Prostate Specific Antigen PSA

Does Your PSA Indicate Cancer?

Prostate Specific Antigen or PSA, is an enzyme found in a man's blood produced exclusively by prostate cells. Normal PSA levels in the blood are very small amounts between 0-2.5 ng/ml. As a man ages his prostate can become larger, leading to slightly higher normal levels of PSA. This is why it is important to have your PSA and prostate exam as part of your yearly physical.

Testing for PSA, requires that a man's blood be drawn and sent to the lab for analysis.  If higher than normal levels are discovered, action is recommended.  Levels greater than 2.5 ng/ml, can have many different causes. Prostate Cancer is one cause.  Higher levels of PSA can be found in the blood as prostate cancer cells begin to proliferate in an uncontrolled way. But elevated PSA levels doesn't necessarily mean prostate cancer.  PSA can also rise for benign, non-cancerous conditions such as enlarged prostate, prostate inflammation, infection, or trauma.  Get checked by your doctor.

IMPORTANT: All elevated readings of PSA should be checked.

Prostate Specific Antigen or PSA, is an enzyme found in a man's blood produced exclusively by prostate cells. Normal PSA levels in the blood are very small amounts between 0-2.5 ng/ml. As a man ages his prostate can become larger, leading to slightly higher normal levels of PSA. This is why it is important to have your PSA and prostate exam as part of your yearly physical.

Testing for PSA, requires that a man's blood be drawn and sent to the lab for analysis.  If higher than normal levels are discovered, action is recommended.  Levels greater than 2.5 ng/ml, can have many different causes. Prostate Cancer is one cause.  Higher levels of PSA can be found in the blood as prostate cancer cells begin to proliferate in an uncontrolled way. But elevated PSA levels doesn't necessarily mean prostate cancer.  PSA can also rise for benign, non-cancerous conditions such as enlarged prostate, prostate inflammation, infection, or trauma.  Get checked by your doctor.

IMPORTANT: All elevated readings of PSA should be checked.

Prostate Cancer Screen – Combine PSA Test with DRE

When screening for prostate cancer, the PSA test should be combined with a Digital Rectal Exam, DRE.  During a DRE exam, the Doctor inserts a gloved and lubricated finger into the rectum.  The posterior of the prostate can be examined for irregularities.  Occasionally, the PSA is elevated but the DRE, does not reveal any abnormalities. Sometimes the opposite is true, and PSA is normal, but the DRE is abnormal. For this reason, the Prostate Specific Antigen PSA blood test combined  with the DRE is best for early detection.

To Learn more about the tests that confirm prostate cancer: See Our Test and Diagnosis Page.

PSA is measured by 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 (monoclonal antibody technique). This test should be part of a man’s yearly exam, starting somewhere after age forty five.

PSA Monitoring Following Treatment

Prostate Specific Antigen or PSA is important for diagnosis, treatment and follow-up.  Sometimes prostate cancer treatment does not eradicate the cancer.  That is why PSA monitoring after treatment is so important. Normal prostate cells and prostate cancer cells will make PSA even if they are outside the prostate.  Returning prostate cancer cells, confined to the prostate or that have spread to the bone or lymph nodes, will cause the PSA to rise. PSA monitoring following treatment is a proven method for determining prostate treatment effectiveness or success.  

Prostate Specific Antigen - PSA

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PSA and Age

Austrian Researchers in the Tyrol PCa Early Detection Program, (PLoS ONE. 10(7):e0134134, 2015), have researched what PSA levels within age ranges should raise concern about the likelihood of significant prostate cancer. Based on age, what PSA level might trigger a referral to a urologist? Using these PSA trigger levels they “detected all relevant PCa with a significant reduction of biopsies.”

 

Age Range PSA Trigger Levels
Less Than 59 Years PSA 1.75 ng/mL
Between 60-69 years  PSA 2.25 ng/ml
Greater than 70 years PSA 3.25 ng/mL

 

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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