The PSA test stands for Prostate-Specific Antigen, a protein produced by the cells of the prostate gland. Its job is to help keep the semen liquid so the sperm can swim freely.
PSA usually hangs around the prostate gland and semen, but small amounts can also move into the bloodstream and be measured by a blood test called the PSA Test. You can have an elevated PSA if your prostate becomes inflamed for any reason as a result of infection or BPH. The PSA test is also one of the methods used to detect prostate cancer as elevated levels of PSA are present in the blood of men who have the disease (although there are other reasons for an elevated PSA unrelated to cancer). Note that you may have no symptoms of prostate cancer but still have an elevated PSA.
The PSA test is also used to monitor the effects of treatment for cancer, including surgery, radiation, chemotherapy, or hormone therapy, to determine if the therapy is effective and to chart the progress of the disease before and after treatment.
The PSA test is a simple blood test that is part of a prostate screening decision made between you and your doctor. Until May 2012, the general consensus among the medical community was that starting around age 40 to 50, depending on an individual’s risk factors, men should undergo PSA testing. But at that time, the US Preventive Services Task Force (USPSTF) announced it was not recommending PSA testing for men because it believed the risks outweighed the benefits. This new recommendation met strong resistance from doctors as well as organizations such as the American Urological Association, the American Cancer Society, and others, all of whom believe the PSA test, although not perfect, is still a viable tool for prostate cancer screening
Until recently, a PSA level less than 4.0 ng/mL (nanograms per milliliter) was considered normal and safe. Today the safe limit is thought to be lower than that, but no one is quite sure what that level should be. (Prostate Specific Antigen Test [PSA] National Cancer Institute).
|Standard PSA Levels|
|0 to 4.0 ng/mL is considered safe|
|4.0 to 10.0 ng/mL is suspicious|
|> 10.0 ng/mL is dangerous|
Because of these arbitrary guidelines, many men with PSA levels slightly greater than 4.0 used to undergo prostate biopsies and other advanced diagnostic tests designed to detect prostate cancer. However, studies revealed that 65 to 75 percent of men who had elevated PSAs who underwent prostate biopsies did not have prostate cancer, while some men who had so-called “safe” PSA levels did have cancer. At this time, the medical community still has not reached a consensus on which PSA levels are “safe,” “suspicious,” and “dangerous”.
Doctors do agree however that the risk of finding prostate cancer rises as the PSA levels goes up. According to the American Cancer Society, a PSA level between 4.0 and 10.0 ng/mL means a man has a 25 percent chance of having prostate cancer, while a PSA greater than 10.0 ng/mL indicates a 50 percent risk. Remember, however, that these numbers reflect risk only: many men who have elevated PSA levels do not have prostate cancer.
Clinicians are also interested in PSA velocity, which is a measurement that considers annual changes in PSA values. Such changes rise more rapidly in men who have prostate cancer than in those who do not. Measuring a man’s PSA velocity can be useful in detecting prostate cancer in its early stages in men who have mildly elevated PSA levels and a normal digital rectal exam, and in predicting cancer when PSA changes are followed over at least one to two years.
In a study from Johns Hopkins and the National Institute on Aging, for example the investigators reported that a rise in PSA levels of more than 0.75 ng/mL per year was an early indicator of prostate cancer among men who had a PSA level between 4 ng/mL and 10 ng/mL. Another study, published in the New England Journal of Medicine, evaluated 1,095 men with prostate cancer and looked at their PSA levels one year before as well as at diagnosis. They found that a rapid increase in PSA level (more than 2 ng/mL) over one year before diagnosis of prostate cancer or surgery predicted a higher likelihood that a man would die of prostate cancer over the next seven years. (D’Amico)
In fact, PSA velocity may be even more predictive, according to a Johns Hopkins study. H. Ballentine Carter, MD, and his colleagues evaluated the PSA velocity of 104 men who had prostate cancer who had not died from the disease, 20 men who had died of prostate cancer, and 856 without prostate cancer. The investigators found that a man’s PSA velocity 10 to 15 years before they received a prostate cancer diagnosis was associated with survival 25 years later: those with a lower PSA velocity (0.35 ng/mL or less per year) had a 92 percent survival rate compared with a 54 percent survival rate among those with a higher PSA velocity (greater than 0.35 ng/mL). (Carter)
If your PSA is considered high your doctor may choose to do additional tests that may initially include:
- Digital rectal examination (DRE) (if your doctor has not already done so as part of your general examination);
- Transrectal ultrasound;
- Computed tomography scan (or one of several other scans); or
- Prostate biopsy
If no disease is found after any additional tests then your doctor may recommend ways to lower your PSA as part of a general approach to a healthy lifestyle
Generally speaking, a low PSA is a good result. However, if your PSA level is “artificially” pushed down, it could hide a rising PSA level that otherwise would be noticed and investigated.
If you take a statin drug to lower your cholesterol or you regularly use a nonsteroidal anti-inflammatory drug, such as ibuprofen or aspirin for headache or muscle aches, for example, these drugs can result in a “pushed down” PSA level. The same effect can occur if you are obese, which may be the result of body fat decreasing the amount of PSA that is in circulation in the bloodstream. Therefore if you fit into either of these categories, your PSA test results may not be as reliable a reflection of your prostate’s health as it could be. Thus it is important to tell your doctor if you are taking any of these medications.
Many factors can cause a rise in a PSA level, such as:
|• Advancing age
• Catheterization (have been recently catherized)
• Urinary tract surgery
• Use of certain chemotherapy drugs
• Recent ejaculation and having too much sex
• Use of sports supplements taken by athletes (especially body builders) that can cause a rise in testosterone level
• Riding a bicycle
• Sports injuries
• Having a digital rectal exam (DRE) of the prostate
• Prostate cancer (and the symptoms associated with it)
Some factors that can cause an elevated PSA have nothing to do with an unhealthy prostate. The PSA test is also not always 100 percent precise, and test results may vary from lab to lab.
In addition, if your prostate gland naturally happens to be very large or very small, your “normal” PSA level may be a bit higher or lower than the accepted average. So what’s normal for you may not be normal for the average man.
Generally, there is no formula to lower the PSA in healthy men. However because the PSA level is a reflection of the current state of the prostate, it makes sense to keep the prostate gland in optimal health.
The bottom line is a commonsense and basic one: practice good habits to promote prostate health which includes:
|Eat a healthful diet based on The Prostate Diet: The Prostate Diet has been designed to fight inflammation (which causes disease), help prevent prostate cancer, and keep your prostate functioning at its best.|
|Follow the 6 Pillars of Prostate Health|
|Exercise regularly: That means at least three times a week, but preferably, everyday.
|Reduce stress: Emotions place an immense load on the physical body including disruption of the natural hormonal balance.
|Lose weight: Studies show that being overweight and/or obese significantly increases your chance of prostate disease as well as decreases long term survival rates.|
|Practice safe sex: Unless you are in a monogamous sexual relationship with a partner you know to be STD free, be safe not sorry, and always practice safe sex.|
|Avoid additives and foods that can harm the prostate: Avoid additives and foods that can harm the prostate or have been shown to cause or increase the risk of cancer and prostate disorders.
|Take supplements: Supplements that have been shown to be beneficial for prostate health include:Vitamin D, Zinc, Saw Palmetto, Beta sitosterol, Pygeum africanum, Stinging Nettle Root, Rye pollen (cernilton), Quercetin and Green tea extract. Read more on best supplements for prostate health|
|Avoid exposure to toxins: Stay away from chemicals and other substances that can increase the risk of developing cancer.
|Lead a “prostate friendly” lifestyle: Read more on prostate health and lifestyle|
Generally, doctors consider an elevated PSA level to be a warning, but certainly not dangerous in and of itself. That is, treatment is reserved for the underlying problem, such as BPH, prostatitis, or prostate cancer, and not your PSA level. If your doctor runs whatever tests he or she believes are necessary and determines there is absolutely nothing wrong with your prostate, then there’s generally nothing to treat.
Some experts argue that the PSA is not that reliable because it can give false positive (indicating cancer that is not there) and false negative (missing prostate cancer that is there) results. In fact, roughly 80 percent of the 1.6 million men who undergo a prostate biopsy in the United States each year because of an elevated PSA level have negative results on their biopsy, according to Dr. Robert Getzenberg, MD, director of research at the Brady Urological Institute at Johns Hopkins.
Some cases of prostate cancer, especially those that grow rapidly, also may not produce much of an elevated PSA. This can result in a test result that incorrectly indicates that you don’t have prostate cancer when you do.
Overall, the downsides of the PSA test can be boiled down to the following:
- Concern about false-positive results that are caused by elevated PSA levels from something other than prostate cancer
- Having to undergo invasive, stressful, expensive or time-consuming follow-up tests such as a prostate biopsy
- Getting a false-negative result, leading to a missed diagnosis of aggressive prostate cancer that needs treatment
- Experiencing anxiety or stress caused by knowing you have a slow-growing cancer that doesn’t need treatment
- Having surgery, radiation, or other treatments that cause side effects that are more harmful than leaving the cancer untreated
As you can see, the simple act of getting the PSA test can result in many different scenarios. Thus it is important that you have a doctor who has lots of experience in interpreting PSA results along with any other information gathered from you and other tests as part of your prostate screening decision.
Want to read more about the PSA test and the Prostate Cancer Screening Process? Click here
References for the PSA Test:
Carter HB et al. Detection of life-threatening prostate cancer with prostate-specific antigen velocity during a window of curability. J Natl Cancer Inst 2006; 98: 1521-27
D’Amico AV et al. Preoperative PSA velocity and the risk of death from prostate cancer after radical prostatectomy. N Engl J Med 2004 Jul 8; 351(2): 125-35 the PSA test