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?
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.
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?
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?
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.
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.
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