Do I Need The Psa Test
The PSA test is not recommended for men who dont have symptoms of prostate cancer, as it can lead to unnecessary investigations and treatments that have serious side effects.
If you are at higher risk of developing prostate cancer, or if you have symptoms that may indicate cancer, PSA testing may be of more benefit.
Cancer Council Australia and the Royal Australian College of General Practitioners both recommend against routine screening in men without symptoms. That is because the PSA test is not very accurate for screening men without symptoms. High PSA levels can be due to many things, and cancer is just one of them. And a man with prostate cancer can have a normal PSA level.
As there is a range of risks and potential benefits of PSA testing, talk to your doctor to help make an informed decision.
Noncancerous Prostatic Disease And Urologic Manipulation
The serum PSA level can also be altered by noncancerous prostatic disease and urologic manipulations. Elevation of PSA levels has been demonstrated in acute prostatitis, subclinical or chronic prostatitis, and urinary retention. Nadler et al reported that serum PSA levels higher than 4.0 ng/mL in 148 men with subclinical prostatitis could be attributed to their disease because all these men had negative findings from biopsies repeated on multiple occasions.
No significant change occurs in the PSA level after a digital rectal examination , but a vigorous prostate massage can produce a short-term 2-fold increase. Cystoscopy, urethral catheterization, and transrectal ultrasonography of the prostate do not tend to elevate the PSA level. Needle biopsy of the prostate raises the PSA level by a median of 7.9 ng/mL within 5 minutes after the biopsy, and this level persists for 24 hours.
The time it takes for PSA to return to baseline levels depends on the precipitating event and the half-life . After a biopsy, 2 to 4 weeks may elapse before the PSA returns to its original level. If an infection occurs as a result of the biopsy, the return to baseline levels may take longer. After ejaculation, PSA levels have been reported to return to their original levels within 48 hours, whereas fPSA returns to baseline at 6 hours because of its shorter half-life .
What Causes A Raised Prostate Specific Antigen Level
A raised PSA level may mean you have prostate cancer but about two out of three men with a raised PSA level will not have prostate cancer.
Other conditions may also cause a raised PSA level, including:
- Transurethral resection of the prostate operation. TURP is a prostate operation used if you have benign enlargement of the prostate.
- If you have a tube to help pass urine
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What Does A Psa Test Do
As mentioned above, a PSA test measures the amount of prostate-specific antigen found in a man’s blood. Many factors including prostate cancer can cause someone’s PSA levels to rise. A PSA test is designed as an early detection and monitoring screening tool for prostate cancer.
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What Do The Results Mean
High PSA levels can mean cancer or a noncancerous condition such as a prostate infection, which can be treated with antibiotics. If your PSA levels are higher than normal, your health care provider will probably order more tests, including:
- A rectal exam. For this test, your health care provider will insert a gloved finger into your rectum to feel your prostate.
- A biopsy. This is a minor surgical procedure, where a provider will take a small sample of prostate cells for testing.
If you have questions about your results, talk to your health care provider.
Learn more about laboratory tests, reference ranges, and understanding results.
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What It’s Used For
A PSA test is used mainly as a screening test for cancer of the prostate. In men who have been diagnosed with prostate cancer, PSA is measured to determine if the cancer has returned after surgery. It can also be used to determine whether the cancer is growing or shrinking after treatment with hormones or radiation.;;
The question of whether or not to perform screening tests for prostate cancer remains controversial. PSA testing can be used to detect the earliest stage of prostate cancer, before the disease causes any symptoms. PSA testing may reduce the chance of dying from prostate cancer in some men by detecting cancer at an early age. However, there is currently no clear way to define the men who would definitely benefit from PSA testing.;
On the other hand, more often an elevated PSA level leads to over diagnosis or finds a cancer that would not affect how long a man lives or his quality of life. First, the high PSA level may be caused by some other condition, such as a benign enlarged prostate or an inflamed prostate gland. Second, most prostate cancers diagnosed after PSA screening are localized cancers that have little potential to cause harm.;;
Many older men develop prostate cancer that never spreads and never causes any problems. Most of these harmless cancers would go undetected if screening was not done.;;
A man who decides to undergo screening for prostate cancer might think the following:;;
A man who chooses not to be screened might think this way:;;
What Is Psa Velocity And Psa Doubling Time
Change in PSA levels over time can be used to assess both cancer risk and aggressiveness of the particular tumor. Most urologists use these PSA metrics to help drive patient counseling and care. PSA velocity is defined as the rate of change in PSA over time. PSA doubling time is the time it takes the PSA value to increase by 100% . Although these two measures do not appear to be useful in determining who is at risk for prostate cancer, they do appear to be useful in monitoring some individuals with prostate cancer.
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Genetic Testing For Some Men With Prostate Cancer
Some doctors now recommend that some men with prostate cancer be tested to look for certain inherited gene changes. This includes men in whom a family cancer syndrome is suspected, as well as men with prostate cancer that has certain high-risk features or that has spread to other parts of the body. Talk to your doctor about the possible pros, cons, and limitations of such testing.;
What Does Psa Mean
PSA, or prostate-specific antigen, is a protein produced by the prostate and found mostly in semen, with very small amounts released into the bloodstream. When theres a problem with the prostatesuch as the development and growth of prostate cancermore PSA is released. Sometimes, a mans prostate releases slightly high PSA for other reasons. Rising PSA eventually reaches a level where it can be easily detected by a blood test.
For more information on rising PSA, download or order your free copy of the Prostate Cancer Patient Guide.
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What Is Being Tested
The PSA blood test can help detect or monitor prostate cancer.
The prostate is a small gland at the base of the bladder in men. It is part of the male reproductive system, and produces the protein PSA. PSA is released into semen but some also enters the bloodstream.
High levels of PSA can be caused by prostate cancer, but they are usually caused by other conditions.
If you have prostate symptoms, you might be asked to have a PSA test. It might help point your doctor in certain directions, but it doesnt diagnose prostate cancer. The only way to do that is with a biopsy.
If you have been diagnosed with prostate cancer, the PSA test can help monitor your condition. When the levels go up, this suggests the cancer is growing. When they go down, this suggests it might be shrinking.
The Test Is Often Not Needed
Most men with high PSAs dont have prostate cancer. Their high PSAs might be due to:
- An enlarged prostate gland.
- Recent sexual activity.
- A recent, long bike ride.
Up to 25% of men with high PSAs may have prostate cancer, depending on age and PSA level. But most of these cancers do not cause problems. It is common for older men to have some cancer cells in their prostate glands. These cancers are usually slow to grow. They are not likely to spread beyond the prostate. They usually dont cause symptoms, or death.
Studies show that routine PSA tests of 1,000 men ages 55 to 69 prevent one prostate cancer death. But the PSA also has risks.
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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 .
Will Medicare Cover Prostate Specific Antigen Tests
Medicare Advantage policies must cover a minimum of what Medicare will cover. What exactly does this mean for you? While youll get a routine PSA test at no charge to you, there may be extra fees.
If your doctors decide he wants to run follow-up tests, you wont need to pay for these. Instead, your Medicare Advantage policy will pay for screenings. Remember that Medicare advantage plans run within a network. Your provider and the facility you get treatment in will have to be in your network. If not, youll undoubtedly have high medical bills to pay.
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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.
Forensic Identification Of Semen
PSA was first identified by researchers attempting to find a substance in seminal fluid that would aid in the investigation of rape cases. PSA is now used to indicate the presence of semen in forensic serology. The semen of adult males has PSA levels far in excess of those found in other tissues; therefore, a high level of PSA found in a sample is an indicator that semen may be present. Because PSA is a biomarker that is expressed independently of spermatozoa, it remains useful in identifying semen from vasectomized and azoospermic males.
PSA can also be found at low levels in other body fluids, such as urine and breast milk, thus setting a high minimum threshold of interpretation to rule out false positive results and conclusively state that semen is present. While traditional tests such as crossover electrophoresis have a sufficiently low sensitivity to detect only seminal PSA, newer diagnostics tests developed from clinical prostate cancer screening methods have lowered the threshold of detection down to 4 ng/mL. This level of antigen has been shown to be present in the peripheral blood of males with prostate cancer, and rarely in female urine samples and breast milk.
No studies have been performed to assess the PSA levels in the tissues and secretions of pre-pubescent children. Therefore, the presence of PSA from a high sensitivity test cannot conclusively identify the presence of semen, so care must be taken with the interpretation of such results.
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Psa In Other Biologic Fluids And Tissues
Concentration of PSA in human body fluids
| Fluid | |
|---|---|
| female serum | 0.01 – 0.53 |
It is now clear that the term prostate-specific antigen is a misnomer: it is an antigen but is not specific to the prostate. Although present in large amounts in prostatic tissue and semen, it has been detected in other body fluids and tissues.
In women, PSA is found in female ejaculate at concentrations roughly equal to that found in male semen. Other than semen and female ejaculate, the greatest concentrations of PSA in biological fluids are detected in breast milk and amniotic fluid. Low concentrations of PSA have been identified in the urethral glands, endometrium, normal breast tissue and salivary gland tissue. PSA also is found in the serum of women with breast, lung, or uterine cancer and in some patients with renal cancer.
Tissue samples can be stained for the presence of PSA in order to determine the origin of malignant cells that have metastasized.
Prostate Cancer Screening Ages 40 To 54
The PSA test is a blood test that measures how much of a particular protein is in your blood. Its been the standardfor prostate cancer screening for 30 years.
Your doctor will consider many factors before suggesting when to startprostate cancer screening. But hell probably start by recommending the PSAtest.
While the general guidelines recommend starting at age 55, you may need PSAscreening between the ages of 40 and 54 if you:
- Have at least one first-degree relative who has had prostate cancer
- Have at least two extended family members who have had prostate cancer
- Are African-American, an ethnicity that has a higher risk of developing more aggressive cancers
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Use In Men Already Diagnosed With Prostate Cancer
The PSA test can also be useful if you have already been diagnosed with prostate cancer.
- In men just diagnosed with prostate cancer, the PSA level can be used together with physical exam results and tumor grade to help decide if other tests are needed.
- The PSA level is used to help determine the stage of your cancer. This can affect your treatment options, since some treatments are not likely to be helpful if the cancer has spread to other parts of the body.
- PSA tests are often an important part of determining how well treatment is working, as well as in watching for a possible recurrence of the cancer after treatment .
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.
References
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Does Medicare Cover Prostate Cancer Screenings
Part B will cover both PSA tests to check for cancer, as well as digital rectal examinations. When you decide to move forward with a digital rectal exam, youll pay 20%. Youll then pay the Part B deductible and any applicable copays. If you have a PSA test, you wont be liable for costs. But youll need to be sure your doctor accepts Medicare, or you could have to pay the full costs.
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:
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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.