What is PSA test for prostate cancer

What Do High Levels In A PSA Test Indicate

The cells in the prostate gland produce a protein called the Prostate Specific Antigen (PSA) that can be present in both normal and malignant cells. The prostate gland exists in men and is responsible for producing semen. Cancer in the prostate can either grow in a benign state or a malignant state.

What is PSA test for prostate cancer - medicametrix

There are two ways cancer can progress: in the benign state a person may be asymptomatic or in the early stage of progression. As such, the course of action may only require surveillance or monitoring through frequent medical tests and management of the condition. In the malignant state, the cancer cells may either grow slowly and be confined to the prostate gland or rapidly spread to other parts of the body. Here, early detection of prostate cancer may be key to diagnosing and treating the condition. Depending on the medical intervention, it can increase the survival rate of a prostate cancer patient.

PSA or Prostate Specific Antigen is used to measure the specific cells in the prostate and is not meant to detect cancer. Another function of the Prostate Specific Antigen (PSA), is to help aid urine control. There may be several reasons for increased levels of PSA:

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  • With an increase in age, older men may tend to be detected with higher levels of PSA
  • PSA levels can alter and change in their values – due to lifestyle choices, obesity, inflammation in the prostate or, because of some medical treatments
  • If you get a score lower than 4ng/ml it does not necessarily indicate the absence of prostate cancer – in fact, other tests need to be done in combination to detect it

There are several home PSA test options available in the market. This requires taking a blood sample to determine the PSA levels in the blood. Higher scores have shown to indicate proclivity to higher risks. However, a standalone test may not be conclusive. To get a PSA home test kit, a person may also need to meet certain risk criteria. It is not advisable to do a self-examination as only a skilled medical practitioner would be able to assess or give you an accurate diagnosis. Self-examination may also lead to the risk of injury. If you are experiencing symptoms related to prostate cancer, you must immediately consult your doctor.

Types of screening methods used commonly to detect prostate cancer:

  1. Digital Rectal Exam (DRE) – A doctor uses a glove that is lubricated by inserting a finger into the rectum to feel the prostate gland. It may be accompanied by an ultrasound.
  2. A blood test measuring PSA levels. There are many types of PSA tests such as 4K Score Tests, Prostate Health Index (PHI) or, Percent-free PSA. These may be a little more advanced, so if the results are abnormal, then your doctor may refer you to a different type of PSA blood test.
  3. A biopsy may be conducted from the results of PSA levels determination and/or rectal exam; herein a small amount of tissue from the prostate is extracted and sent for testing.
Significance and functioning of PSA Tests

There are many types and stages of prostate cancer. Some may be detected as being benign (also known as slow-growth cancers) and some might be extremely aggressive. The first step is to take a PSA test, accompanied by Grade Tests and Gleason Scores. These will be touched upon later in this article. Several biopsies and tests will determine the nature of the prostate gland if the screening criteria are met. Sometimes it may just be inflammation and enlargement of the prostate with no presence of cancer cells in them. There are four stages of cancer progression. If the cancer spreads beyond the prostate to other parts of the body, then your doctor may advise immediate treatment or even surgery.

Higher PSA levels may be observed but no Prostate cancer will be detected in some cases. In fact, men who are obese need biopsies if the PSA score is low. Another condition known as Benign Prostatic Hyperplasia (BPH) causes inflammation in the prostate gland; increasing the PSA levels significantly. The PSA is the best test for early-stage detection, especially for men under 40 years. Your doctor may not immediately start any treatment if your test returns higher levels. Several tests and biopsies will need to be conducted and scores have to be observed over a period of time.

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The PSA Test is a blood test whose primary function is to screen for prostate cancer. It helps detect the amount of PSA levels in the blood and is measured as ng/ml in the blood. The PSA test can detect any spike in PSA levels, which may be indicative of cancer. However, there are a lot of conflicting studies on PSA testing and it may no longer be the sole method of detecting prostate cancer.

The PSA levels can neither be considered normal or abnormal. Research has found that men detected with Prostate cancer seem to have higher levels of PSA. Given below in the table are permissible limits and dangerous levels. If your levels are higher than 2.5 ng/ml, talk to your doctor about the risks involved. If your levels are higher than 10 ng/ml then there is a very high chance of you being detected with prostate cancer.

PSA levels an their indication by Medicametrix

PSA levels tend to go up with age. As such, your doctor may recommend age-specific screening. It does not indicate that you have prostate problems. Certain medication which are Dutasteride/Finasteride-based may also affect PSA levels. These drugs can suppress them throwing up inaccurate test results.

In accordance with the guidelines laid down by the American Urological Association these are the age-specific screening tests to be taken:

  • If you are under 40 then no screening is required
  • Between ages of 40-54 years if you are at average risk (no genetic history, ethnicity, lifestyle stress, etc.); you may choose not to get screened but if you are at high risk then it is advisable to get screened
  • Between ages of 55-69; screening is as per doctor’s advice
  • If you are over 70 years, you can choose to avoid screening and opt for supportive healthcare if life expectancy is lower

There are some alternative tests, other than the PSA which can help your doctor arrive at a need for a biopsy. Sometimes these tests can be inconclusive or hard to detect the presence of cancer:

  1. Percent-free PSA: The PSA exists in two formats – attached to blood proteins or the ones that are free to move about in the bloodstream. The test shows how much of the PSA moves freely compared to the total PSA level. The amount of free PSA is found to be lower in men who are diagnosed with prostate cancer. If the PSA levels are somewhere between 4 to 10 then there is a chance you may have prostate cancer and may need to get tested. In some cases, a biopsy may also be ordered by the doctor.
  2. Urine PCA3 test: The test is used to match a genetic mix similar to those men who are detected with prostate cancer with more than 50% test results reliability for matching. This also can be used to initiate a biopsy.
  3. PSA velocity: This may be considered as a part of the PSA test wherein any changes in the PSA level is measured over a period of time. Even in conditions, where the PSA level may be within acceptable limits, a higher PSA velocity may indicate the presence of a malignant cancer.
Are PSA tests alone sufficient to determine Prostate Cancer?

A PSA test may prove to be useful in the early detection of prostate cancer. Some men may have an elevated PSA (> 4 ng/ml) due to age, obesity, BPH or, other causes. Hence, there may be non-cancerous causes that may see a PSA level spike. In fact, research shows that almost 70-80% of the men who undergo a biopsy or ultrasound do not have cancer. Sometimes the PSA test does not determine the presence of cancerous tissues. As a result, a man’s age is considered before PSA levels are measured over a period of time. This allows it to be used as an indicator to track the PSA levels over a period of time.

There is considerable research being done to improve testing and screening of prostate cancer. Biomarkers and antigens are being identified, which when found in elevated levels can only be an indication of prostate cancer. There are other methods used in combination with the PSA tests that can be more effective.

Grade Group is assigned on prostate biopsy where a prostate tissue is extracted and examined under the microscope to the semblance of a normal prostate tissue. A grade is then given based on the growth rate of the abnormal cells.

A Gleason score on the other hand ranges from 1 to 5. It assigns a lower score to a tissue that looks healthy or a higher score if tissue is abnormal. Both tests may be used to increase the accuracy in the detection of growth and the likelihood of cancer cells spreading. These tests together may be considered much more reliable than PSA tests alone.

Pros of PSA screening
  • An early detection can help you get treated early and in an informed manner with choices for treatment options
  • As such cancer is treatable more easily when it is confined to the Prostate rather than when it becomes malignant and starts spreading to other parts of the body
  • The testing method is simple and can be done via a blood test
  • Once the test is done, it can provide some assurance especially if you are in the high-risk group and you may opt for future tests
  • The simple testing method has led to the decline of prostate cancer deaths over a course of time. However, this could be due to other reasons as well, such as improvement in medical and healthcare facilities, healthcare becoming more accessible, and increased awareness
Cons of PSA screening
  • If the prostate cancer is just benign and never grows beyond the prostate then the test can cause more anxiety for the patient
  • Not all prostate cancers may need immediate treatment as getting certain treatments may have side effects, cause urinary incontinence and, in severe cases, even erectile dysfunction
  • These tests may not be 100% accurate as even with increased PSA levels, prostate cancer may be absent
  • Follow up testing may be expensive, stressful or, even invasive
  • If the cancer is a slow-growing one, then the stress of having to live with it can be difficult
Causes for high PSA levels

Reasons for high PSA - medicametrix

There are many risks that can determine prostate cancer and there may be many reasons for high PSA levels. In fact, higher PSA levels may not indicate prostate cancer. Some of these reasons include:

  1. Age: PSA levels seem to increase with age and have no direct correlation with prostate cancer. This may be due to the growth of benign, prostatic tissue. Enlargement of the prostate can also lead to an increase in PSA levels.
  2. BPH: Another common reason is Benign Prostatic Hyperplasia (BPH) which largely affects the bladder and urinary tract. The enlargement happens possibly from hormonal changes as men get older. Medication includes alpha-blockers or alpha-reductase inhibitors.
  3. Urinary Tract Infection: An UTI can be detected with a urine test and common symptoms include a constant urge to urinate, incontinence, loss of bladder control, burning sensation/pain, and lower back pain. A UTI is also found to increase PSA levels.
  4. Prostatitis: This may be caused by a bacterial infection and causes inflammation and pain in the prostate gland. It may also cause pain in the abdomen, discomfort passing urine or also cause flu-like symptoms. There is also a possibility of nerve damage in the urinary tract that could lead to Prostatitis.
  5. Post-ejaculation: A few studies have confirmed an increase in PSA levels for up to 24 hours in some men after ejaculation, however, more research is needed to fully understand the effects of ejaculation and PSA.
  6. Prostate Injury: Any injury sustained by a fall or accident may also increase the PSA levels temporarily

It is important to remember that prostate cancer will cause an increase in PSA levels and you must follow your doctor’s recommendation for testing and treatment. Along with a PSA test, you may be recommended other screening tests such as a DRE, or ultrasound or a biopsy even. Your doctor may also recommend these tests if you are over 50 years or belong to a high-risk category. This may include ethnicity as African American men are at higher risk than Asian men. Another risk criteria is a family history of prostate cancer.

If your doctor recommends a biopsy, it’s better to fully understand all the risks associated with it. Holding off on further tests if the cancer growth is in the benign stages may be better. Talk to your doctor about the various options that are available. You may even get a second opinion about your current care options. Prostate cancer when detected early is treatable and it is important to keep a positive mindset.

A myth surrounding prostate cancer is that surgery or chemo are always necessary. There are other options from the several treatments available. Some tumors may be aggressive and others might progress slowly over years. If the cancer has grown over several stages and has spread to many parts of the body, then there are options for immediate surgery and radiation. The risks can be determined based on family genetics, age, and ethnicity. Men with lower risk can also be monitored with active surveillance. This means getting frequent PSA level tests, biopsies or DREs.

Consuming a low-fat diet with replacements for red meat, unhealthy oils and dairy products helps manage weight and lowers the risk of heart disease. Increasing intake of fruits and vegetables is beneficial due to their vitamin and nutrient content. It has been found that soy-based products lower PSA levels as they contain isoflavones, which have anti-inflammatory properties. Exercising every day for 30 minutes, being active and moderate exposure to the sun is beneficial. Vitamin D intake is also beneficial in reducing prostate cancer risk. Prostate massage therapy has also proven to aid in clearing prostatic ducts or any excess fluid.