Free PSA (Prostate specific antigen) Test: Procedure, Purpose, Results, Normal range, Cost, Price, Online booking

What is Free PSA (Prostate-specific antigen) test?

Prostate-specific antigen is a protein that is secreted by the prostate gland in men. Prostate is a small gland located below the urinary bladder. Most of the PSA is released in the semen (PSA facilitates the passage of sperms in the fallopian tube), some amount of PSA also goes into the bloodstream. The levels of PSA in men may increase slightly with age and as the prostate gets bigger. However, PSA levels also surge in certain conditions that range from prostate inflammation to prostate cancer.

The prostate-specific antigen is present in two forms in the blood—attached to proteins and in free form. Together, they form the total PSA. Since high levels of prostate-specific antigen may be seen in conditions other than prostate cancer, the total prostate-specific antigen test cannot say for sure if the levels are increased due to prostate cancer. Thus, this test is only used as a screening tool and not as a diagnostic test for prostate cancer.

Free prostate-specific antigen test can be employed as a confirmatory test after a prostate-specific antigen test to estimate your risk of prostate cancer. Free prostate-specific antigen percentage also evaluates the aggressiveness of the cancer.

The percent-free prostate-specific antigen is a ratio of the free prostate-specific antigen to the total prostate-specific antigen.

A low free prostate-specific antigen percentage indicates a greater risk of prostate cancer and vice versa. Low free prostate-specific antigen percentage could also indicate high-grade cancer, whereas a high free prostate-specific antigen percentage indicates a slow-growing tumour.

Why is Free PSA (Prostate specific antigen) test performed?
How do you prepare for a free PSA (Prostate Specific Antigen) test?
How is free PSA (Prostate Specific Antigen) test performed?
Free PSA (Prostate Specific Antigen) test results and normal range

Why is Free PSA (Prostate specific antigen) test performed?

Your doctor may order this test if you are above 50 years of age or if your brother or father has prostate cancer. You may also be asked to get this test if you have the following symptoms of prostate cancer:

This test may be used to determine the effectiveness of prostate cancer treatment, such as radiation, surgery, chemotherapy or hormone therapy. During treatment, the levels of prostate-specific antigen fall drastically. Your doctor may order this test regularly to check if the cancer has relapsed.

Free PSA test can be performed instead of a biopsy to rule out prostate cancer. However, a biopsy may be required if the free prostate-specific antigen levels indicate the risk of cancer. The test can also provide the doctor information on how aggressive the cancer is if it relapses after treatment.

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How do you prepare for a free PSA (Prostate Specific Antigen) test?

No particular preparations are required. You do not need to fast either. Abstain from ejaculating for three days before the test. If you are on any medicines, inform your doctor as some drugs affect the results of this test.

For example, male hormones such as testosterone may increase the levels of prostate-specific antigen in your body. Drugs that may lower the levels of prostate-specific antigen are:

5-alpha reductase inhibitors, such as finasteride and dutasteride
Herbal mixtures
Aspirin
Statins, such as atorvastatin, rosuvastatin and simvastatin
Thiazide diuretics, such as hydrochlorothiazide

How is free PSA (Prostate Specific Antigen) test performed?

This test will be performed on a blood sample taken from a vein in your arm. Sample collection only takes a few minutes. A lab technician will place the sample in a labelled container and immediately send it to the laboratory for testing.

You may feel slight pain as the needle is inserted. Some people also get a temporary bruise at the venipuncture site, it generally goes away in a few days.

If you tend to feel uneasy at the sight of blood, please inform your doctor or nurse so that they can look after you better.

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Free PSA (Prostate Specific Antigen) test results and normal range

The prostate-specific antigen-free test helps to avoid unnecessary prostate biopsies. If your total prostate-specific antigen levels are in the borderline range of 4-10 ng/mL (nanograms per millilitre), a prostate-specific antigen-free test is done to decide if you need a biopsy.

The table below outlines the probability of prostate cancer based on the free prostate-specific antigen percentage when the total prostate-specific antigen is between 4 and 10 ng/mL:

Percent-free prostate-specific antigen	Probability of prostate cancer
0%-10%	56%
10%-15%	28%
15%-20%	20%
20%-25%	16%
>25%	8%

The following factors are considered while interpreting the results:

Race
Age
Family history
Prostate-specific antigen velocity (the rate of change from the previous test results)
Findings on digital rectal examination

Disclaimer: All results must be clinically correlated with the patient’s complaints to make a complete and accurate diagnosis. The above information is provided from a purely educational point of view and is in no way a substitute for medical advice by a qualified doctor.

References

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Xiaomei Ma. et al. The Cost Implications of Prostate Cancer Screening in the Medicare Population. Cancer. 2014 Jan 1; 120(1): 10.1002/cncr.28373. PMID: 24122801
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