How Is Psa Measured
The level of PSA in your body is measured with a simple blood test. The typical test for diagnosis and risk group determination is the total PSA which is simply a measure of all the PSA. Since the amount of PSA in the blood is very low, detection of it requires a very sensitive technology . This test not only determines the levels in the blood, but whether or not the proteins joined with other substances in the blood stream. This is known as bound prostate specific antigen.
How Is Psa Testing Used In The Management Of Prostate Cancer After Treatment
A periodic PSA determination is used to detect disease recurrence after treatment. Serum PSA should decrease and remain at undetectable levels after a radical prostatectomy . An increase in the PSA over time after radical prostatectomy is suggestive of recurrent prostate cancer. Similarly, failure of the PSA to decrease to an undetectable level after radical prostatectomy may indicate residual prostate cancer. Similarly, serum PSA should fall to a low level following radiation therapy, high intensity focused ultrasound, and cryotherapy and remain at or near this level over time.
What Is Free Psa
Free PSA is a diagnostics test separate and unique from the standard PSA Blood Test.; Total PSA is the sum of the free and the bound forms. Most PSA binds to other proteins in the blood. The remaining unattached PSA is named free PSA. Men with a lower percentage of free PSA have a higher risk for prostate cancer. For example, a man whose total PSA is 6.0 ng/ml with a 10 percent free PSA has a higher likelihood of having prostate cancer than another patient whose total PSA also is 6.0 ng/ml but with 35 percent free PSA. Therefore a high free PSA percentage is good. Free PSA is not used to monitor results after treatment only to evaluate risk before diagnosis. The free PSA test is particularly helpful in situations where a biopsy is negative but the PSA is slightly high. If there is a low free PSA, another biopsy 6-12 months later is usually recommended. If it is high, then a longer wait is usually recommended.
The free PSA test is a road sign to help determine whether further work-up and follow-up is necessary. A high free PSA does not guarantee that a person is free of prostate cancer. In some cases, a biopsy of a nodule will turn up prostate cancer despite a low overall total PSA and a high level free PSA. The total PSA is what is measured with the standard PSA test.
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How Should The Psa Test Be Used For The Early Detection Of Prostate Cancer
Ultimately, the decision to use PSA for the early detection of prostate cancer should be individualized. Men should be informed of the known risks and the potential benefits of early screening. Not all men are appropriate candidates for screening efforts. For instance, screening in men with less than a 10-year life expectancy, either due to age or other illness, is discouraged as there will be most likely no benefit for them.
If prostate cancer is detected on prostate biopsy, all treatment options should be discussed. The benefits and risks of the many treatment options should be reviewed and discussed with men found to have prostate cancer. The AUA recommends that this discussion include active surveillance in men with low-risk prostate cancer. The goal of active surveillance is to allow men to maintain their quality of life when the disease is slow-growing or inactive but still allow them to be cured of prostate cancer when the disease appears to become more aggressive or is fast-growing. Other novel biomarkers, such as PCA3 , may assist the clinician in these decisions.
Prostate Specific Antigen Test
A blood test called a prostate specific antigen test measures the level of PSA in the blood. PSA is a substance made by the prostate. The levels of PSA in the blood can be higher in men who have prostate cancer. The PSA level may also be elevated in other conditions that affect the prostate.
As a rule, the higher the PSA level in the blood, the more likely a prostate problem is present. But many factors, such as age and race, can affect PSA levels. Some prostate glands make more PSA than others.
PSA levels also can be affected by
- Certain medical procedures.
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What Is A Prostate
The prostate-specific antigen blood test is a screening test. It measures the amount of prostate-specific antigen in a man’s blood.;;
PSA is a chemical made by the prostate. The prostate is a sex gland located near a man’s bladder. It produces the fluid in semen.;;
PSA levels normally increase as a man ages. But a higher-than-normal PSA level can be one clue that cancer has developed in the prostate gland.;;
However, high levels of PSA also can be found in other conditions that are noncancerous. These include prostatitis and benign prostatic hyperplasia , an enlargement of the prostate that affects many older men.;
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 Happens After The Procedure
The doctor will send the biopsy to a lab for analysis. Theyâll discuss the results with you when theyâre ready, which is usually within a week. Meanwhile:
- You can go back to your normal meals and activities.
- Do NOT take aspirin, products with aspirin, anti-inflammatory drugs such as Advil, Motrin, or Naprosyn, or indomethacin for at least 3 days after the procedure.
- Drink six to eight glasses of water every day for 3 days after the test to help flush your urinary system.
- You may notice a small amount of blood in your urine, semen, or stool up to 7 days afterward. This is normal.
- If your rear end is sore, soak in a warm bath for 20 minutes.
- Take your antibiotics until all the pills are gone. If you miss a dose, take it when you remember and then go back to your regular schedule.
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.
At-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 process
Dr. Diamandis Lunenfeld-Tanenbaum Research Institute, Sinai Health System
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What Is A Prostate Specific Antigen Test
The prostate specific antigen test is a blood test that measures the level of PSA in your blood. PSA is made by the prostate gland. The PSA level in your bloodstream is measured in nanograms per millilitre .
When you have a PSA test, you should not have:
- An active urine infection.
- Produced semen during sex or masturbation in the previous 48 hours.
- Exercised heavily in the previous 48 hours.
- Had a prostate biopsy in the previous six weeks.
- Had an examination of the back passage with a gloved finger in the previous week.
- Gay, bisexual, and other men who have sex with men should avoid receptive anal intercourse for 48 hours before a PSA test.
Each of these may produce an unusually high PSA result.
If you decide to have a PSA test, your doctor will give you a digital rectal examination to feel the prostate. This is to find out if the prostate is enlarged or feels abnormal in any way.
What Is Free/total Psa Ratio
Although prostate cancer cells do not produce more PSA than benign prostate tissue, the PSA produced from cancerous cells appears to escape an enzymatic processing that cleaves the bond between PSA and the protein that binds to it. Therefore, men with prostate cancer have a greater fraction of complexed, or bound, serum PSA and a lower amount of unbound PSA compared with men without prostate cancer. Therefore, the free/total PSA ratio can be additionally used in clinical practice to discriminate between PSA elevation secondary to benign prostatic disease and prostate cancers. This is particularly useful for patients with a total PSA level between 4.0 and 10.0 ng/mL and a negative normal rectal exam to help the health care provider to decide if a biopsy is necessary. In one study, prostate cancer was found in 56% of men with a free/total PSA less than 0.10 but in only 8% of men with free/total PSA greater than 0.25 . Nevertheless, the concept of free PSA must be used with caution as several factors may influence the free/total PSA ratio such as temperature and prostate size. Furthermore, the free PSA measurement is not clinically useful for patients with total serum PSA values less than 10.0 ng/mL or in the follow-up of patients with known prostate cancer.
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If Screening Test Results Arent Normal
If you are screened for prostate cancer and your initial blood PSA level is higher than normal, it doesnt always mean that you have prostate cancer. Many men with higher than normal PSA levels do not have cancer. Still, further testing will be needed to help find out what is going on. Your doctor may advise one of these options:
- Waiting a while and having a second PSA test
- Getting another type of test to get a better idea of if you might have cancer
- Getting a prostate biopsy to find out if you have cancer
Its important to discuss your options, including their possible pros and cons, with your doctor to help you choose one you are comfortable with. Factors that might affect which option is best for you include:;
- Your age and overall health
- The likelihood that you have prostate cancer
- Your own comfort level with waiting or getting further tests
If your initial PSA test was ordered by your primary care provider, you may be referred to a urologist for this discussion or for further testing.
Does An Elevated Psa Level Always Mean Cancer
Though there is always some risk of the test resulting in a “false negative” , an increase in PSA levels may be caused by:
- A prostate gland biopsy
- A resection of the prostate
- Rigorous physical activity related to the prostate
- Excessive doses of chemotherapeutic drugs
- Enlarged prostate
- The test returns an elevated PSA level that, after further testing, reveals there is no underlying condition
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Who Should Get A Digital Rectal Exam
Not all medical institutions agree on when men should begin screening for prostate cancer or even if a DRE should be part of the screening.
To help detect prostate cancer in its early stages, the American Cancer Society recommends that men talk to their doctors about the benefits, risks, and limitations of prostate cancer screening before deciding whether to be tested.
For most men at average risk, discussions about screening begin at age 50. However, some doctors recommend that men at higher risk of prostate cancer — African-American men or men with a family history of prostate cancer — start screening earlier.
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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 Are Some Of The Limitations And Potential Harms Of The Psa Test For Prostate Cancer Screening
Detecting prostate cancer early may not reduce the chance of dying from prostate cancer. When used in screening, the PSA test can help detect small tumors that do not cause symptoms. Finding a small tumor, however, may not necessarily reduce a mans chance of dying from prostate cancer. Many tumors found through PSA testing grow so slowly that they are unlikely to threaten a mans life. Detecting tumors that are not life-threatening;
that requires treatment.
What Is Prostatic Specific Antigen
PSA stands for prostate-specific antigen. It is a protein produced by the cells of the prostate gland. This antigen helps keep the semen liquified so that sperm can swim freely. The antigen is usually found in the prostate gland and semen, but small amounts of it can also move into the bloodstream and can be measured by a blood test called a PSA test. Prostate cancer cells usually produce more PSA than do benign cells, causing the levels in your blood to rise. However levels can also be elevated in men with enlarged or inflamed prostate glands.
Limitations Of A Psa Screening
For many men, PSA screening is automatically ordered for a man along with general blood tests at an annual exam.While this is probably unnecessary for symptom-less men under fifty, it does allow for a baseline PSA to be established.
The baseline values can then be used as a reference for future testing. Some men will have normal values that stay essentially constant as they age, and others will have an age-related rise.
According to the USPSTF, for men aged 55 to 69 years, a decision to undergo periodic PSA-based screening for prostate cancer is optional. It should include a complete discussion of the potential benefits and harms of screening.
While the actual test poses no problems, the repercussions of an out-of-range PSA level can result in additional unneeded testing and potential complications.
For example, if a mans PSA exceeds the upper limit , he is often referred to a urologist for a biopsy.A biopsy has the advantage of being able to detect prostate cancer early, but it has its own set of side effects and complications.
Since prostate cancer is generally non-aggressive and slow-growing, detection can become more of a hardship than the disease.
Most biopsies today use take multiple core samples of the prostate to increase the likelihood of finding cancer. However, this also increases the seriousness of biopsy side effects.
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Why Do I Need A Psa Test
You may get a PSA test if you have certain risk factors for prostate cancer. These include:
- A father or brother with prostate cancer
- Being African-American. Prostate cancer is more common in African American men. The reason for this is unknown.
- Your age. Prostate cancer is more common in men over the age of 50.
You may also get a PSA test if:
- You have symptoms such as painful or frequent urination, and pelvic and/or back pain.
- You’ve already been diagnosed with prostate cancer. The PSA test can help monitor the effects of your treatment.
Factors That Affect Psa Levels
It is important to note that PSA levels can rise naturally with age, and that a number of benign conditions can also affect PSA levels, such as prostatitis , benign prostatic hyperplasia , urinary tract infection , or even injury to the prostate.
Other factors such as sexual activity right before testing, certain exercises, or even diet can impact the PSA levels as well. It is essential to consult a doctor regarding the meaning and next steps of your PSA testing results.
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Discusses Physiology Pathophysiology And General Clinical Aspects As They Relate To A Laboratory Test
Prostate-specific antigen is a glycoprotein that is produced by the prostate gland, the lining of the urethra, and the bulbourethral gland. Normally, very little PSA is secreted in the blood. Increases in glandular size and tissue damage caused by benign prostatic hypertrophy, prostatitis, or prostate cancer may increase circulating PSA levels.
In patients with previously diagnosed prostate cancer, PSA testing is advocated as an early indicator of tumor recurrence and as an indicator of response to therapy. The role of PSA in early detection of prostate cancer is controversial. The American Cancer Society recommends annual examination with digital rectal examination and serum PSA beginning at age 50, and for those men with a life expectancy of at least 10 years after detection of prostate cancer. For men in high-risk groups, such as African Americans or men with a first-degree relative diagnosed at a younger age, testing should begin at a younger age. It is generally recommended that information be provided to patients about the benefits and limitations of testing and treatment so they can make informed decisions.