Understanding Psa Test Results
28 August 2020
Medicare data suggests that up to 21% of Australian men aged 4574 choose to have a Prostate Specific Antigen Test each year, and about 19% of men aged over 74 also undergo testing.
While PSA testing helps to identify men with an increased risk of undiagnosed prostate cancer, and can help to diagnose prostate cancers earlier, it can also produce false positive results, and in some men picks up cancers that are so slow growing that they do not affect a mans life expectancy, a finding known as over-diagnosis. False positives and over-diagnosis can cause harm, which means men and their doctors need to carefully consider the pros and cons of testing, based on each mans age and other individual characteristics.
For men with no family history of prostate cancer and no symptoms, the current guidelines recommend that men who decide to undergo regular testing should be offered PSA testing every two years from age 50 to 69.
For men with a family history of prostate cancer who decide to undergo testing, the guidelines recommend men be offered PSA testing every two years from age 40/45 to 69, with the starting age depending on the strength of their family history.
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What is PSA?
Prostate Specific Antigen is a protein made in the prostate gland. The prostate is a walnut-sized gland that sits below the bladder in front of the rectum. It surrounds the urethra, the passage in the penis through which urine and semen pass.
The Role Of Psa In Choosing The Best Treatment
If you have received a diagnosis of prostate cancer, your PSA levels can be used along with the results of other tests and physical exams and your tumors Gleason score to help determine which tests are needed for further evaluation and to decide on the best treatment plan. After treatment has begun, your PSA and other tests will be used to determine how well the treatment is working: The more successful the therapy, the lower the PSA.
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Pros And Cons Of The Psa Test
- it may reassure you if the test result is normal
- it can find early signs of cancer, meaning you can get treated early
- PSA testing may reduce your risk of dying if you do have cancer
- it can miss cancer and provide false reassurance
- it may lead to unnecessary worry and medical tests when there’s no cancer
- it cannot tell the difference between slow-growing and fast-growing cancers
- it may make you worry by finding a slow-growing cancer that may never cause any problems
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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 :
What Is The Psa Test And Who Needs To Take It
The PSA test is a blood test to measure the levels of PSA in the bloodstream. PSA stands for prostate-specific antigen and is a protein that has a role in reproduction the PSA protein helps sperm to become mobile after ejaculation so that fertilisation can take place. PSA is made by the prostate gland, which is situated between the bladder and the base of the penis, and its secretions contribute to the volume of fluid that is ejaculated. When the prostate gland is diseased or has been operated on, higher levels of PSA might enter the bloodstream. Doctors have discovered that higher levels of PSA in the bloodstream can sometimes indicate the presence of prostate cancer.
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What Do The Numbers Mean
PSA levels are measured as a number of nanograms in each milliliter of fluid tested. This is written as ng/mL.
- PSA level 2.5 ng/mL or lower: This is a normal PSA level for men under age 60, but in some cases, prostate cancer may still be present.
- PSA level between 2.5 and 4 ng/mL: This is a normal PSA level for most men.
- PSA level between 4 and 10 ng/mL: This indicates that prostate cancer might be present. At this level, there is about a 25% chance that you have prostate cancer.
- PSA level 10 ng/mL or above: There is a 50 percent chance that prostate cancer is present. The higher the PSA rises above 10 ng/mL, the greater the chance that you have prostate cancer.
Your doctor may also monitor your PSA velocity, or doubling time, which means recording your baseline PSA the level at your very first PSA test and seeing how fast the PSA level increases over time. Rapid increases in PSA readings can suggest cancer. If your PSA is slightly high, you and your doctor may decide to keep an eye on your levels on a regular basis to look for any change in the PSA velocity.
How Are Researchers Trying To Improve The Psa Test
Scientists are investigating ways to improve the PSA test to give doctors the ability to better distinguish cancerous from benign conditions and slow-growing cancers from fast-growing, potentially lethal cancers. None has been proven to decrease the risk of death from prostate cancer. Some of the methods being studied include:
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Risk Factors For Prostate Cancer
Some risk factors have been linked to prostate cancer. A risk factor is something that can raise your chance of developing a disease. Having one or more risk factors doesn’t mean that you will get prostate cancer. It just means that your risk of the disease is greater.
- Age. Men who are 50 or older have a higher risk of prostate cancer.
- Race. African-American men have the highest risk of prostate cancerâthe disease tends to start at younger ages and grows faster than in men of other races. After African-American men, prostate cancer is most common among white men, followed by Hispanic and Native American men. Asian-American men have the lowest rates of prostate cancer.
- Family history. Men whose fathers or brothers have had prostate cancer have a 2 to 3 times higher risk of prostate cancer than men who do not have a family history of the disease. A man who has 3 immediate family members with prostate cancer has about 10 times the risk of a man who does not have a family history of prostate cancer. The younger a man’s relatives are when they have prostate cancer, the greater his risk for developing the disease. Prostate cancer risk also appears to be slightly higher for men from families with a history of breast cancer.
- Diet. The risk of prostate cancer may be higher for men who eat high-fat diets.
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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What Do The Experts Recommend
Experts have set up guidelines to advise men about prostate cancer screening.
These guidelines are based on a man’s age and his risk of getting prostate cancer. Some things that put men at a higher risk include:
- Being African American.
- Having a father or brother who had prostate cancer before age 65.
- Knowing that a gene change, such as BRCA, runs in your family.
Most experts agree on the following age-related recommendations.
Age 40 and under:
Men aren’t advised to get the PSA test, since testing in this age group causes more harm than good.
Age 40 to 54 years:
- Men at average risk aren’t advised to get the PSA test, since testing in this age group causes more harm than good.
- Around age 45, men at higher risk may want to talk with their doctors about the pros and cons of testing before deciding whether to get the PSA test.
Age 55 to 69 years:
Men who are thinking about getting the PSA test are advised to talk with their doctors about the pros and cons of testing before deciding whether to get the PSA test.
Ages 70 and older:
Most men aren’t advised to get the PSA test, since testing in this age group causes more harm than good.
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 as imawaretm 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.
âAt-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 processâ
Dr. Diamandisâ Lunenfeld-Tanenbaum Research Institute, Sinai Health System
Have not had a biopsy yet, the Oncologist â actually as I understand the Head of the Department has agreed to see me on 4 August as it is very apparent with the bone scans and PSA levels and DRE that this is prostrate cancer and prostrate cancer in the bone.
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What Is The Test To See If I Have Elevated Psa
Healthcare providers use a blood test to measure PSA levels.
You may have a digital rectal exam together with a PSA test to check for signs of prostate cancer. During a DRE, your provider inserts a gloved finger into the rectum to check for bumps or other irregularities.
Depending on the results of your initial test, your provider may want you to repeat the test. PSA levels can change. A second test gives your provider more details about your prostate health.
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.
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Individualized Prostate Cancer Screening
Coltman says that men and their doctors can no longer rely on PSA levels alone when deciding whether to have a prostate biopsy.
“The situation now is that the individual man with his individual urologist will have to assess what the person feels are his risk factors,” he says. “In consultation with his doctor, the individual man must come to grips with the question of whether or not a biopsy should be done. It will become a more personalized interaction.”
Who’s at high risk? Men with the following factors have the highest risk of prostate cancer:
- Age. A man’s risk of prostate cancer increases with age.
- Race. “African American men have the highest incidence of prostate cancer and the highest death rate from prostate cancer of any men in the world,” Coltman says.
- Family history. A man’s risk increases if his brother or father has had prostate cancer.
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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An Elevated Psa Is Not A Diagnosis For Cancer
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An elevated PSA is not a diagnosis for prostate cancer, nor does it always lead to a biopsy.
The PSA blood test is often the first step in screening for prostate cancer. It is included in a two-part screening process that also includes the digital rectal exam .
The PSA level may differ depending on many factors such as age, race and family history of prostate diseases such as prostatitis. An elevated PSA doesnt always mean Prostate Cancer, thats why it is critical for every patient to receive an individualized approach, said Dr. Samadi, Chairman of Urology and Chief of Robotic Surgery at Lenox Hill Hospital.
Since the PSA is not prostate-cancer specific, abnormal results are further, or an elevated PSA is not a diagnosis for cancer. Things like evaluating a patient, knowing their medical and family history, following a PSA trend, as well as the velocity at which PSA changes can help a physician make an informed decision about what an elevated PSA might mean. Because PSA tests are not necessarily straightforward, simple or easy diagnostic tools, knowing the risk factors and tracking the changes in PSA can help you and your physician interpret a PSA properly.
An elevated PSA is not a diagnosis for prostate cancer, nor does it always lead to a biopsy. It may indicate other conditions such as Benign Prostatic Hyperplasia , Prostatitis or a urinary tract infection.
So besides prostate cancer, what else can cause a PSA to rise, fluctuate or become elevated?
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 Is Biopsy And How Is It Done
Once we find an abnormal area in the prostate on ultrasound, we need to remove small pieces of prostate for pathological examination called prostate biopsy.
While the ultrasound probe is in the rectum, a biopsy needle is inserted through the probe and under the ultrasound guidance, biopsies are performed. Six to twelve tine pieces of tissue are taken from the prostate. These pieces of prostate tissue are then sent to a Laboratory where a pathologist who is an expert in prostate cancer examined these pieces under the microscope to determine.
- Whether cancer is present
- Evaluate microscopic features of cancer
- Whether suspicious lesions are present
- Or the biopsy is negative for cancer
- Whether inflammation is present