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What is a Prostate-specific Antigen (PSA) test?

A PSA test measures the amount of Prostate-specific Antigen, a protein present in both healthy and cancerous cells of the prostate gland. Prostate gland is part of the male reproductive system that produces the fluid which carries sperms during ejaculation.

A PSA test is generally performed along with a digital rectal exam (DRE) to check for prostate cancer and determine the nature of the problem in men who may or may not experience any apparent symptoms of the condition.

  1. Why is a PSA test performed?
  2. How do you prepare for a PSA test?
  3. How is a PSA test performed?
  4. What do PSA test results indicate?

PSA test is performed to:

  • Detect prostate cancer
  • Monitor if prostate cancer has reduced or is growing after treatment
  • Check for cancer relapse
  • Detect a benign prostate condition
  • Detect inflammation in prostate gland
  • Detect infection in prostate gland

This test is generally recommended for men aged 50 years or older. It is also recommended for men aged 40-45 years with a family history of prostate cancer and other risk factors to check for prostate cancer. PSA test cannot be used as a diagnostic test for prostate cancer. It is done with the help of a prostate biopsy.

Men should refrain from sexual activity for about three days before this test, as ejaculation can increase PSA levels.

Riding a bicycle before the test may alter test results so it should be avoided.

Inform the healthcare provider about any recent needle biopsy of the prostate or cystoscopy, as these examinations can increase PSA levels for a few weeks.

Also, it is important to tell the doctor about any recently treated urinary tract infection along with information regarding the use of medications, supplements, herbs, illegal drugs, vitamins and prescribed drugs before the test.

A blood sample is collected in a tube from a vein in the arm using sterile needles. The area from where the blood is to be taken is cleaned with an alcohol swab before collecting blood and covered with a bandage or small gauze after sample withdrawal.

The risks of blood collection include bleeding, bruising, infection, light-headed feeling, haematoma (accumulation of blood under the skin), and multiple punctures on skin when trying to locate a vein. Some people might experience a stinging or pricking pain at the site of injection. The area might feel sore after a while. However, most of these signs would disappear quickly.

Normal results: PSA levels of 4.0 ng/mL are considered to be normal. Some healthcare providers use the following age group ranges to define the normal levels of PSA:

  • 40 to 49 years: 0-2.5 ng/mL
  • 50 to 59 years: 0-3.5 ng/mL
  • 60 to 69 years: 0-4.5 ng/mL
  • 70 to 79 years: 0-6.5 ng/mL

Abnormal results: Higher than normal PSA levels indicate the possibility of prostate cancer. Other conditions that increase PSA levels in blood include:

  • Recent tests performed on the prostate, such as a biopsy, or the bladder, such as cystoscopy
  • Recent ejaculation or sexual intercourse
  • Benign prostate hyperplasia
  • Urinary tract infection
  • Prostatitis (prostate infection)
  • A catheter tube that was recently placed into the bladder to drain urine
  • Excess doses of chemotherapeutic medications

Men at high risk of cancer might have to undergo another PSA test within three months, a prostate biopsy to confirm PSA results and a follow-up test called free PSA (fPSA).

If PSA levels continue to rise, a DRE test, urine test, cystoscopy, transrectal ultrasound and x-rays might be recommended to detect the nature of the problem. If an individual has high PSA levels without prostate cancer, the doctor might continue to perform PSA and DRE test to monitor any changes in PSA levels over time. A magnetic resonance imaging (MRI) scan of the prostate gland might be recommended to identify cancer in certain areas of the prostate gland, which are difficult to be tested using a biopsy.

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 perspective and is in no way a substitute for medical advice from a qualified doctor.  

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References

  1. National Cancer Institute [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; Prostate-Specific Antigen (PSA) Test
  2. Harvard Health Publishing. Harvard Medical School [internet]: Harvard University; Understanding the Prostate-Specific Antigen (PSA) Test
  3. Morgan TM, Palapattu GS, Partin AW, Wei JT. Prostate cancer tumor markers. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016:chap 108.
  4. National Cancer Institute [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; Prostate Cancer Screening (PDQ®)–Health Professional Version
  5. US Preventive Services Task Force, Grossman DC, Curry SJ, et al. Screening for Prostate Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2018;319(18):1901-1913. PMID: 29801017
  6. University of Rochester Medical Center [Internet]. Rochester (NY): University of Rochester Medical Center; c2017. Health Encyclopedia: Prostate-Specific Antigen (PSA)