PSA Tests for Prostate Cancer: The Test That Can Provide the Crucial Advantage of Early Detection

If you are visiting your doctor for a checkup or because of troublesome urinary or sexual symptoms, you may need to undergo several tests. Along with a general examination, your doctor will want to conduct a digital rectal examination (DRE) and prostate-specific antigen (PSA) blood test, to rule out prostate cancer, because PSA levels help indentify any abnormalities of the prostate, including but not limited to prostate cancer.

Prostate-specific antigen (PSA) is a protein enzyme produced in the prostate gland, and is found nowhere else in the body in significant amounts. The function of PSA is to liquefy semen so that sperm can better travel up the female reproductive tract. When the prostate is healthy, normally, a small amount of PSA is constantly released into the bloodstream. Since PSA is created by both normal and cancerous cells, large amounts found in the blood of some men strongly indicate prostate cancer. PSA levels can be high sometimes, although less often, in the blood of men who do not have prostate cancer.  PSA levels can increase when the prostate is irritated or damaged, or it could mean that your prostate is enlarged, in which the walls between the prostate and the bloodstream break down, allowing some of the PSA to escape into the blood.

Some doctors put the normal PSA levels range from 0.0 to 4.0, and believe there is a greater chance  of prostate cancer when PSA levels are higher.  Others believe the upper limit of a normal PSA level should be 2.5.  Many urologists believe that since most prostates increase in size as a man ages, the PSA level for prostate cancer should be adjusted for age.

Age-Corrected Limits for Normal PSA levels and Prostate Cancer Risk

Despite their differences in what should be considered normal PSA levels, experts can agree that PSA is a continuum, and to put it simply, the lower the PSA level is, the better it means for you. If you do have a mild to moderate increase in your PSA level, prostate cancer may be ruled out by other tests.  However, most agree that the higher the PSA level, the greater the risk is of developing prostate cancer. A PSA level that is higher than normal is very suggestive of prostate cancer.

When the disease is present, generally, the higher PSA level means prostate cancer is large and most likely has spread beyond the prostate. But the level of PSA cannot definitively determine the presence or absence of prostate cancer.  PSA levels alone do not provide enough information to distinguish between benign prostate conditions and prostate cancer, and PSA levels can only indicate that a prostate problem might exist. Your doctor will take the result of your PSA levels into account, along with other factors, then let you know if you should have additional testing.

Factors That Can Elevate PSA Levels (Other Than Protate Cancer)

Other factors can affect your PSA level besides prostate cancer. PSA levels may also be elevated due to medical procedures such as cystoscopy, (a test in which a slender tube with a lens and a light is used to see the bladder and urethra), prostate biopsy, or by massaging the prostate, which occurs during treatment for prostatitis, but should not be elevated by a normal digital rectal exam. PSA is also partially determined by genes, so some men have higher PSA levels on genetic basis alone. Some evidence points to strenuous bicycle and motorcycle riding as a reason for an increase PSA levels because of  the seat pressure on the prostate, but other studies disagree.  Also, a man’s PSA level may decreases after a long period of rest and increase slightly with movement. Other than prostate cancer, PSA levels can also increase from sexual activity, and for this reason, men are advised not to ejaculate for 2 days prior to having their PSA test for prostate cancer.

Abnormal PSA levels and prostate cancer may be disguised by certain drugs and supplements. PSA levels may be decreased in men who are obese and in men who are taking finasterie (Proscar) for BPH or finasteride (Propecia) to prevent baldness.  Several medicines and herbal preparations may lower blood PSA Levels, so tell your doctor if you are taking finasteride (Proscar or Propecia) or dutaseride (Avodart) or any supplement marketed for “Prostate Health.”  All these factors need to be taken into account when evaluating PSA levels and prostate cancer.

What A High PSA level May Mean

Though most men with prostate cancer have PSA levels in the 10s or 20s, PSA levels can go into the hundreds or even the thousands.  A reading at these higher levels almost always means you have advanced prostate cancer, Usually additional tests will show the cancer may have spread to the bones or the lymph nodes. Some prostate infections will push a PSA level up over 100 or higher but with treatment, within a few months, it returns to normal.

As stated earlier, a PSA level can be elevated for a number of reasons other than prostate cancer. PSA levels can increase because of any inflammation or infection of the prostate, simple enlargement or noncancerous growth of the prostate gland, in which there is more tissue to produce PSA, stones within prostate, a recent urinary catheter or procedure,  and recent prostate biopsies or r bladder surgery.

Factors Affecting PSA Levels (Not Prostate Cancer)

When used together correctly, the digital rectal exam (DRE) and the prostate-specific antigen (PSA) blood test can provide the best information to determine if the prostate gland has prostate cancer, and PSA levels can help to detect cancers early, even before they can be felt on exam. An ideal screening test would also detect every cancer.  That is, if a man has cancer, the test results would always show abnormal prostate cancer PSA Levels.  But in reality there is no perfect test.  Some men have normal PSA levels, and yet have prostate cancer.  If the cancer is not detected by another means, such as a digital rectal exam, a normal PSA level could give a man a false sense of security.