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Prostate Specific Antigen Psa Levels

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What Happens If My Biopsies Comes Back Negative

The Prostate Specific Antigen (PSA) Test

Just because your biopsies are negative, does not mean that you do not have cancer in your prostate. You need to be seen on a regular basis for digital rectal examination and PSA testing. If there is significant change in your PSA, we may suggest repeat biopsies. The average risk of finding cancer in a repeat biopsy following a benign diagnosis is about 18%.

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

Average Psa Test Doubling Time

Another red flag. This calculation denotes the time it takes your PSA values to double.

Therefore it may signify the aggressiveness of any prostate abnormalities, whether it’s an enlarged prostate, prostatitis, or prostate cancer.

If your average PSA readings double in less than three years your doctor will most likely order a biopsy, to look in to the problem further and discuss possible prostate cancer treatment options.

Also Check: What Size Prostate Is Considered Enlarged

Normal Psa Levels By Age Chart

What is a normal PSA level by age? We mentioned earlier in this article that PSA levels increase with age due to age related growth of the prostate gland. A doctor will therefore take into account an age-adjusted PSA level when discussing your prostate health:

Age Range
70 0 to 6.5

Although there are normal PSA levels by age range, it is still important to screen routinely to ensure these normal levels are not rising.

What Is It Used For

Patient Guide to Prostate Specific Antigen (PSA)

A PSA test is used to screen for prostate cancer. Cancer screening means looking for signs of cancer before it causes symptoms. But screening tests can’t diagnose cancer. If a screening test finds signs of cancer, you’ll need other tests to find out if you have cancer and how serious it may be.

Most types of prostate cancer grow very slowly. They don’t spread beyond the prostate and may never cause health problems. In fact, you can live a long life with prostate cancer and never know you have it. The goal of prostate cancer screening is to help find cancers that may be more likely to spread so they can be treated early. But there are challenges and possible harms from using a PSA test to screen for prostate cancer:

  • A PSA test can’t tell the different between abnormal PSA levels from prostate cancer and noncancerous conditions. If your PSA level is high, a prostate biopsy is the only way to find out if the cause is cancer. And prostate biopsies have possible harms.
  • A PSA test may lead to finding and treating prostate cancer that would never have affected your health. If prostate cancer is found:
  • It can be difficult to tell the difference between slow-growing cancers and those that are likely to grow faster and spread in your body.
  • You could have prostate cancer treatment that you never really needed. And cancer treatment may cause serious harms, such as:
  • Problems controlling your bowels

PSA testing may also be used to:

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What Happens If My Psa Level Is Elevated

If you have a high PSA level, you will need ongoing PSA tests and DREs so your provider can look for any changes. If the PSA level continues to increase or if your healthcare provider finds a lump during a DRE, you may need other tests, including:

  • Transrectal ultrasound and prostate biopsies.
  • Iso PSA or 4Kscore® .

A biopsy can tell you definitively if you have prostate cancer. The biopsy results also affect your treatment. For example, if the biopsy shows a lot of cancer cells, you might need more aggressive treatment.

Why It Is Done

The prostate-specific antigen test is done to:

  • Screen men for prostate cancer. Since other common medical conditions, such as benign prostatic hyperplasia and prostatitis, can cause high PSA levels, a prostate biopsy may be done if your doctor is concerned about signs of prostate cancer.
  • Check if cancer may be present when results from other tests, such as a digital rectal examination, are not normal. A PSA test does not diagnose cancer, but it can be used along with other tests to determine if cancer is present.
  • Watch prostate cancer during active surveillance or other treatment. If PSA levels increase, the cancer may be growing or spreading. PSA is usually not present in a man who has had his prostate gland removed. A PSA level that rises after prostate removal may mean the cancer has returned or has spread.

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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.

Problems With The Psa Test

What Is A Prostate Specific Antigen (PSA) Test? | Ask Cleveland Clinic’s Expert

There are reasons doctors donât agree on whether you need this test:

  • Finding prostate cancer early doesnât always protect you. The PSA test often finds small, slow-growing tumors that arenât life-threatening. Treating them anyway, whether itâs with surgery or radiation, can expose you to harmful side effects and complications. Also, finding cancer early may not help if you have an aggressive tumor or if it spread to distant body parts before you found it.
  • The results arenât always accurate. If you have a high level but you donât have cancer, the test results can create a lot of worry and lead to medical procedures you donât need. A negative result if you really do have cancer can prevent you from getting treatment you do need.

Read Also: Can Advanced Prostate Cancer Be Cured

What Is A Dangerous Psa Level

The earlier the cancer is detected, the greater the chance for successful treatment. Understanding the levels of prostate-specific antigen is important to reach a diagnosis.

  • PSA levels less than or equal to 2.5 ng/ml in men under 60 years are considered normal, though few men can still have prostate cancer.

  • Levels between 2.5 and 4 ng/ml are considered healthy for almost all men.

  • Levels between 4 and 10 ng/ml indicate a 25 % chance of having prostate cancer.

  • Levels that breach 10 ng/ml raise a red flag for an individual, which indicates high chances of having prostate cancer.

The Role Of Psa In Staging

Prostate cancer causes cells to become malignant and multiply uncontrollably. This can lead to overproduction of PSA, and higher levels of PSA in the bloodstream.

However, some men who have prostate cancer do not exhibit elevated PSA levels. And certain noncancerous conditions, like a prostate infection or benign enlargement, can also cause high PSA levels.

PSA levels are just one factor used in determining the stage of prostate cancer. Another diagnostic tool is called the Gleason scale. This rates the extent of abnormality in your prostate cells after biopsy.

At a certain point in prostate cancers late-stage progression, Gleason and PSA become less useful. When a tumor is large enough, doctors no longer need these numbers to predict its growth or malignancy.

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What Is A Normal Psa Test Result

There is no specific normal or abnormal level of PSA in the blood. In the past, PSA levels of 4.0 ng/mL and lower were considered normal. However, some individuals with PSA levels below 4.0 ng/mL have prostate cancer and many with higher PSA levels between 4 and 10 ng/mL do not have prostate cancer .

In addition, various factors can cause someones PSA level to fluctuate. For example, the PSA level tends to increase with age, prostate gland size, and inflammation or infection. A recent prostate biopsy will also increase the PSA level, as can or vigorous exercise in the 2 days before testing. Conversely, some drugsincluding finasteride and dutasteride, which are used to treat BPHlower the PSA level.

In general, however, the higher a mans PSA level, the more likely it is that he has prostate cancer.

Relative Risk Of Prostate Cancer By Psa

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According to the American Cancer Society :

  • Males with PSAs over 10 have a one in two chance of having prostate cancer.
  • Males with “borderline” PSAs between 4.0 and 10 have a one in four chance of having prostate cancer.
  • Males with PSAs below 4.0 have a one in seven chance of having prostate cancer.

As such, clinical experience is needed to make an informed choice. This includes exploring all other possible causes for PSA increases, including certain medications, BPH, prostatitis, and other urological problems. Even riding a bicycle or having recently ejaculated can lead to short-term spikes in PSA levels.

Read Also: Pae Treatment For Enlarged Prostate

What Is A Psa Test

The PSA test is the leading method of screening for prostate cancer. PSA screening can help catch the disease at an early stage when treatment may be more effective and potentially have fewer side effects. The PSA test may be done along with a digital rectal exam , in which a physician inserts a gloved finger into the rectum to examine the prostate for irregularities.

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.

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Psa Levels By Age Chart

The main difference between the PSA scores of prostatitis and an enlarged prostate, compared to prostate cancer, is the ratio of free vs bound PSA within your test sample.

  • Prostate Cancer will have a higher bound PSA ratio.
  • An enlarged prostate and prostatitis will have a higher free PSA ratio.
  • If your free PSA results are less than 25%, your risk for developing prostate cancer is between 10% to 20%.
  • If your free PSA results are less than 10%, your risk for developing prostate cancer jumps to around 50%.

How Is The Psa Count Measured

Prostate Specific Antigen (PSA) | Overview for Med Students | Urology

PSA is measured by a simple blood test that does not require fasting or special preparation. Since the amount of PSA in the blood is very low, detection of it requires a very sensitive type of technology . The PSA protein can exist in the blood by itself or be bound with other substances .

PSA is mostly bound to three substances: alpha-2-macroglobulin, alpha 1-antichymotrypsin , and albumin. Total PSA is the sum of the free and the bound forms. The total PSA is what is measured with the standard PSA test.

More recently, a precursor of PSA, proenzyme PSA , has been identified, which may be helpful in determining prostate cancer risk in men with a PSA under 10 and a normal digital rectal examination. The prostate health index is a new approved test that measures the total PSA, free PSA, and proenzyme PSA. The National Comprehensive Cancer Network guidelines include use of PHI as a secondary test option for men making decisions about an initial or repeat biopsy.

The 4K score test is another test that incorporates PSA. The 4K score uses a prediction model based on clinical variables and laboratory measurements of total PSA, free PSA, intact PSA, and a related protein known as hK2 .

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Other Tests For Prostate Cancer

Early diagnosis and regular screening can aid in both the diagnosis and decision on treatment when it comes to prostate cancers.

  • Phi test: The Prostate Health Index combines three blood tests for prostate-specific antigen , total PSA, free PSA, and pro-PSA. These are different fractions of PSA antigens found in the blood. Experts believe that these values give a more accurate Phi score and better determine the probability of finding cancer during a biopsy.
  • PCA3: This is a urine test that accurately detects the risk of prostate cancer by examining the expression of the PCA3 gene, a gene-specific to prostate cancer.
  • 4KScore: Another blood test measures total PSA, free PSA, intact PSA, and certain enzymes called kallikrein. A special computer-based algorithm used with the patientâs age and physical exam gives a probability of having aggressive prostate cancer.
  • However, none of these tests are conclusive on their own. When performed in addition to a PSA test, a digital rectal exam and biopsy can provide more information about specific cancer.

    What Do The Results Mean

    There is no specific normal or abnormal level for PSA in blood. In general, the higher your PSA level, the more likely it is that you have cancer. But it’s possible to have a high PSA without prostate cancer, or a low PSA with prostate cancer.

    If you had a PSA test for a prostate cancer screening or because you have prostate symptoms:

    • High PSA levels can mean you have prostate cancer or a prostate condition that’s not cancer, such as an infection or an enlarged prostate. If your PSA levels are higher than normal, your provider may talk with you about having more tests to diagnose the cause. These tests may include:
    • Another PSA test, more commonly if you don’t have any symptoms. PSA levels can go up and down, so it helpful to see if your PSA levels change over time.
    • A digital rectal exam . For this test, your provider inserts a gloved, lubricated finger into your rectum to feel your prostate for lumps or anything unusual.
    • A urine test. A sample of your urine is tested for infection.
    • A prostate biopsy. A biopsy is minor surgery. A doctor removes samples of tissue from your prostate so it can be studied under a microscope to look for cancer cells. A biopsy is the only way to diagnose cancer. It may be recommended if your provider thinks you may have prostate cancer.

    If you have questions about your results, talk with your provider.

    Learn more about laboratory tests, reference ranges, and understanding results.

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    Improving Prostate Cancer Relapse Forecast By 14 Months

    WEST LAFAYETTE, Ind. A new tool could help save lives by predicting prostate cancer relapse 14 months earlier than current standard methods. The tool, a computer model, makes its predictions by using levels of a single biomarker produced by prostate cells to forecast the interplay of biochemical reactions linked to prostate cancer.

    In developing the model, researchers also found four promising model-based biomarkers, parameters the model calculates that appear to predict relapse. The research was recently published in iScience, an open-access journal from Cell Press.

    Researchers developed and tested the model using health care records of 166 prostate cancer patients, 10 of whom relapsed within six years after receiving external beam radiotherapy . Although the model made its predictions based on data for which the outcome was already known, contributing researcher Hector Gomez, a Purdue University professor of mechanical engineering, said it could be a useful tool for doctors monitoring patients after radiation treatment.

    I think this has huge potential for clinical use. Look at the amount of time you gain on detecting relapse in patients compared with current practice, said Gomez, a member of the Purdue Center for Cancer Research. Thats more than a year of time gained for a secondary treatment that might be able to beat the disease.

    Writer/Media contact: Mary Martialay,

    Hector Gomez, , is available for phone or virtual interviews.

    What Is Psa Velocity

    The Memorial Sloan Kettering Cancer Center Recommendations for Prostate ...

    The amount by which the prostate-specific antigen levels rise in a year is called PSA velocity. Thus, if the initial PSA reading is about 10 ng/mL and it rises rapidly year on year, this can point to early-stage prostate cancer.

    • Most research indicates that an increase of 0.75 ng/mL a year is an early indicator of prostate cancer if a man has a total PSA result between 4.0 and 10.0 ng/mL.
    • An increase of 2.0 ng/mL over a year predicts a higher likelihood of death due to aggressive prostate cancer.
    • PSA velocity may help predict survivability from prostate cancer.
    • Men with a PSA increase of 0.35 ng/ML or less over a year have a 92 percent survival rate.
    • Men with PSA levels of more than 0.35 ng/mL over a year have a 54 percent survival rate.

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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:

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