PSA Test: Prostate Cancer Screening Explained

Understanding the PSA Test

The PSA (Prostate-Specific Antigen) test measures a protein produced by the prostate gland. It's used to screen for prostate cancer, monitor treatment, and detect recurrence. While useful, PSA testing should involve informed decision-making with healthcare providers.

What is PSA?

PSA is a protein specific to the prostate gland. Elevated levels can indicate prostate cancer, benign prostatic hyperplasia (BPH), or prostatitis. However, many factors affect PSA levels, making interpretation complex.

PSA Levels and Interpretation

PSA Ranges

• • Less than 4.0 ng/mL: Generally considered normal
• • 4.0-10.0 ng/mL: Borderline, may warrant further evaluation
• • Greater than 10.0 ng/mL: May indicate prostate cancer risk

Important Considerations

PSA levels increase with age, urinary tract infection, recent ejaculation, and vigorous cycling. A single elevated PSA should be rechecked. PSA velocity (rate of change) is more meaningful than absolute values for cancer detection.

Conditions Affecting PSA Levels

• ✓ Prostate Cancer: Most concerning cause of elevation
• ✓ Benign Prostatic Hyperplasia (BPH): Prostate enlargement common in aging
• ✓ Prostatitis: Prostate inflammation or infection
• ✓ Urinary Tract Infection: Can temporarily elevate PSA

Screening Recommendations

Medical organizations vary on screening recommendations. Generally, informed decision-making is recommended for men 40-69 years old. Men at higher risk (African American men, those with family history) should discuss screening at age 40. Risk-benefit discussions should precede testing.

Further Evaluation After Elevated PSA

1. PSA Recheck

Elevated PSA is often rechecked to confirm elevation, as levels can fluctuate.

2. Free PSA Percentage

Distinguishes benign from malignant elevations. Low free PSA percentage increases cancer risk.

3. Digital Rectal Exam (DRE)

Physical examination assessing prostate size and abnormalities.

4. Transrectal Ultrasound and Biopsy

Performed if cancer is suspected to obtain tissue diagnosis.

Preparation for PSA Test

No special preparation is required. Avoid recent ejaculation (48 hours before test if possible), intense exercise, and urinary tract procedures. A simple blood draw provides the sample.