladder exam that involves passing a scope or taking a biopsy.
“Since it takes about two to three days for PSA to go down by half, you should wait two to three weeks after this type of trauma to do a PSA test,” Milner says.
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What Happens During A Rectal Examination
First, youll be asked to undress from the waist down. If youre wearing a loose skirt, you can usually just remove your underwear.
Let the doctor or nurse know if youd like to get changed behind a curtain or be alone in the room.
The doctor or nurse will:
If youre a man, the doctor or nurse may press on your prostate. This can make you feel the urge to pee, but it should not hurt.
Once youre dressed, theyll discuss the results of the examination with you.
Page last reviewed: 23 December 2020 Next review due: 23 December 2023
Significance Of A Rising Psa
Many doctors use PSA levels to determine the diagnosis and treatment of prostate problems. Unfortunately, some urologists subscribe to the theory that almost any rise in a mans PSA value should be followed up with a prostate biopsy.
Men are also led to believe that PSA levels are all-important for diagnosing prostate cancer both by their peers and by the media. However, many situations can significantly rise in PSA that does not indicate cancer or require significant treatment.
Other conditions that can cause increased PSA levels include an enlarged prostate or an inflamed or infected prostate . In addition, PSA values can be temporarily increased by external stress on the prostate, such as bicycle or motorcycle riding as well as sexual activity, especially intense sexual or physical activity.
For older men, the general upper limit that is considered normal is 4.0 ng/mL. However, normal prostates emit a higher level of PSA as a man ages. The PSA level also tends to increase with the size of the prostate, especially with BPH. A CAT scan or an MRI can determine the size of a mans prostate, but such tests may not always be warranted.
Some doctors use rising PSA as a major factor in determining if a man needs a biopsy or further treatment, especially when the PSA rise is showing a steep slope.
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Who Should Have Regular Screening Tests For High Psa
The PSA test was first developed to observe prostate changes in men who had a history of prostate cancer. Then it became more widely used in the general population as a way to detect and prevent prostate cancer before symptoms developed. But routine screening can find prostate cancers that grow slowly and do not need treatment. Talk to your healthcare provider to see if you should have regular PSA tests.
Are There Any New Developments In The Treatment Of Prostate Cancer
Doctors often successfully treat prostate cancer. Sometimes, however, the disease returns . An FDA-approved radiotracer for PET/CT called Axumin® helps detect and locate cancer that recurs following radiation therapy or surgery.
Conventional imaging, such as MRI or ultrasound, cannot locate recurring prostate cancer when it is small. PET/CT with Axumin® can detect recurring cancer when PSA levels are low and when the cancer is small.
Identifying the exact location and extent of the disease at an early state is vital. It allows doctors to specifically target the cancer and limit exposure to healthy tissues.
Prostate-specific membrane antigen is a protein that helps develop prostate cancer. A PSMA scan uses PET imaging and a radiotracer to locate recurrent cancer. Doctors are studying Lutetium-177 PSMA therapy in clinical trials for use in treating prostate cancer. Neither of these procedures has FDA approval yet. For more information about the clinical trials, visit .
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It’s Important To Know Your Free Psa Level
The PSA molecule circulates throughout the body in two formseither bound to other proteins or unbound. The free PSA measures the unbound molecule and is often used by urologists as another helpful indicator for prostate cancer. The lower the percent of free PSA, the higher the risk of having prostate cancer. Patients with free PSA of less than 10 percent can have up to a 56 percent risk of harboring a focus of cancer in their prostates.
Comparing Free And Total Psa
Comparing the results of total and free PSA tests can give doctors an idea of how likely it is that a person has prostate cancer.
Free PSA ranges can vary, but generally, a higher ratio of free PSA to total PSA indicates a lower risk of prostate cancer. On the other hand, a low ratio of free PSA to total PSA indicates a higher risk of having prostate cancer.
However, PSA tests alone will not confirm a diagnosis, as other factors can affect PSA levels. A digital rectal exam and prostate biopsy may also be necessary.
PSA kinetics can affect PSA levels.
PSA kinetics reflect how levels change over time, as can happen when a person has or is undergoing treatment for prostate cancer. The factors involved are PSA velocity and doubling time.
PSA velocity measures how rapidly levels are rising, and it can indicate that prostate cancer is recurring or progressing.
Doubling time is a calculation of how long it takes for PSA levels to double. It can give an idea about how quickly the cancer is progressing. For example, a faster doubling time can suggest a more aggressive cancer.
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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.
What Does A Fluctuating Psa Mean
I am 59 years old and have a fluctuating PSA. In 2005, it was 2.5 ng/ml. A 12-core biopsy was negative. In 2006, my PSA dropped to 0.97 ng/ml. In 2007, it went up to 2.54, and I had another biopsy. All 14 cores were negative for cancer. What does this mean for my prostate health?
Kevin Loughlin, M.D., M.B.A., director of Urologic Research at Brigham and Womens Hospital, responds:
Variations in PSA like yours arent particularly remarkable. In fact, fluctuations in PSA of up to 36% from one day to the next may have nothing to do with cancer. Prostate infections and inflammation may account for some of the variation, as can an enlarged prostate and advancing age. However, the Prostate Cancer Prevention Trial found that prostate cancer might be detected in 23.9% of patients with a PSA of 2.1 to 3 ng/ml, so you dont want to ignore an elevated PSA either.
Before you have a third biopsy, consider having your free PSA measured. A 2008 study of 125 men who had a prostate biopsy showed that the percentage of free PSA in men with a total PSA of 2.5 ng/ml or less could indicate who was most likely to have prostate cancer: 59% of the men with a free PSA of 14% or less had prostate cancer versus just 13% of the men with a free PSA of 28% or more. So the lower your percentage of free PSA, the more you might want to think about having another biopsy.
Originally published November 2009 last reviewed March 16, 2011.
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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.