Why The Test Is Performed
Reasons for a PSA test:
- This test may be done to screen for prostate cancer.
- It is also used to follow people after prostate cancer treatment to see if the cancer has come back.
- If a provider feels the prostate gland is not normal during physical exam.
MORE ABOUT SCREENING FOR PROSTATE CANCER
Measuring the PSA level can increase the chance of finding prostate cancer when it is very early. But there is debate over the value of the PSA test for detecting prostate cancer. No single answer fits all men.
For some men 55 through 69 years old, screening may help reduce the chance of death from prostate cancer. However, for many men, screening and treatment could potentially be harmful instead of beneficial.
Before having the test, talk to your provider about the pros and cons of having a PSA test. Ask about:
- Whether screening decreases your chance of dying from prostate cancer
- Whether there is any harm from prostate cancer screening, such as side-effects from testing or overtreatment of cancer when discovered
Men younger than age 55 have a higher chance of developing prostate cancer and should talk with their provider about PSA screening if they:
- Have a family history of prostate cancer
- Are African American
What Are Other Tests Available For Men At Risk For Prostate Cancer
While traditionally, the options available to men at risk for prostate cancer were limited to PSA blood test and a prostate exam , a number of exciting, innovative options became available to men, and more exciting innovations are expected in the coming years.
PSA is still a useful test but is being supplanted by more informative tests such as 4KScore and PHI .
PHI is a new test that provides an incremental improvement over the PSA test alone when it comes to predicting the risk of prostate cancer. It can be used to reduce the need for unnecessary biopsies in some men.
Read more about the differences between PHI and 4KScore tests.
Factors That Might Affect Psa Levels
One reason its hard to use a set cutoff point with the PSA test when looking for prostate cancer is that a number of factors other than cancer can also affect PSA levels.
Factors that might raise PSA levels include:
- An enlarged prostate: Conditions such as benign prostatic hyperplasia, a non-cancerous enlargement of the prostate that affects many men as they grow older, can raise PSA levels.
- Older age: PSA levels normally go up slowly as you get older, even if you have no prostate abnormality.
- Prostatitis: This is an infection or inflammation of the prostate gland, which can raise PSA levels.
- Ejaculation: Thiscan make the PSA go up for a short time. This is why some doctors suggest that men abstain from ejaculation for a day or two before testing.
- Riding a bicycle: Some studies have suggested that cycling may raise PSA levels for a short time , although not all studies have found this.
- Certain urologic procedures: Some procedures done in a doctors office that affect the prostate, such as a prostate biopsy or cystoscopy, can raise PSA levels for a short time. Some studies have suggested that a digital rectal exam might raise PSA levels slightly, although other studies have not found this. Still, if both a PSA test and a DRE are being done during a doctor visit, some doctors advise having the blood drawn for the PSA before having the DRE, just in case.
- Certain medicines: Taking male hormones like testosterone may cause a rise in PSA.
Some things might lower PSA levels :
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What About Fasting For A Blood Test During Pregnancy
There are several blood tests you may need if youre pregnant. These are designed to assess any potential health concerns that you or your baby might experience during pregnancy or after you give birth. Some of these tests will require you to fast beforehand. Your doctor will advise you how to prepare for each test.
Fasting is usually safe if youre pregnant, provided youre in good health and arent having a high-risk pregnancy. For your overall comfort, your doctor may advise you to drink extra water or to remain indoors, especially if the weather is very hot or humid.
Fasting may increase heartburn in some pregnant women. If you experience uncomfortable or concerning symptoms of any kind while youre waiting to have your blood drawn, let your doctor know immediately.
If youre seeing a doctor other than your obstetrician-gynecologist, make sure they are made aware of your pregnancy before your blood test.
What Do Psa Test Results Mean
- PSA test results are typically reported as nanograms of PSA per milliliter of blood.
- There is no specific normal or abnormal PSA level in the blood.
- In the past, a level of 4.0 ng/mL was considered as the upper limit of normal, but a patient with a normal PSA may still have cancer, and elevated PSA levels can be produced by a normal prostate gland.
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Special Types Of Psa Tests
The PSA level from a screening test is sometimes referred to as total PSA, because it includes the different forms of PSA . If you decide to get a PSA screening test and the result isnt normal, some doctors might consider using different types of PSA tests to help decide if you need a prostate biopsy, although not all doctors agree on how to use these tests. If your PSA test result isnt normal, ask your doctor to discuss your cancer risk and your need for further tests.
Percent-free PSA: PSA occurs in 2 major forms in the blood. One form is attached to blood proteins, while the other circulates free . The percent-free PSA is the ratio of how much PSA circulates free compared to the total PSA level. The percentage of free PSA is lower in men who have prostate cancer than in men who do not.
If your PSA test result is in the borderline range , the percent-free PSA might be used to help decide if you should have a prostate biopsy. A lower percent-free PSA means that your chance of having prostate cancer is higher and you should probably have a biopsy.
Many doctors recommend a prostate biopsy for men whose percent-free PSA is 10% or less, and advise that men consider a biopsy if it is between 10% and 25%. Using these cutoffs detects most cancers and helps some men avoid unnecessary biopsies. This test is widely used, but not all doctors agree that 25% is the best cutoff point to decide on a biopsy, and the cutoff may change depending on the overall PSA level.
Further Tests For Prostate Cancer
If results of the PSA test or the DRE are abnormal, a urologist will likely recommend a biopsy, where small samples of tissue are removed from the prostate and examined.
If cancer is diagnosed, other tests may be used to check the progression of the cancer, including:
- magnetic resonance imaging scan of the prostate – often done before a biopsy
- bone scan – to check whether or not cancer cells have spread to the bones
- computed tomography scan – a specialised x-ray
- pelvic lymph node dissection – a nearby lymph node is removed and examined to check whether or not cancer cells have entered the lymphatic system .
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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:
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 55to 69 . This rating has now been certified official by the task force.
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How To Prepare For The Test
The PSA test is meant to check for prostate cancer by measuring the prostate-specific antigen , a protein often elevated in men with prostate cancer.
But only about 25 percent of men with mild and moderate elevations might actually have prostate cancer. Instead, those high levels could be due to problems such as an enlarged prostate gland , a prostate infection, recent sexual activity, or even a recent long bike ride, says Scott Eggener, M.D., co-director of the prostate cancer program at the University of Chicago.
These steps can make sure that the results are as accurate as possible:
Wait after a urinary tract infection. If youve had a recent UTI or catheter, hold off on the test for a few months. Both can cause prostate inflammation that can artificially elevate PSA levels.
Abstain from sex. Ejaculation up to 72 hours before the test could raise PSA levels a minimal amount.
Have the digital rectal exam after the blood test.As part of a prostate-cancer exam, your doctor may perform this test, which is used to check the size of the prostate gland and to look for abnormal bumps or other changes. But if you do it before having the PSA test, it could cause the release of PSA into the bloodstream and possibly lead to a false positive result.
Who Performs Psa Testing
A PSA test requires a blood sample that is drawn in a lab. Your primary care provider or a may order the test. You do not need to fast before the PSA blood draw, but you may want to abstain from having sex or ejaculating for a couple of days beforehand. Some studies have correlated ejaculation with a temporary rise in PSA levels.
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What Abnormal Results Mean
A high PSA level has been linked to an increased chance of having prostate cancer.
PSA testing is an important tool for detecting prostate cancer, but it is not foolproof. Other conditions can cause a rise in PSA, including:
- A larger prostate
- Recent tests on your bladder or prostate
- Catheter tube recently placed into your bladder to drain urine
- Recent intercourse or ejaculation
Your provider will consider the following things when deciding on the next step:
- Your age
- If you had a PSA test in the past and how much and how fast your PSA level has changed
- If a prostate lump was found during your exam
- Other symptoms you may have
- Other risk factors for prostate cancer, such as ethnicity and family history
Men at high risk may need to have more tests. These may include:
- Repeating your PSA test, most often sometime within 3 months. You may receive treatment for a prostate infection first.
- A prostate biopsy will be done if the first PSA level is high, or if the level keeps rising when the PSA is measured again.
- A follow-up test called a free PSA . This measures the percentage of PSA in your blood that is not bound to other proteins. The lower the level of this test, the more likely it is that prostate cancer is present.
Other tests may also be done. The exact role of these tests in deciding on treatment is unclear.
- A urine test called PCA-3.
- An MRI of the prostate may help identify cancer in an area of the prostate that is hard to reach during a biopsy.
Who Can Have The Psa Test
Although there is no screening programme, if you are aged over 50 you can ask your GP for the PSA test. Or you may be offered one as part of a general health check.
Before you have the test, your GP or nurse will talk through the benefits and disadvantages of having your PSA checked. If you are aged under 50 but at higher risk of prostate cancer, you can talk to your GP about having the PSA test.
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If You Are Transgender
If you are a trans man you do not have a prostate and do not need a PSA test.
Trans women and non-binary people assigned male at birth still have a prostate gland, whether they have had genital gender-affirming surgery or not. This means they may still get prostate cancer, although there is not enough evidence to know how common this is.
If you are a trans woman or non-binary person assigned male at birth and would like to have the PSA test, talk to your GP.
You may worry about talking to your doctor or practice nurse about this, but they are used to talking about many different needs. If you find it difficult to start the conversation, you could try showing them this information. You should talk about any worrying symptoms or concerns with your GP or nurse.
Prostate cancer UK have detailed information about trans women and prostate cancer.
The LGBT Foundation can also give you confidential advice and support. You can also talk to one of our cancer support specialists.
What Is The Chance Of A Diagnosis Of Prostate Cancer
Around 17,000 new cases of prostate cancer are diagnosed each year in Australia. It affects mostly men in older age groups and is rare in men under 50 years of age.
The chance of developing prostate cancer is significantly higher in men who have a close relative with prostate cancer the risks are higher if the relative was diagnosed before the age of 60.
If you have a family history of prostate cancer, talk to your doctor.
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How To Get Tested
Samples used for PSA testing are collected by trained health care professionals at hospitals, labs, and other medical settings. Before getting tested, its best to talk to your doctor about the risks and benefits of PSA testing. You may be able to schedule your own PSA test at a clinic or laboratory without a doctors order. However, you will need a doctor to interpret the results of your test and recommend next steps.
Why Do Some Blood Tests Require Fasting
Certain blood tests require you to fast for 8-12 hours. The reason for asking you to fast is because when eat or drink beverages, certain nutrients, substances or vitamins enter into the bloodstream and can be responsible for giving a wrong result. Fasting before these advised blood tests ensures more accurate results.
Certain blood tests require you to not even drink water. Otherwise, drinking normal water will keep you hydrated and prevent your veins from collapsing, so drawing blood becomes easier since your veins are visible.
Avoid food, alcohol, soda or aerated drinks, tea, coffee, chewing gums and even exercising while fasting.
You need to consult your physician if you can take your regular dose of medications during fasting or adjust the dose timings for the purpose of fasting. This is because certain drugs can alter test results.
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Other Factors That Influence Psa Levels
The PSA blood test alone cannot diagnose prostate cancer. It is possible, although rare, to have prostate cancer without raised PSA levels in the blood. A higher-than-normal PSA level doesnt automatically indicate prostate cancer either. A high PSA level is due to cancer in around one in three cases.
PSA levels can be raised by other factors, including:
- , also known as benign prostatic enlargement .
For this reason, the PSA blood test isnt used in isolation when checking for prostate cancer.
What Is A Normal Psa Level
Your doctor may talk about a normal PSA level. Unlike some other blood tests, there is not one normal PSA level for everyone. The PSA level naturally gets higher as you get older and varies depending on the size of your prostate. The size of the prostate is different for each individual and the prostate gets bigger with age.
Your doctor will tell you what they think the normal level of PSA should be for you. They generally use these levels:
- A PSA level of up to 3 nanograms per millilitre of blood if you are in your 50s.
- A PSA level of up to 4ng/ml if you are in your 60s.
- A PSA level of up to 5ng/ml if you are in your 70s.
- There are no PSA level limits if you are aged 80 and over.
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What Research Has Been Done To Study Prostate Cancer Screening
Several randomized clinical trials of prostate cancer screening have been carried out. One of the largest is the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial, which NCI conducted to determine whether certain screening tests can help reduce the numbers of deaths from several common cancers. In the prostate portion of the trial, the PSA test and DRE were evaluated for their ability to decrease a mans chances of dying from prostate cancer.
The PLCO investigators found that men who underwent annual prostate cancer screening had a higher incidence of prostate cancer than men in the control group but the same rate of deaths from the disease . Overall, the results suggest that many men were treated for prostate cancers that would not have been detected in their lifetime without screening. Consequently, these men were exposed unnecessarily to the potential harms of treatment.
A second large trial, the European Randomized Study of Screening for Prostate Cancer , compared prostate cancer deaths in men randomly assigned to PSA-based screening or no screening. As in the PLCO, men in ERSPC who were screened for prostate cancer had a higher incidence of the disease than control men. In contrast to the PLCO, however, men who were screened had a lower rate of death from prostate cancer .