What Is The Psa Test
Prostate-specific antigen, or PSA, is a protein produced by normal, as well as malignant, cells of the prostate gland. The PSA test measures the level of PSA in a mans blood. For this test, a blood sample is sent to a laboratory for analysis. The results are usually reported as nanograms of PSA per milliliter of blood.
The blood level of PSA is often elevated in men with prostate cancer, and the PSA test was originally approved by the US Food and Drug Administration in 1986 to monitor the progression of prostate cancer in men who had already been diagnosed with the disease. In 1994, FDA approved the use of the PSA test in conjunction with a digital rectal exam to test asymptomatic men for prostate cancer. Men who report prostate symptoms often undergo PSA testing to help doctors determine the nature of the problem.
In addition to prostate cancer, a number of benign conditions can cause a mans PSA level to rise. The most frequent benign prostate conditions that cause an elevation in PSA level are prostatitis and benign prostatic hyperplasia . There is no evidence that prostatitis or BPH leads to prostate cancer, but it is possible for a man to have one or both of these conditions and to develop prostate cancer as well.
Risk Factors That Can Affect Psa Levels
There are many other risk factors that can raise PSA levels, including:
- Enlarged prostate, also called benign prostatic hyperplasia , which is common in older men
- Older age, which naturally results in higher PSA levels
- Ejaculation within 1 to 2 days of the blood draw
- Riding a bicycle, which may raise levels for a short time after
- Certain urologic procedures, like prostate cystoscopy
- Certain medicines, such as male hormones
Factors that may specifically lower PSA levelseven among men with prostate cancerinclude:
- 5-alpha reductase inhibitors, which treat BPH or other urinary symptoms
- Some medications, such as aspirin or statins
- Herbal mixtures or supplements, which could skew the results
In certain cases, a factor that lowers PSA does lower the risk of developing prostate cancer. In others, however, lowering the PSA level has no effect and could be harmful, as prostate cancer could go undetected if the level drops too far.
As Screening Falls Will More Men Die From Prostate Cancer
As an oncologist who cares for cancer patients, I have no desire to trivialize cancer, and I know that prostate cancer is far worse than losing a tooth. So I use the analogy reluctantly, hesitantly, and only because I think it helps us think more clearly about screening. There is a big difference between the phrase reduces the risk of dying from prostate cancer and the phrase reduces the risk of dying. Men must understand the difference to make an informed choice.
The USPSTFs C recommendation for PSA screening means the decision should be individualized, something I support. Prostate cancer screening may be OK for some men those who are more tolerant of risk and uncertainty but it is surely not right for others. As for African-American men, or men with a family history, the USPSTF provides caution that there is no good evidence to show greater benefit from the test, and it is possible the harms are greater in these groups. PSA screening is OK only if doctors are honest about what the test can and cannot do.
PSA screening has real harms. It reduces the risk of losing one of your 32 teeth by 20 percent, but we have no idea what it does for the other 31 . For some men, the benefit and uncertainty might be worth it. But for others it may seem like so much for so little.
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When Should You Get Your First Prostate Exam
In 30 seconds
The answer to when you should get your first prostate exam depends on your medical history and genetic predisposition.
Your prostate grows throughout your life, which means youre more likely to experience problems as you age.
Prostate cancer is often symptomless, but if you feel unwell, consult a doctor: identifying whats wrong will help you get the right treatment.
First off, what is a prostate? This is a walnut-sized gland located below the bladder, near your rectum. It secretes fluid that becomes part of semen, helping to carry sperm. has two main growth phases first in puberty, and the second from around age 25, continuing at a rate of 14% increase each decade.
Sometimes the prostate can become enlarged enough to cause problems or as a result of related health issues. The most common prostate problems are:
- Prostatitis: when your prostate becomes inflamed as a result of an infection
- Benign prostatic hyperplasia : an overly enlarged prostate
- Prostate cancer
The recommended age for a prostate exam takes into account the fact the prostate grows throughout adulthood, but BPH, prostatitis and prostate cancer can affect you at any age. Below, well outline what to look out for, when to get a prostate exam, and what that entails.
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When To Startand Stopscreening
The doctors and researchers who recommend screening argue that cases of prostate cancer found very early can be cured more quickly, with less chance of relapse or spread. Those who recommend against routine screening point to the slow-moving nature of prostate cancer and the side effects of surgical and medical treatment, which can be considerable.
The introduction of PSA screening in the US led to an initial increase in the number of prostate cancer cases diagnosed each year, even though many of these new cases were non-aggressive or low-risk prostate cancer. The issue was not that screening was harmful, it was that many of these low-risk cancers did not necessarily need immediate treatment. It seems strange to say that a patient might be better off leaving cancer untreated, but in some cases, it can be true. For a few years, the United States Preventative Services Task Force recommended against PSA screening. We are now seeing more cases of advanced prostate cancer diagnosed in recent years. This may be a long-tail effect of that USPSTF recommendation. It has now been changed to note that for men aged 55 to 69 years, the decision to undergo PSA screening is an individual one and should be discussed with your doctor. USPSTF continues to recommend against screening for men aged 70 and over.
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Avoid Having Sex Before A Psa Test To Avoid False Results
Dr. David Samadi
You’ve made you’re appointment with the urologist for your annual PSA test. Whether a man looks forward to this doctor’s visit or not, it is a necessary part of screening for any issues that may be affecting the prostate gland.
There’s just one thing to remember no sex for 48 hours before the test.
A PSA, or prostate specific antigen test, is a simple blood test that measures the amount of prostate specific antigen present in the blood.
PSA is a protein that men have in their blood which is released by the prostate gland. In healthy males, the amount of PSA men have in their blood is low generally less than 4.0 ng/mL.
However, when men age, their prostate can experience physiological or pathological changes which cause the PSA to rise.
The prostate is a walnut-sized gland located between the bladder and the penis. The prostate is just in front of the rectum. The urethra runs through the center of the prostate, from the bladder to the penis, letting urine flow out of the body.
However, the PSA test is far from foolproof. Values of the PSA test can vary depending on when the test is administered. A man can help get the most accurate score by following certain suggestions before he has the PSA test done.
The reason for refraining from sexual activity right before getting a PSA test is that semen released during sex can cause PSA levels to rise temporarily, which may influence or affect the test results.
How The Prostate Changes As You Age
Because the prostate gland tends to grow larger with age, it may squeeze the urethra and cause problems in passing urine. Sometimes men in their 30s and 40s may begin to have these urinary symptoms and need medical attention. For others, symptoms aren’t noticed until much later in life. An infection or a tumor can also make the prostate larger. Be sure to tell your doctor if you have any of the urinary symptoms listed below.
Tell your doctor if you have these urinary symptoms:
- Are passing urine more during the day
- Have an urgent need to pass urine
- Have less urine flow
- Feel burning when you pass urine
- Need to get up many times during the night to pass urine
Growing older raises your risk of prostate problems. The three most common prostate problems are inflammation , enlarged prostate , and prostate cancer.
One change does not lead to another. For example, having prostatitis or an enlarged prostate does not increase your risk of prostate cancer. It is also possible for you to have more than one condition at the same time.
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When To Get Tested
You’ll have your first follow-up PSA test 1 to 3 months after your surgery. You need to wait because some PSA stays in your blood after your prostate is removed. If you wait until it has cleared, that will make an accurate result more likely.
Then you’ll have repeat PSA tests once every 6 to 12 months for about 5 years. If your doctor says chances are high that your cancer will come back, you may need them once every 3 months. If your PSA levels stay normal, you can switch to once-a-year PSA tests. Ask your doctor how often you’ll need a test.
Does My Psa Level Determine Whether I Have Prostate Cancer
Your provider looks at two factors related to your PSA:
- Your PSA level: A higher level means a higher risk of prostate cancer.
- A continuous rise: PSA levels that continue to rise after two or more tests may mean you have cancer.
But the PSA level alone doesnt determine if you have cancer or not. Two men can even have the same PSA levels but different risks of prostate cancer. And a high PSA level may reflect prostate problems that arent cancer.
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What Causes An Elevated Psa Level
Prostate cancer is the main cause of an elevated PSA level. But PSA levels increase with age and can reflect different prostate conditions. Other factors that may raise a persons PSA level include:
- Prostate enlargement and inflammation .
- Urinary tract infection.
- Urinary catheter placement.
Your healthcare provider will also consider whether your medications affect PSA levels. For example, 5-alpha reductase blockers treat enlarged prostates and will lower PSA levels.
Diagnosis And Treatment Of Female Prostate Cancer
Due to the challenges of diagnosis, the signs of female prostate cancer are often mistakenly attributed to underlying conditions in the urinary tract or reproductive system.
Unfortunately, the initial stage of cancer in the Skene glands is asymptomatic. Once your menstrual cycle is disrupted, sex becomes painful, or youre always feeling sick, the disease is quite advanced.
Treatment of female prostate cancer follows a similar strategy to that of other reproductive cancers. If chemical and radiation therapies arent successful in eradicating tumors, then surgery will likely be required to excise them. Frequently, the surgical removal of larger tumors and the chemical destruction of smaller tumors happen simultaneously.
In more severe cases, the organ or organs containing the cancerous growths must be removed as well. This could include your Skene glands, uterus, ovaries, or your entire reproductive system . Whenever cancer in the Skene glands goes undiagnosed and untreated, bladder cancer may follow.
Medical experts have theorized that female prostate cancer could be linked to a history of sexually transmitted infections. The Skene glands, like the male prostate, act as guardians against infections that travel throughout the reproductive system.
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What Is A Prostatectomy
A prostatectomy is a surgical procedure for the partial or complete removalof the prostate. It may be performed to treatprostate cancerorbenign prostatic hyperplasia.
A common surgical approach to prostatectomy includes making a surgicalincision and removing the prostate gland . This may beaccomplished with either of two methods, the retropubic or suprapubicincision , or a perineum incision .
Prior to having a prostatectomy, it’s often necessary to have aprostate biopsy. Please see this procedure for additional information.
Prostate Cancer: Treatment Advances You Should Know About
Prostate cancer treatment has entered the robotics age. Using advancedrobotic technology, Johns Hopkins surgeons can see the prostate in 3-D,magnifying everything 10 times. Johns Hopkins urologist Mohamad Allaf, M.D., explains what this means for patients, including fewer side effects.
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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The New Recommendations For Prostate Cancer Screenings Are A Bad Deal
Vinay PrasadApril 11, 2017
That popping sound you may have heard on Tuesday was made by urologists opening the champagne bottles they had chilled in anticipation of the United States Preventive Services Task Force upgrading its recommendation about PSA screening for prostate cancer from a D to a C .
Much like a teacher changing a dissatisfied students grade from a D to a C and only after much complaining the new guidelines should hardly be construed as a ringing endorsement. PSA screening remains a difficult decision for healthy men and their doctors.
The test measures the amount of a protein called prostate-specific antigen in the bloodstream. A PSA level above 4.0 nanograms per milliliter of blood has been used as the traditional cutoff to suggest the possibility of prostate cancer . Screening means testing healthy individuals to see if they might have hidden cancer.
The data on which the USPSTF based its new recommendation for PSA screening is similar to the data it used for its prior recommendation in 2012. No study has shown that the test saves lives or improves the quality of life. It does not reduce mortality or extend survival in any randomized trial to date, nor when all studies are combined together. Let me say that again: There is no proof that PSA screening extends your life, improves the years you have, or reduces your risk of dying.
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 it’s 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 can’t 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 Is Prostate Intraepithelial Neoplasia Or Atypical Or Suspicious Cells On Biopsy
In about 10% of prostate needle biopsy reports, the pathologist will tell us that the final diagnosis is neither benign nor malignant. They describe this condition as
- High Grade Intraepithelial Neoplasia
- A premalignant condition
- Biopsy should be repeated soon
- 25% risk of cancer on repeat biopsy
- Low Grade Intraepithelial Neoplasia
- Repeat biopsy is not indicated unless there is a rise in PSA
- Atypia
Immediate Radiation When Psa Levels Spike After Prostate Cancer Surgery Helps Reduce Risk Of Recurrence
- By Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases
Following surgery to remove a cancerous prostate gland, some men experience a biochemical recurrence, meaning that prostate-specific antigen has become detectable in their blood. Since only the prostate releases PSA, removing the gland should drop this protein to undetectable levels in the body. Detecting PSA could signify that prostate cancer cells are lingering, and forming new tumors before they can be seen with modern imaging technology. PSA isnt always reliable for cancer screening, but it is a very sensitive marker of new cancer growth after initial treatment.
Doctors usually treat biochemical recurrence by irradiating the prostate bed, or the area where the gland used to be. Studies have shown that this treatment, which is called salvage radiation, helps to minimize the risk that prostate cancer will return and spread, or metastasize. But when to initiate salvage radiation has been open question, since PSA will also rise if small amounts of benign prostate tissue have been left behind after surgery. Many times, doctors dont know if biochemical recurrence is really cancer, so they wait to see if the PSA levels will rise any further.
In this newer era of ultra-sensitive PSA testing we didnt know if giving salvage radiation at lower levels would make a difference or not, Tendulkar said. Now we know that it does.
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