The PSA test detects the level of prostate-specific antigen (PSA) that is produced by a man’s prostate gland. Elevated levels of PSA are indications that something is wrong with the prostate – it could be enlarged, inflamed or have a malignancy. However, just because the test shows high PSA levels, doesn’t mean you should assume something is wrong with your prostate.
Doctors consider a PSA level under 4 nanograms per milliliter (ng/mL) as normal, though there are some men with prostate cancer who have PSA levels that are lower than this. Some medical experts recommend that the cutoff point be less than 2.5 or 3 ng/ML, especially if the patient is young.
The levels of PSA taken at any one time should not be the only indicator of disease, according to experts. Most men with elevated PSA levels have an enlarged prostate, and this is simply a sign of aging, but not necessarily an indicator of cancer. The patient’s doctor also needs to observe how the levels are trending. If they are going up very quickly, the doctor might conduct more extensive tests to check for prostate cancer.
What Is the PSA Test and Who Is It For?
The traditional PSA test is a simple blood test. A vial of blood is taken, sent to a lab, and the results come back within a few days.
The American Cancer Society recommends that patients consult with their doctors about completing a PSA test when they are over the age of 50 or have an unusually high risk for prostate cancer. Other than that, the test isn’t recommended for men under 40 years old or for men between 40 and 54 who aren’t considered high risk for the disease. The test is also not recommended for men who are over 70 and who are expected to not live more than 10 to 15 years because prostate cancer is usually such a slow growing cancer.
Some medical experts do not recommend the PSA test for men of any age. They believe that prostate cancer screenings cause over diagnosis when small, benign tumors are found, which otherwise would have gone unnoticed. The test can also bring about false positives and false negatives, leading to unnecessary stress and anxiety.
A doctor who has a patient with high readings may follow the test with a biopsy of the prostate to look for cancer. Though a biopsy is usually safe, it’s not completely risk-free.
New Types of PSA Tests
Researchers have recently developed new forms of the PSA test that seem to be more accurate when it comes to identifying prostate cancer. These new tests are:
- Percentage free PSA. The percentage free PSA tells the doctor how much of the antigen is circulating freely in the blood and compares this to the man’s total PSA. Free PSA is lower when the patient has prostate cancer.
- PSA velocity test. The PSA velocity test tracks the levels of the antigen over a period of time. If a man has the test one year and has an increase that’s larger than 0.75 ng/mL the next year, it indicates that he may have a malignancy, and a biopsy should be performed.
- Urine PCA3. A urine test called the PCA3 looks for abnormal genes that are found in about half of men with prostate cancer.
Should I Get a PSA Test?
The PSA test is a useful but not flawless test. It does remind both doctor and patient to be vigilant when it comes to checking for prostate cancer, but as with anything, it also has its risks.
Before you have any type of prostate exam done, talk to your doctor or an experienced urologist about the benefits and risks for your particular prostate health situation.