How Does The PSA Test Work?

by Ben Ong
Reading Time: 9 minutes

PSA test

A raised PSA level can be a sign of a problem.

And a PSA Test can help diagnose that problem. If you want to know more about the PSA test, you will find this information helpful. We’ll explain what the PSA test is, how it works and how it helps detect prostate problems. We will also explain the good and the bad regarding the test, what the results mean and what might happen afterward.


What Does PSA Stand For? 

PSA stands for “prostate specific antigen”. It is a protein produced by prostate cells. Prostate cancer cells also produce PSA. It’s quite normal to have a small amount of PSA in your blood. But as you get older, the amount rises and your prostate gets bigger. A raised PSA level is not always a medical concern, but may suggest a problem with your prostate.

A typical prostate gland has the size and shape of a walnut. However, it grows bigger as you get older. It’s located underneath the bladder and surrounds the urethra. These structures form the urinary tract. Urine and semen go through the urethra.

The prostate is a gland. Its main function is to help make semen. This is the fluid that carries sperm. The prostate gland produces a component of seminal fluid. Its muscles help propel the seminal fluid into the urethra during ejaculation.


How Does The PSA Test Work?PSA test

The PSA test is a lab test that measures the amount of prostate specific antigen (PSA) in your blood. The amount of PSA is measured in nanograms per milliliter of blood (ng/ml).

This test became part of treating prostate problems as experts have observed that high PSA levels were linked to men with prostate cancer. In 1986, the FDA has approved the PSA test to monitor the progression of prostate cancer.

In 1994 they approved its routine use along with a digital rectal exam (DRE), for men who don’t have symptoms of prostate cancer. Since then, men who experience prostate symptoms undergo routine PSA tests.

However, recent studies show that the PSA test is not an accurate indicator of prostate cancer. There are cases in which some men who don’t have prostate cancer are diagnosed with it. As a result, they undergo unnecessary and dangerous invasive treatments with many long-term adverse effects.

Despite claims that PSA tests reduce prostate cancer deaths by 21%. There are cases where treatment costs for those who are misdiagnosed with prostate cancer, outweigh its benefits.

As a result, doctors do not automatically recommend the PSA test for men who don’t have symptoms. Instead, they perform further assessment by looking at one’s risk for prostate cancer.


What Causes High PSA Levels?

A high PSA level can be a sign of a prostate problem. This could mean that you might have an enlarged prostate, prostatitis or prostate cancer.

An enlarged prostate is also called benign prostatic hyperplasia (BPH).

This is a common condition in men over the age of about 50. It is one of the most common causes or urinary problems.  Though the exact cause is unknown, it is most likely a normal part of the aging process. It may also be caused by changes in hormone levels and prostate cell growth.

Prostatitis is a condition related to a set of symptoms that may be caused by an infection or swelling of the prostate. Like an enlarged prostate, this is common among older men. It may cause urinary problems, pelvic pain, fever and chills.

Note that BPH and prostatitis are different from prostate cancer. Cancer develops when prostate cells start to grow in an uncontrolled way. The growth of normal cells is carefully controlled by our body. As cells grow old and die, they are replaced with new cells. This mechanism doesn’t happen with prostate cancer cells.

Often, prostate cancer grows slowly and has a low risk of spreading. Treatment may not always be advised, but may be done if the cancer is spreading more quickly than normal. This is done especially if the cancer has spread to other parts of the body, which poses a serious health risk.


BPH, Prostatitis and Prostate Cancer

BPH, prostatitis and prostate cancer can cause certain urinary symptoms:

  • Frequent urination, especially at night
  • A sense of urgency to urinate
  • Difficulty starting to urinate, taking a long time to finish urinating
  • Straining or painful urination
  • Dribbling or weak urine flow
  • Incomplete emptying of the bladder

Other symptoms include pain when ejaculating, blood in the urine or semen and problems getting and keeping an erection. Note however, that these other symptoms are not always caused by a prostate disease.


PSA test

What Do PSA Test Results Mean?

The PSA test alone can’t diagnose any disease and high PSA levels don’t always mean that you have prostate cancer or any other prostate problem. There are a lot of factors that can affect your PSA levels, so the doctor won’t consider your PSA level on its own.

There is no specific normal or abnormal level of PSA. Factors such as age and ethnicity make it hard for researchers to establish a normal range. However, most doctors consider PSA levels of 4.0 ng/ml as high, and would often recommend a prostate biopsy. One study shows that men with this level of PSA often have prostate cancer.  

Low PSA levels also don’t always mean that you don’t have prostate cancer. Studies show that some men with a PSA of below 4.0 ng/ml do have prostate cancer.


What Happens After The Test?PSA test

To know if your PSA test results are truly significant, the doctor will look at other factors, such as the results of your DRE, age, ethnicity, family history, body weight. The doctor will also look at any other health problems or factors that might raise your PSA.

What happens after the PSA test depends on a thorough assessment, and the doctor will advise you on the next step based on data gathered from your health history, physical exam and PSA test.

The doctor might recommend a DRE to further check your prostate. In this procedure, the doctor or nurse feels your prostate through the wall of the rectum by sliding a finger gently into your anus.

This is done to feel for any hard or lumpy areas in your prostate, and to get an idea of its size. While it may be necessary to rule out any prostate problem, it can be uncomfortable and embarrassing.

A prostate biopsy may also be recommended to confirm prostate cancer. This procedure involves using needles to extract tissue samples from the prostate gland. The sample is looked at under a microscope to see if there are cancer cells.

The prostate biopsy is the only way to know for certain if you have prostate cancer. A biopsy reveals how aggressive the cancer is, and helps doctors decide which treatment options are suitable. However, it can only show whether there was cancer in the samples taken. A prostate biopsy can also cause serious infection, pain and urinary problems.

In some cases, the doctor wouldn’t recommend anything even if you have a high PSA level.  Because prostate cancer often grows very slowly, some doctors recommend watchful waiting or active surveillance. This involves close monitoring and a less intensive series of DREs, PSA tests and biopsies.

What’s good about watchful waiting is that prostate cancer treatment is only done when necessary, and this saves you from the potential adverse effects of radiation and drugs. However, watchful waiting is not likely to be a good option if you have a fast-growing cancer or if the cancer has spread outside the prostate.  


Is The PSA Test Reliable?

The PSA test is used as a guide for doctors to determine if you have a problem with your prostate. However, the PSA test alone is not a reliable indicator. Though PSA testing can help detect prostate cancer at an early stage, having an elevated PSA doesn’t always mean that a man has cancer.

There are non-cancerous PSA-raising factors, like BPH and prostatitis. Studies have shown that about 70% to 80% of people with high PSA levels do not have prostate cancer. To confirm the presence of cancer, you have to undergo prostate biopsy.

Some drugs can also lower your PSA, and can possibly hide the risk of prostate cancer. A study from Duke University has found that cholesterol-lowering statins and non-steroidal anti-inflammatory drugs (NSAIDs), lower serum PSA levels, which can compromise cancer screenings.

The PSA test doesn’t detect all cancers. One in five of men with prostate cancer have a normal PSA, so the test may give some false sense of security. And some men with low PSA can have prostate cancer.

For this reason, doctors carefully look at all factors to make a proper diagnosis. A man’s age is also taken into account, because normal PSA levels change over time.

In short, your PSA level won’t give you a definite answer about cancer. Yet, it is still useful for doctors to determine if a prostate biopsy is necessary.


How Accurate is the PSA Test For Prostate Cancer?PSA test

As we’ve mentioned earlier, the PSA test alone cannot determine if you have prostate cancer or not. And even if the PSA test can help detect a tumor at its early stage, it may not reduce the chance of death.

And not all types of prostate cancer are life-threatening. Some tumors that are detected by PSA testing can grow very slowly without posing any immediate and serious threat.

Finding such tumors is called “over-diagnosis” that often leads to “over-treatment”. A man with a non-life threatening tumor doesn’t necessarily need to take prostate medications. The harmful effects of over-treatment can outweigh the benefits.

Policies about prostate cancer screening programs differ in the US and UK. Prostate cancer screening programs in the US aim to detect prostate cancer at its early stage, so that it could be treated more easily.

Currently, there is no similar program for prostate cancer in the UK. The reason for this is that the PSA test isn’t a sure test to detect prostate cancer and to be used as part of a screening program.

The NHS believes that it’s important to know if the benefits of a prostate screening program outweigh any risks. Right now, it isn’t clear whether screening with the PSA does more good.


How Much Does The PSA Test Cost?

Currently, PSA tests cost between $20 to $50, and is frequently covered by insurance. This coverage is especially for men who are at least 50 years old. It may also come with additional charges if it is obtained from a clinic.

Where To Get a PSA Test Done?

You may take your PSA test at any clinic of a licensed GP or a hospital. However, you have to decide whether the PSA test is right for you. It’s a simple test, but not a simple decision, and it’s better to talk to your doctor first.

In some cases, the doctor may not recommend the PSA test if you don’t have prostate symptoms, and if you have other health problems that may pose a risk.

Simply put, talk to your doctor to have an informed decision. Think about the pros and cons of the test before taking it.

There are PSA tests that are available for home use. This comes with a lancet, blood collection kit, bandage, and a prepaid mailer to return to the lab. However, you have to check the FDA website to make sure your PSA home test kit is approved.


Should I Go For a PSA Test?

Before taking a PSA test, you have to make sure that it will work for you. That is why it’s very important to talk with your doctor and have him/her assess your condition carefully and thoroughly.

Here are the pros of a PSA test:

  • It may detect prostate cancer at its early stage.
  • Regular testing can benefit men at risk for prostate cancer.
  • It may help detect a fast-growing cancer and early treatment may stop its spread.
  • It’s a simple test and the first diagnostic step to take
  • Knowing is better than not knowing

And here are the cons:

  • The PSA test can miss prostate cancer, giving you a false sense of security.
  • Not all types of prostate cancers need treatment. Some tumors are not life-threatening and grow slowly.
  • It may not be needed because some cancers come with a low PSA.
  • A high PSA level doesn’t always mean you have prostate cancer.
  • A diagnosis of prostate cancer can be stressful for you, even if you’re cancer is not that serious.
  • You may need more tests, like a prostate biopsy. The biopsy can be painful, and may cause infection and bleeding.
  • Over-treatment of early-stage prostate cancer with drugs can lead to long-term, harmful side effects.

It can be hard to decide whether or not to have a PSA test, so you need to talk to your doctor. Ask if you are at risk for prostate cancer. Ask about its pros and cons, and seek more info to better understand the test. Keep in mind that you should know for sure if the PSA test is for you.


References:

Hamilton, R., et al. 2008. The Influence of Statin Medications on Prostate-specific Antigen Levels. J Natl Cancer Inst (2008) 100 (21): 1511-1518. DOI: https://doi.org/10.1093/jnci/djn362

Kindermann, W., et al. 2011. Influencing of the PSA concentration in serum by physical exercise (especially bicycle riding). Urologe A. 2011 Feb;50(2):188-96. doi: 10.1007/s00120-010-2489-z.

Lechevallier, E., et al. 1999. Effect of digital rectal examination on serum complexed and free prostate-specific antigen and percentage of free prostate-specific antigen. Urology. 1999 Nov;54(5):857-61.

Loughlin, K.. 2011. Is PSA reliable?. [ONLINE] Available at: http://www.harvardprostateknowledge.org/is-psa-reliable. [Accessed 30 June 2017].

Thompson, IM., et al. 2004. Prevalence of prostate cancer among men with a prostate-specific antigen level < or =4.0 ng per milliliter. N Engl J Med. 2004 May 27;350(22):2239-46.

How Does The PSA Test Work?
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  1. Rick

    Ben, Thank you very much for the service you provide. I am just now looking for information. I am 61 and in the last year my prostate score sent from 4.3 to 5.1. I have BPH symptoms and started Flomax a few weeks ago. My urologist recommends a biopsy. Not interested in my suggestion for an MRI or ultrasound and the advanced PSA is not covered by insurance. I have taken a prostate supplement from Life Extension for some time and am looking for options besides a biopsy. My father is 85 with no prostate issues, but his brother had a radical prostatectomy at my age with real poor quality of life since. I am pouring through your site and am preparing to challenge the biopsy again with the advice you provide here. Diet next.

    • Ben Ong

      Hi Rick, I can see that you are concerned about the increase in your PSA score. The PSA is only a very rough indicator. It certainly does not predict prostate cancer, but it may give you an early indication. The PSA score, however, is the very best indication of the general health of your prostate. It may be an enlarged prostate or an inflamed one or prostatitis that causes your PSA reading to rise. But it can also be prostate cancer or a mix of any of them. It is important to remember that a high PSA score is the result of a problem, not the cause of one. There are many ways to reduce your PSA count and prevent the risk of developing further prostate health issues.
      I recommend making changes to your diet and lifestyle and taking our harmless Total Health supplement designed to reduce or eliminate inflammation, enlargement and irritation in the prostate. If there is no cancer present, your PSA level will come down by using this method. If there is a lowering of your PSA level then a biopsy will not be required. You can read about the most effective natural prostate supplement if you click here: https://www.bensnaturalhealth.com/health-products/total-health-vegicaps.html#product_tabs_ingredients
      Our highly bio-available and natural ingredients work synergistically with the ketogenic diet and keeping physically active. A ketogenic diet consists of 70% healthy fats, 25% high-quality protein and 5% carbohydrates. You can read find more information on the ketogenic diet here: http://www.bensprostate.com/ketogenic-diet-help-prostate-disease/
      High intakes of dairy, red meat and animal fats increase the risk of prostate enlargement. Whereas consuming food which are rich in fruits and vegetables reduce the risk of prostate enlargement. It is important that you choose organic and fresh vegetables otherwise the nutrient quality of the fruits and vegetables will be suboptimal. A lack of high quality fruit and vegetables can lead to lead to deficiencies in micronutrients which are important for prostate health.
      It is very important that you maintain adequate levels of physical activity throughout the whole year very important. Research shows that men who exercise frequently are far less likely to develop BPH or prostate cancer. Physical activity also helps to maintain a healthy body weight, which is very important because excess body weight increases oestrogen and inflammation, which contribute to prostate diseases. Research also shows a correlation between increases in body weight and an increase in prostate size. Furthermore, the effectiveness of supplements is blunted in men with excess body weight, so it is highly important to maintain a healthy body weight.
      It is recommended that we undertake 150 minutes of aerobic exercise per week either in the form of brisk walking, running, cycling or swimming. Two resistance training sessions should also be conducted weekly. Resistance training will increase muscle mass and help reduce excess body weight. This will also help to boost your levels of testosterone. Sedentary time should be limited to no longer than 1 hour. If possible every 30 minutes stand up and make some sort of movement for a minute or so. I hope this information helps you and I wish you good health, Ben.

  2. Tom Bobo

    I’m 70 yrs old and was diagnosed with prostate cancer 17 yrs ago. My biopsy didn’t go well and I developed sepsis from the procedure and came close to death. My Gleeson Score was a 7. I had a radical prostectomy. My PSA started to climb after about 6 months after surgery and was given 7 weeks of radiation treatments. Four years ago I was diagnosed with stage IV bone cancer. My PSA is 1040 as of last blood work. My real concern is my Akaline Phosphatase level at 640. I’ve been at these levels before and responded to Lupron shot to bring down PSA and Akaline Phosphatase. Love my testosterone and haven’t had a Lupron shot in 16 months. I’m on no pharmaceutical drugs but do a lot of alternative protocols. I have a cancer coach and use Cesium Chloride and MSM as well as minerals to keep my bones strong. I try not do many scans because of the radiation exposer to the bones. I built my own near/far infrared sauna which I’ve used almost every day for the last couple of years. I was diagnosed with Lyme disease about 18 months ago and find it is getting harder to control the Lyme than the Bone Cancer. I have pain in my muscles and joints that moves around the body. I have been telling my Oncologist that I’ve had no bone pain for the last 4 years. I’ve been through a lot but I’m still hear and manage to function fairly well. Hopefully this testimony will give encouragement to others with prostate cancer. Questions is do I try the Lupron again to bring down my Akaline Phosphatase and have you had any experience in bringing down Akaline Phosphatase naturally?

    • Ben Ong

      Hi Tom, very sorry to hear about the effects of your biospy and thank you for sharing your encouraging testimony. This topic would benefit from further in-depth discussion so I would suggest getting in touch with [email protected] so that our customer support team can discuss this with you in further detail and answer any other questions you may have.

  3. daniel

    My PSA came in at 4.2 last October so my dr ordered a Biopsy. I am 58 and sure enough had 5 cores with 3 plus 3 or low grade prostate cancer. Dr’s said since one core was over 50% I needed treatment although I am very hesitant and I want more data first to be convinced. Just took another PSA and results came back today at 2.8
    Staying on active surveillance for now and going on Ketogenic diet instead.

  4. Reynaldo Saralde

    Its very informative information.

  5. Reynaldo Saralde

    My PSA level hree months ago showed 8.7 and last month reading dip below 7 after drinking Barley Juice, I have undergone ultra sound on my prostrate and the results is unconclusive as there is no mas seen on the procedure. I continued drinking barley juice since and its a month since and Im going to have PSA test in a month and 1/2. Doesnt have symptoms nowsadays. please advice if I have to undergo biopsy, im 65 years old. Thank

  6. Victor Ortiz

    I have heard from my PCP that there is a new, non-invasive MRI procedure that can more effectively scan the prostate for tumors, which is probably useful before trying a biopsy. Do you have any information about this “new” MRI application and its efficacy?

  7. Homer Garza

    My PSA went steadily up within 2 or 3 weeks from a 4.5 to a 5.1. I opt not to do a biopsy but took Ben Ong supplements for 3 month’s whereas it went down to 2.4. I am 67 years old and have decided that I will continue to take the supplements along with Ben’s dietary advise and continue to exercise, as I had lost 35 pounds during those 3-4 month’s. I will take a PSA tests every 3 month’s or so just to be monitoring progress or lack of it. I have decided that I will NOT undergo any radical treatments no matter what. I had a friend who passed away a couple of months ago due to prostrate cancer that had moved on to his bones and caused him much pain, so I am cognizant of what potentially could happen and I’m OK with my choice. We all have to assess our predicament and make difficult choices and also allow our family in on why those choices are made and that we it is a choice made by the person with the illness.

    • Ben Ong

      Hi Homer,

      Thank you very much for your powerful words. It’s always humbling to see the impact that these changes can make to men.

      I wish you good health,
      Ben

  8. keith

    what minerals are good for the prostate, i take trace minerals,pomagram oil , betasterol, give me moore information , on what else to take

    • Ben Ong

      Hello Keith,

      Hi Keith,

      Boron, Selenium, Zinc, Vanadium, Nickel and Cobalt are all important minerals for the prostate.Vitamin E and Vitamin D are important vitamins for the prostate. These and other more vitamins and minerals including beta sitosterol are in my supplement Total Health for the prostate.

      If you wish to read more about it, please click here.
      If you could tell me more about your current prostate health, your symptoms and other information that will help us give you our best advice. You can send your email at [email protected]

  9. keith

    are minerals important for your prostate, along with pomagram seeds or oil beta sterols, selinamin

  10. Pat

    My husband has taken a few PSA tests and they have ranged from 6 to 20. He is 80 yrs old. The Dr suggested a biopsy which I refused. He also has dementia. I have found that when he has an elevated number if he gets a high amount of vitamin C via IV that after a few treatments his PSA drops close to 7. It might help lower other men’s number too. It is worth a try.

  11. Sal Ratan

    Hi Ben
    I had my PSA label very high
    Like 10.4 and my Docter put me on Anti biotic like Cypriot for month and I did blood and Urine test and I found out that my PSA is down to only 9.8 then My Doc sujested me to go for Biopsy, Biopsy came Benign.
    On those days I only felt one of Right testicle was stolen, and I had pain there.
    I went to Hospital and Dr over there told me that I have a small Syst, which can be desolve or drain out but they they gave me another anti biotic called Levofloxacin 500mg for 14days.
    I am feeling better now , I hope I don’t have any thing bad!
    He did prescribe Tamsulosin .4 mg and Finasteride 5 mg.
    Should I take this regularly?
    Please let me know!
    Thx

    • Ben Ong

      Hi Sal,

      Firstly, you absolutely shouldn’t be taking those drugs. I’ve written about it at http://www.bensprostate.com/prostate-drugs-good/ and http://www.bensprostate.com/never-take-prostate-drugs/

      However, once you’re on it, you need to wean yourself off it in a managed process. My team can help you with the detail of how to transition from drugs to nutritional supplements. Just email them at [email protected] and they’ll ask you some questions and then design a treatment plan.

      I wish you good health,
      Ben

      • Quinn

        Hi Ben and Sal,
        I have suffered a discomfort on my left testicle for many years. I had a ultrasound three times in last 6+ years to monitor it, and each time it says that I have Bilateral small epididymal cysts and Small hydroceles on it. Now I am 58 years old. I had a physical exam back to August last year, and found out that PSA is 5.4. I had the second test early December last year, and PSA number is 6.9. The doctor asked me to take Cipro for three weeks. I had the third PSA test, and the number is 7.21. I am sure if the cysts cause my high PSA number. Would you advise how I should do it?

        • Ben Ong

          Hi Quinn, can you please get in touch with our customer service team either by emailing [email protected] or calling our toll free number +1 888-868-3554, so that they can discuss this with you in further detail and see how to best advise you. Wishing you good health.

  12. Richard Edwards

    I wish I had had more general knowledge about PSA test and the prostate earlier. My GP did not sound the alarm until my PSA reached 8. Had I known 4 was a threshhold reading, I might have changed my diet and got on your supplements earlier with the associated benefits. I think the main downside of the PSA test is the potential for the medical practitioner to unduly influence the patient with fear at an elevated result. That seems to me the main reason that the test has fallen from favor in the medical community. It’s still considered a good indicator after the treatment to indicate the recurrence of cancer.

    • Ben Ong

      Hi Richard,

      Thanks for your comment. You’re right that the issue is not with the test, but with the way the medical establishment can push individuals to get unnecessary treatments off the back of it. I’m sorry you hadn’t heard of us sooner – but let me know if there’s anything we can help you with now.

      I wish you good health,
      Ben

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