Prostate Specific Antigen (PSA) is a protein produced in the ducts of the prostate. PSA is released with the ejaculatory fluid (semen) and makes thickened semen runnier, which helps sperm travel more easily2.
PSA is produced by both normal and malignant prostate cells, and is absorbed into the bloodstream. The amount of PSA found in the blood stream can be measured and aid in providing information regarding prostate health2.
This page is a resource to help you learn more about PSA testing so that you can take better control of your health and make the decisions that are right for you.
PSA testing, or a PSA blood test measures the amount of PSA found in the blood. The PSA level that is considered normal for an average man increases with age and can range from 0 to 4 nanograms per milliliter (ng/ml)2.
PSA levels in the blood increases with prostate size, age, and can also increase with prostate disease such as BPH, prostate cancer and prostatitis (infection of the prostate)2. The PSA test can be combined with a digital rectal exam for a more accurate guide to early cancer detection. A PSA test might be conducted to confirm a diagnosis of prostate cancer, for physicians to plan a procedure roadmap to manage or remedy a prostate condition, or for doctors to monitor if prostate cancer has returned.
PSA testing can be an option for men who may meet certain personal risk factors for prostate cancer such as genetics. When your PSA levels are high, your doctor can work with you to determine what the causes are and go over all follow-up options and next-steps. It is important to note that there are a variety of limitations associated with PSA testing as it may not be the right course of action for everyone. Your doctor can help you decide your risk levels and what testing is right for you.
Follow-up care, such as additional tests or a biopsy may be required if it is established that your PSA levels are high after a PSA test. Here are some examples of additional testing:
References
1. Canadian Cancer Society. (2020). Prostate-Specific Antigen (PSA) Test. Retrieved from: https://www.cancer.ca/en/cancer-information/diagnosis-and-treatment/tests-and-procedures/prostate-specific-antigen-psa/?region=on
2. National Cancer Institute. (2011, August). Understanding Prostate Changes. Retrieved from: https://www.cancer.gov/types/prostate/understanding-prostate-changes/prostate-booklet.pdf.
Ultimately, PSA testing is an important tool in the early detection of prostate abnormalities, because while Benign prostatic enlargement and prostatic injury may also raise the PSA level, PSA testing is the primary method for identifying the possibility of prostate cancer . The PSA test is recommended at least every two years for men starting at age 55 and for those at increased hereditary risk at age 40, with results guiding further diagnostic evaluation. This pamphlet has been prepared so that you can learn about PSA testing and the role that it may play in your continued prostate health.
PSA testing, sometimes simply called the PSA test, is a simple blood test that quantifies the level of PSA in the bloodstream. The level of PSA that is considered normal, produced by healthy prostate tissue, varies with age and can range from 0 to 4 nanograms per milliliter (ng/ml) for an average man. . By comparing your PSA level with age-based reference ranges, your clinician may determine whether further evaluation is warranted. Normal PSA results do not always indicate the complete absence of cancer, and elevated results may not automatically mean cancer is present, so a range of diagnostic follow-up, including imaging studies and possible tissue biopsy, can confirm or exclude the presence of malignancy.
PSA concentrations in serum are influenced by factors such as prostate volume, advancing age, and particular prostate pathologies, including benign prostatic hyperplasia (BPH), prostate malignancy, and prostatitis. When used in conjunction with a digital rectal examination, the serum PSA assay provides a more nuanced basis for the early identification of prostate cancer. Circumstances warranting the PSA investigation include the need to corroborate an initial cancer diagnosis, to inform a comprehensive treatment strategy for a prostate disorder, and to surveil for the potential biochemical recurrence of prostate malignancy post-intervention.
Eligibility for PSA screening can reasonably extend to men possessing certain genetic predispositions, a category in which hereditary prostate cancer syndromes are noteworthy. When levels of PSA are elevated, healthcare providers may delve into differential diagnosis, execute an algorithm of confirmatory testing, and consider a spectrum of interventional or observational strategies. However, it is crucial to recognize the inherent limitations of the PSA assay; its specificity and sensitivity are not uniformly ideal across all populations. A clinician can evaluate individual risk factors, contextualize PSA results, and recommend the most appropriate diagnostic or surveillance protocol.
When elevated PSA levels are confirmed by testing, further evaluation is often warranted to clarify the underlying cause. The following are commonly implemented diagnostic steps:
These investigations are intended to guide clinical decision-making and may lead to consideration of a prostate biopsy if suspicion remains.