Prostate cancer is a life-threatening condition, and it is important to start a treatment early. In order to diagnose prostate cancer and to determine how effective the treatment is, you will have to take the prostate-specific antigen (PSA) test. This blood test checks the levels of PSA in your body. PSA, also known as kallikrein-3, is a substance originally produced by your prostate cells, and elevated PSA levels may indicate other conditions like an enlarged prostate or prostatitis.
What Is PSA?
Your prostate cells produce this protein that biochemically belongs to the protease family of kallikrein. Most of the PSA produced in your body will go out through semen, which works to liquefy the semen after ejaculation. Under normal circumstances, only a very small amount of PSA may escape into the blood stream, and elevated levels in blood willusually mean that something isn't just right.
When Is a PSA Test Needed?
You have to undergo a PSA test if:
- Your doctor suspects your symptoms signal prostate cancer. Your physician may also recommend a prostate biopsy for correct diagnosis because other conditions such as enlarged or inflamed prostate may also increase PSA levels.
- The results of a digital rectal exam or other tests aren't normal. In this case, your doctor orders a PSA test to check if cancer is present or not. A PSA test may not confirm you have cancer, but it confirms whether you should go for further screening or not.
- You're undergoing prostate cancer treatment. Through PSA tests, your doctor can keep an eye on your PSA levels that if the levels increase, it usually means the cancer grows. PSA isn't detectable when you have your prostate gland removed. If you're still noticing a PSA level, it usually means that cancer has returned or spread.
What Is a Normal PSA Test Result?
The normal PSA range will change with age. Generally, it is normal:
- For people between age 40 and 49 to have PSA level around 2.7 ng/mL.
- For people between age 50 and 59 to have PSA level under 3.9 ng/mL.
- For people between age 60 and 69 to have PSA level under 5.0 ng/mL.
- For people between age 70 and 75 to have PSA level under 7.2 ng/mL.
It is worth mentioning that even if your PSA levels are abnormally high, it doesn't mean you have cancer. However, sometimes, the PSA test can also miss cancer completely. In fact, the studies show that 15 out of every 100 men with prostate cancer will have a PSA level within the normal range. It is, therefore, important to repeat the testing or go for additional testing to make a correct diagnosis.
What's more, some factors may affect the result of a PSA test. For instance:
- Several conditions can raise PSA levels and affect the result. The conditions include an inflamed prostate, an enlarged prostate and more. The levels will go up as you age.
- Many drugs may lower PSA levels. Certain drugs used to treat urinary conditions may lower your PSA levels. Similarly, large doses of specific medications used during chemotherapy may also lower PSA levels.
- The test result can be misleading in some cases. An elevated PSA level doesn’t qualify to the fact that you have cancer, whereas a normal PSA level doesn't mean you cannot have prostate cancer.
- Over diagnosis. Many studies have confirmed that between 17 and 50 percent of men who had prostate cancer detected by PSA test would never show any symptoms during their lifetimes. Treating these symptoms-free prostate tumors is known as over-diagnosis because a person can lead a healthy life with such type of prostate cancer.
What If a PSA Test Shows an Elevated Level?
If you don't have any symptoms of prostate cancer, but your test show elevated PSA level, your doctor will ask for another PSA test to ensure the first result was correct. If the PSA level is still abnormally high, the doctor may recommend you to continue with PSA tests and DREs (digital rectal examinations) at regular intervals to notice any change over time.
If your doctor finds a suspicious lump during a DRE and notices your PSA level going up, he may suggest you to undergo some additional tests to make a correct diagnosis. A urine test is usually a good way to diagnose a urinary tract infection, but the physician may also ask you to go for imaging tests, such as x-rays, transrectal ultrasound or cystoscopy.
If your healthcare provider finds more signs of prostate cancer, they may recommend you to have a prostate biopsy that involves taking out multiple samples of prostate tissue for examination. During the procedure, the surgeon will insert hollow needles through the wall of the rectum to collect prostate tissue. Some surgeons may choose to insert the needles through the skin between the anus and the scrotum. After that, a pathologist examines the prostate tissue to diagnose prostate cancer.
Words about PSA Test for Patients with Prostate Cancer
The simple purpose of conducting a PSA test for patients with prostate cancer is to ensure that a prostate cancer has not returned after treatment. When you have already been treated for prostate cancer, an elevated PSA level, which is usually the first sign of a recurrence, will suggest that your cancer has returned.
The doctor may decide to conduct multiple PSA tests to confirm the findings and may even ask for additional tests to confirm a recurrence. Be sure to follow the advice of your health care provider when you notice an elevated PSA level for the first time after successful cancer treatment.