What tests can detect prostate cancer early? What tests can detect prostate cancer early? American Cancer Society recommendations for prostate cancer early detection What tests can detect prostate cancer early? The tests discussed below are used to look for warning signs of prostate cancer. But these early detection tests can’t tell for sure if you have cancer. If the result of one of these tests is abnormal, you will probably need a prostate biopsy to determine if you have cancer (see If prostate cancer screening test results aren’t normal ). Prostate-specific antigen (PSA) blood test Prostate-specific antigen (PSA) is a substance made by cells in the prostate gland (both normal cells and cancer cells). PSA is mostly found in semen, but a small amount is also found in the blood. Most men without prostate cancer have PSA levels under 4 nanograms per milliliter (ng/mL) of blood. The chance of having prostate cancer goes up as the PSA level goes up. When prostate cancer develops, the PSA level usually goes above 4. Still, a level below 4 does not guarantee that a man doesn’t have cancer. About 15% of men with a PSA below 4 will have prostate cancer on a biopsy.

Men with a PSA level between 4 and 10 have about a 1 in 4 chance of having prostate cancer. If the PSA is more than 10, the chance of having prostate cancer is over 50%. If your PSA level is high, your doctor may advise either waiting a while and repeating the test, or getting a prostate biopsy to find out if you have cancer. When considering whether to do a prostate biopsy to look for cancer, not all doctors use the same PSA cutoff point. Some may advise it if the PSA is 4 or higher, while others might recommend it starting at a lower level, such as 2.5 or 3. Other factors, such as your age, race, and family history, may affect this decision. Factors that might affect PSA levels A number of factors other than prostate cancer can also raise PSA levels: An enlarged prostate: Conditions such as benign prostatic hyperplasia (BPH), a non-cancerous enlargement of the prostate that affects many men as they grow older, can raise PSA levels. Older age: PSA levels normally go up slowly as you get older, even if you have no prostate abnormality.

Prostatitis: This term refers to infection or inflammation of the prostate gland, which can raise PSA levels. Ejaculation: This can make the PSA go up for a short time, and then go down again. This is why some doctors suggest that men abstain from ejaculation for a day or two before testing. Riding a bicycle: Some studies have suggested that cycling may raise PSA levels (possibly because the seat puts pressure on the prostate), although not all studies have found this. Certain urologic procedures: Some procedures done in a doctor’s office that affect the prostate, such as a prostate biopsy or cystoscopy, can result in higher PSA levels for a short time. Some studies have suggested that a digital rectal exam (DRE) might raise PSA levels slightly, although other studies have not found this. Still, if both a PSA test and a DRE are being done during a doctor visit, some doctors advise having the blood drawn for the PSA before having the DRE, just in case. Certain medicines: Taking male hormones like testosterone (or other medicines that raise testosterone levels) may cause a rise in PSA.

Some things might cause PSA levels to go down (even if a man has prostate cancer): 5-alpha reductase inhibitors: Certain drugs used to treat BPH or urinary symptoms, such as finasteride (Proscar or Propecia) or dutasteride (Avodart), may lower PSA levels. These drugs can also affect prostate cancer risk (discussed in Can prostate cancer be prevented? ). Tell your doctor if you are taking these medicines because they may lower PSA levels, so the doctor might need to adjust the reading. Herbal mixtures: Some mixtures that are sold as dietary supplements may also mask a high PSA level. This is why it’s important to let your doctor know if you are taking any type of supplement, even ones that are not necessarily meant for prostate health. Saw palmetto (an herb used by some men to treat BPH) does not seem to affect PSA. Obesity: Obese (very overweight) men tend to have lower PSA levels. Aspirin: Some research has suggested that men taking aspirin regularly may have lower PSA levels. This effect may be greater in non-smokers. More research is needed to confirm this finding.

If you take aspirin regularly (for example, to help prevent heart disease), talk to your doctor before you stop taking it for any reason. Statins: Some studies have linked the long-term use of cholesterol-lowering drugs known as statins, such as atorvastatin (Lipitor), rosuvastatin (Crestor), and simvastatin (Zocor), with lower PSA levels. Thiazide diuretics: Thiazide diuretics, such as hydrochlorothiazide (HCTZ), are a type of water pill often used to treat high blood pressure. Taking a thiazide diuretic for years is linked to lower PSA levels. For men not known to have prostate cancer, it’s not always clear if lowering the PSA is helpful. In some cases the factor that lowers the PSA may also lower a man’s risk of prostate cancer. But in other cases, it might lower the PSA level without affecting a man’s risk of cancer. This could actually be harmful, if it were to lower the PSA from an abnormal level to a normal one, as it might result in not detecting a cancer. This is why it’s important to talk to your doctor about anything that might affect your PSA level.

Special types of PSA tests Some doctors might consider using different types of PSA tests (discussed below) to help decide if you need a prostate biopsy, but not all doctors agree on how to use these other PSA tests. If your PSA test result isn’t normal, ask your doctor to discuss your cancer risk and your need for further tests. Percent-free PSA: PSA occurs in 2 major forms in the blood. One form is attached to blood proteins, while the other circulates free (unattached). The percent-free PSA (fPSA) is the ratio of how much PSA circulates free compared to the total PSA level. The percentage of free PSA is lower in men who have prostate cancer than in men who do not. This test is sometimes used to help decide if you should have a prostate biopsy if your PSA results are in the borderline range (like between 4 and 10). A lower percent-free PSA means that your chance of having prostate cancer is higher and you should probably have a biopsy. Many doctors recommend biopsies for men whose percent-free PSA is 10% or less, and advise that men consider a biopsy if it is between 10% and 25%.

Using these cutoffs detects most cancers and helps some men avoid unnecessary prostate biopsies. This test is widely used, but not all doctors agree that 25% is the best cutoff point to decide on a biopsy, and the cutoff may change depending on the overall PSA level. Complexed PSA: This test directly measures the amount of PSA that is attached to other proteins (the portion of PSA that is not “free”). This test could be done instead of checking the total and free PSA, and it could give the same amount of information as the other tests done separately. This test is being studied to see if it provides the same level of accuracy. Tests that combine different types of PSA: Some newer tests, such as the prostate health index (phi) and the 4Kscore test, combine the results of different types of PSA to get an overall score that reflects the chance a man has prostate cancer. These tests might be useful in men with a slightly elevated PSA, to help determine if they should have a prostate biopsy. Some tests might be used to help determine if a man who has already had a prostate biopsy that didn’t find cancer should have another biopsy. PSA velocity: The PSA velocity is not a separate test.

It is a measure of how fast the PSA rises over time. Normally, PSA levels go up slowly with age. Some research has found that these levels go up faster if a man has cancer, but studies have not shown that the PSA velocity is more helpful than the PSA level itself in finding prostate cancer. For this reason, the ACS guidelines do not recommend using the PSA velocity as part of screening for prostate cancer. PSA density: PSA levels are higher in men with larger prostate glands. The PSA density (PSAD) is sometimes used for men with large prostate glands to try to adjust for this. The doctor measures the volume (size) of the prostate gland with transrectal ultrasound (discussed in If prostate cancer screening test results aren’t normal ) and divides the PSA number by the prostate volume. A higher PSA density indicates a greater likelihood of cancer. PSA density has not been shown to be as useful as the percent-free PSA test. Age-specific PSA ranges: PSA levels are normally higher in older men than in younger men, even when there is no cancer. A PSA result within the borderline range might be very worrisome in a 50-year-old man but cause less concern in an 80-year-old man.

For this reason, some doctors have suggested comparing PSA results with results from other men of the same age. But because the usefulness of age-specific PSA ranges is not well proven, most doctors and professional organizations (as well as the makers of the PSA tests) do not recommend their use at this time. Digital rectal exam (DRE) For a digital rectal exam (DRE), the doctor inserts a gloved, lubricated finger into the rectum to feel for any bumps or hard areas on the prostate that might be cancer. As shown in the picture below, the prostate is just in front of the rectum. Prostate cancers often begin in the back part of the gland, which might be felt during a rectal exam. This exam can be uncomfortable (especially for men who have hemorrhoids), but it usually isn’t painful and only takes a short time. DRE is less effective than the PSA blood test in finding prostate cancer, but it can sometimes find cancers in men with normal PSA levels. For this reason, it may be included as a part of prostate cancer screening.

<!-- SS_END_OPENREGIONMARKER(region1)--> <!--SS_BEGIN_ELEMENT(region1_element1)--><!--SS_END_ELEMENT(region1_element1)--> <!-- SS_BEGIN_SNIPPET(region1_element2,2)--><div id="msgblock-right-column"> </div> <!-- SS_END_SNIPPET(region1_element2,2)--> <!-- SS_BEGIN_CLOSEREGIONMARKER(region1)--> Last Medical Review: 04/01/2016 Prostate-Specific Antigen (PSA) Test - National Cancer Institute Prostate-Specific Antigen (PSA) Test How are researchers trying to improve the PSA test? What is the PSA test? Prostate-specific antigen, or PSA, is a protein produced by cells of the prostate gland. The PSA test measures the level of PSA in a man’s blood. For this test, a blood sample is sent to a laboratory for analysis. The results are usually reported as nanograms of PSA per milliliter (ng/mL) of blood.

The blood level of PSA is often elevated in men with prostate cancer, and the PSA test was originally approved by the FDA in 1986 to monitor the progression of prostate cancer in men who had already been diagnosed with the disease. In 1994, the FDA approved the use of the PSA test in conjunction with a digital rectal exam (DRE) to test asymptomatic men for prostate cancer. Men who report prostate symptoms often undergo PSA testing (along with a DRE) to help doctors determine the nature of the problem. In addition to prostate cancer, a number of benign (not cancerous) conditions can cause a man’s PSA level to rise. The most frequent benign prostate conditions that cause an elevation in PSA level are prostatitis (inflammation of the prostate) and benign prostatic hyperplasia (BPH) (enlargement of the prostate). There is no evidence that prostatitis or BPH leads to prostate cancer, but it is possible for a man to have one or both of these conditions and to develop prostate cancer as well. Is the PSA test recommended for prostate cancer screening? Until recently, many doctors and professional organizations encouraged yearly PSA screening for men beginning at age 50.

Some organizations recommended that men who are at higher risk of prostate cancer, including African American men and men whose father or brother had prostate cancer, begin screening at age 40 or 45. However, as more has been learned about both the benefits and harms of prostate cancer screening, a number of organizations have begun to caution against routine population screening. Although some organizations continue to recommend PSA screening, there is widespread agreement that any man who is considering getting tested should first be informed in detail about the potential harms and benefits. Currently, Medicare provides coverage for an annual PSA test for all Medicare-eligible men age 50 and older. Many private insurers cover PSA screening as well. What is a normal PSA test result? There is no specific normal or abnormal level of PSA in the blood. In the past, most doctors considered PSA levels of 4.0 ng/mL and lower as normal. Therefore, if a man had a PSA level above 4.0 ng/mL, doctors would often recommend a prostate biopsy to determine whether prostate cancer was present. However, more recent studies have shown that some men with PSA levels below 4.0 ng/mL have prostate cancer and that many men with higher levels do not have prostate cancer ( 1 ).

In addition, various factors can cause a man’s PSA level to fluctuate. For example, a man’s PSA level often rises if he has prostatitis or a urinary tract infection. Prostate biopsies and prostate surgery also increase PSA level. Conversely, some drugs—including finasteride and dutasteride , which are used to treat BPH —lower a man’s PSA level. PSA level may also vary somewhat across testing laboratories. Another complicating factor is that studies to establish the normal range of PSA levels have been conducted primarily in populations of white men. Although expert opinions vary, there is no clear consensus regarding the optimal PSA threshold for recommending a prostate biopsy for men of any racial or ethnic group. In general, however, the higher a man’s PSA level, the more likely it is that he has prostate cancer. Moreover, continuous rise in a man’s PSA level over time may also be a sign of prostate cancer. What if a screening test shows an elevated PSA level? If a man who has no symptoms of prostate cancer chooses to undergo prostate cancer screening and is found to have an elevated PSA level, the doctor may recommend another PSA test to confirm the original finding.

If the PSA level is still high, the doctor may recommend that the man continue with PSA tests and DREs at regular intervals to watch for any changes over time. If a man’s PSA level continues to rise or if a suspicious lump is detected during a DRE, the doctor may recommend additional tests to determine the nature of the problem. A urine test may be recommended to check for a urinary tract infection. The doctor may also recommend imaging tests, such as a transrectal ultrasound , x-rays , or cystoscopy . If prostate cancer is suspected, the doctor will recommend a prostate biopsy. During this procedure, multiple samples of prostate tissue are collected by inserting hollow needles into the prostate and then withdrawing them. Most often, the needles are inserted through the wall of the rectum ( transrectal biopsy ); however, the needles may also be inserted through the skin between the scrotum and the anus ( transperineal biopsy ). A pathologist then examines the collected tissue under a microscope . The doctor may use ultrasound to view the prostate during the biopsy, but ultrasound cannot be used alone to diagnose prostate cancer. What are some of the limitations and potential harms of the PSA test for prostate cancer screening?

Detecting prostate cancer early may not reduce the chance of dying from prostate cancer. When used in screening, the PSA test can help detect small tumors that do not cause symptoms. Finding a small tumor, however, may not necessarily reduce a man’s chance of dying from prostate cancer. Some tumors found through PSA testing grow so slowly that they are unlikely to threaten a man’s life. Detecting tumors that are not life threatening is called “overdiagnosis,” and treating these tumors is called “overtreatment.” Overtreatment exposes men unnecessarily to the potential complications and harmful side effects of treatments for early prostate cancer, including surgery and radiation therapy. The side effects of these treatments include urinary incontinence (inability to control urine flow), problems with bowel function , erectile dysfunction (loss of erections , or having erections that are inadequate for sexual intercourse), and infection. In addition, finding cancer early may not help a man who has a fast-growing or aggressive tumor that may have spread to other parts of the body before being detected. The PSA test may give false-positive or false-negative results. A false-positive test result occurs when a man’s PSA level is elevated but no cancer is actually present.

A false-positive test result may create anxiety for a man and his family and lead to additional medical procedures, such as a prostate biopsy, that can be harmful. Possible side effects of biopsies include serious infections, pain, and bleeding. Most men with an elevated PSA level turn out not to have prostate cancer; only about 25 percent of men who have a prostate biopsy due to an elevated PSA level actually have prostate cancer ( 2 ). A false-negative test result occurs when a man’s PSA level is low even though he actually has prostate cancer. False-negative test results may give a man, his family, and his doctor false assurance that he does not have cancer, when he may in fact have a cancer that requires treatment. What research has been done to study prostate cancer screening? Several randomized trials of prostate cancer screening have been carried out. One of the largest is the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, which NCI conducted to determine whether certain screening tests can help reduce the numbers of deaths from several common cancers. In the prostate portion of the trial, the PSA test and DRE were evaluated for their ability to decrease a man’s chances of dying from prostate cancer.

The PLCO investigators found that men who underwent annual prostate cancer screening had a higher incidence of prostate cancer than men in the control group but the same rate of deaths from the disease ( 3 ). Overall, the results suggest that many men were treated for prostate cancers that would not have been detected in their lifetime without screening. Consequently, these men were exposed unnecessarily to the potential harms of treatment. A second large trial, the European Randomized Study of Screening for Prostate Cancer (ERSPC), compared prostate cancer deaths in men randomly assigned to PSA-based screening or no screening. As in the PLCO, men in ERSPC who were screened for prostate cancer had a higher incidence of the disease than control men. In contrast to the PLCO, however, men who were screened had a lower rate of death from prostate cancer ( 4 ). Overview - PSA test - Mayo Clinic Print The PSA test is a blood test used primarily to screen for prostate cancer. The test measures the amount of prostate-specific antigen (PSA) in your blood. PSA is a protein produced by both cancerous and noncancerous tissue in the prostate, a small gland that sits below a man's bladder. PSA is mostly found in semen, which also is produced in the prostate.

Small amounts of PSA ordinarily circulate in the blood. The PSA test can detect high levels of PSA that may indicate the presence of prostate cancer. However, many other conditions, such as an enlarged or inflamed prostate, can also increase PSA levels. Therefore, determining what a high PSA score means can be complicated. There is a lot of conflicting advice about PSA testing. To decide whether to have a PSA test, discuss the issue with your doctor, considering your risk factors and weighing your personal preferences. Hoffman RM. Screening for prostate cancer. Accessed Jan. 6, 2016. AskMayoExpert. Prostate-Specific Antigen (PSA) levels. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2015. Prostate-specific antigen (PSA) test. National Cancer Institute. Accessed Jan. 6, 2016. Ferri FF. Prostate cancer. In: Ferri's Clinical Advisor 2016. Philadelphia, Pa.: Elsevier; 2016. Accessed Jan. 6, 2016. Goldman L, et al., eds. Prostate cancer. In: Goldman-Cecil Medicine.

25th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. Accessed Jan. 6, 2016. Wein AJ, et al., eds. Diagnosis and staging of prostate cancer. In: Campbell-Walsh Urology. 11th ed. Philadelphia, Pa.: Elsevier; 2016. Accessed Jan. 6, 2016. Related PSA: The Test | Prostate Specific Antigen Is there anything else I should know? How is it used? The PSA test and digital rectal exam (DRE) may be used to screen both asymptomatic and symptomatic men for prostate cancer . PSA is a protein produced primarily by cells in the prostate and most of the PSA is released into semen, but small amounts of it are also released into the blood. PSA exists in two forms in the blood: free (not bound) and complexed (cPSA, bound to other proteins). Lab tests can measure free PSA or total PSA (bound plus unbound). Some organizations, such as the U.S.

Preventive Services Task Force, feel that the harms associated with over-diagnosis and over-treatment outweigh the potential benefits and advise against using PSA to screen for prostate cancer in healthy men of any age. The American Cancer Society and the American Urological Association recommend that men discuss the advantages and disadvantages of PSA-based screening for prostate cancer with their healthcare provider before making an informed decision about whether to be screened or not. While elevated PSA levels are associated with cancer, they may be caused by other conditions, such as benign prostatic hyperplasia (BPH) and inflammation of the prostate. An elevated PSA may be followed by a biopsy , which has risk of complications such as pain, fever, blood in the urine, or urinary tract infection. (Read the article on Anatomic Pathology for more information about biopsies.) And though prostate cancer is a relatively common type of cancer in men and the number two cause of death, many prostate cancers are slow-growing. These slow-growing types may never cause symptoms or become life-threatening. Yet prostate cancer found through screening may be treated with surgery or radiation therapy, which can have serious side effects, such as incontinence or erectile dysfunction .

The total PSA test can be elevated temporarily for a variety of reasons, so if an initial PSA is elevated, another PSA may be done a few weeks after the first to determine if the PSA is still elevated. If the repeat test is elevated, a healthcare provider may recommend that series of PSAs be done over time to determine whether the level goes down, stays elevated, or continues to increase. In cases where the cancer appears to be slow-growing, the healthcare provider and patient may decide to monitor its progress rather than pursue immediate treatment (called "watchful waiting"). If the DRE is normal but the PSA is moderately elevated, a free PSA test may be used to look at the ratio of free to total PSA. This can help to distinguish between prostate cancer and other non-cancer causes of elevated PSA. Other tests may also be recommended if either the PSA or the DRE is found to be abnormal. A urinalysis may be done, for example, to check for urinary tract infection and imaging tests, such as an ultrasound, may be done to examine the prostate. If prostate cancer is diagnosed, the total PSA test may be used as a monitoring tool to help determine the effectiveness of treatment.

It may also be ordered at regular intervals after treatment to detect recurrence of the cancer. ^ Back to top When is it ordered? For men who wish to be screened for prostate cancer , the American Cancer Society recommends that healthy men of average risk consider waiting to get tested until age 50, while the American Urological Association recommends screening for men between the ages of 55 and 69 with no routine screening after age 70. For those at high risk, such as American men of African descent and men with a family history of the disease, the recommendation is to consider beginning testing at age 40 or 45. (See Screening Tests for Adults (30-49): Prostate cancer and Screening Tests for Adults (50 and Up): Prostate cancer for details on screening recommendations.) The total PSA test and digital rectal exam (DRE) may also be ordered when a man has symptoms that could be due to prostate cancer, such as difficult, painful, and/or frequent urination, back pain, and/or pelvic pain. If a total PSA level is elevated, a healthcare provider may order a repeat test a few weeks later to determine whether the PSA concentrations have returned to normal.

A free PSA is primarily ordered when a man has a moderately elevated total PSA. The results give the healthcare provider additional information about whether the person is at an increased risk of having prostate cancer and help with the decision of whether to biopsy the prostate. The total PSA may be ordered at regular intervals during treatment of men who have been diagnosed with prostate cancer and when a man with cancer is participating in "watchful waiting" and not currently treating his prostate cancer. ^ Back to top What does the test result mean? PSA test results can be interpreted a number of different ways and there may be differences in cutoff values between different laboratories. The value for total PSA below which the presence of prostate cancer is considered to be unlikely is 4.0 ng/ml (nanograms per milliliter of blood). There are some that feel that this level should be lowered to 2.5 ng/ml in order to detect more cases of prostate cancer. Others argue that this would lead to more over-diagnosing and over-treating cancers that are not clinically significant.

There is agreement that men with a total PSA level greater than 10.0 ng/ml are at an increased risk for prostate cancer (more than a 50% chance, according to the American Cancer Society (ACS)). Total PSA levels between 4.0 ng/ml and 10.0 ng/ml may indicate prostate cancer (about a 25% chance, according to the ACS), benign prostate hyperplasia (BPH) , or inflammation of the prostate. These conditions are more common in the elderly, as is a general increase in PSA levels. Total PSA between 4.0 ng/ml and 10.0 ng/ml is often referred to as the "gray zone." It is in this range that the free PSA may be useful (see next bullet). Free PSA—prostate tumors typically produce mostly complexed PSA (cPSA), not free PSA. Benign prostate cells tend to produce more free PSA, which will not complex with proteins. Thus, when men in the gray zone have decreased levels of free PSA, it means that they have increased cPSA and a higher probability of prostate cancer. Conversely, when they have elevated levels of free PSA and low cPSA, the risk is diminished.

The ratio of free to total PSA can help the individual and his healthcare provider decide whether or not a prostate biopsy should be performed. Additional evaluations of the PSA test results are sometimes used in an effort to increase the usefulness of the total PSA as a screening tool. They include: PSA velocity—the change in PSA concentrations over time; if the PSA continues to rise significantly over time (at least 3 samples at least 18 months apart), then it is more likely that prostate cancer is present. If it climbs rapidly, then the affected person may have a more aggressive form of cancer. PSA doubling time—another version of the PSA velocity; it measures how rapidly the PSA concentration doubles. PSA density—a comparison of the PSA concentration and the volume of the prostate (as measured by ultrasound); if the PSA level is greater than what one would expect given the size of the prostate, the chance that a cancer is present may be higher. Age-specific PSA ranges—since PSA levels naturally increase as a man ages, it has been proposed that normal ranges be tailored to a man's age. During treatment for prostate cancer, the PSA level should begin to fall. At the end of treatment, it should be at very low or undetectable levels in the blood.

If concentrations do not fall to very low levels, then the treatment has not been fully effective. Following treatment, the PSA test is performed at regular intervals to monitor the person for cancer recurrence. Since even tiny increases can be significant, those affected may want to have their monitoring PSA tests done by the same laboratory each time so that testing variation is kept to a minimum. A test called "ultrasensitive PSA" (USPSA) may be useful in monitoring for persistence or recurrence of cancer after treatment. This test detects PSA at much lower levels than the traditional test. It has been suggested that increases in PSA due to the persistence or return of cancer can be identified much sooner with this test. However, results of this test must be interpreted with caution. Because the test is very sensitive , there can be small increases in PSA levels from one time to the next even when no cancer is present ( false positive ). ^ Back to top Is there anything else I should know? Since the DRE can cause a temporary elevation in PSA, the blood sample is usually collected prior to performing the DRE. Prostate manipulation by biopsy or resection of the prostate will significantly elevate PSA levels. The blood test should be done before surgery or six weeks after manipulation.

Rigorous physical activity affecting the prostate, such as bicycle riding, may cause a temporary rise in PSA level. Ejaculation within 24 hours of testing can be associated with elevated PSA levels and should be avoided. Large doses of some chemotherapeutic drugs, such as cyclophosphamide and methotrexate, may increase or decrease PSA levels. In some men, PSA may rise temporarily due to other prostate conditions, especially infection. A study found that in about half of men with a high PSA, values later return to normal. Some authorities recommend that a high PSA should be repeated, between 6 weeks and 3 months after the high PSA, before taking any further action. Some health practitioners will prescribe a course of antibiotics if there is evidence that there is infection of the prostate. PSA Levels: PSA Blood Tests and Prostate Cancer Screening A Prostate-specific antigen (PSA) is a substance produced by the prostate gland . Elevated PSA levels may indicate prostate cancer , a noncancerous condition such as prostatitis , or an enlarged prostate . Most men have PSA levels under four (ng/mL) and this has traditionally been used as the cutoff for concern about the risk of prostate cancer .

Men with prostate cancer often have PSA levels higher than four, although cancer is a possibility at any PSA level. According to published reports, men who have a prostate gland that feels normal on examination and a PSA less than four have a 15% chance of having prostate cancer. Those with a PSA between four and 10 have a 25% chance of having prostate cancer and if the PSA is higher than 10, the risk increases and can be as high as 67%. In the past, most experts viewed PSA levels less than 4 ng/mL as normal. Due to the findings from more recent studies, some recommend lowering the cutoff levels that determine if a PSA value is normal or elevated. Some researchers encourage using less than 2.5 or 3 ng/mL as a cutoff for normal values, particularly in younger patients. Younger patients tend to have smaller prostates and lower PSA values, so any elevation of the PSA in younger men above 2.5 ng/mL is a cause for concern. Just as important as the PSA number is the trend of that number (whether it is going up, how quickly, and over what period of time). It is important to understand that the PSA test is not perfect.

Most men with elevated PSA levels have noncancerous prostate enlargement , which is a normal part of aging. Conversely, low levels of PSA in the bloodstream do not rule out the possibility of prostate cancer . However, most cases of early prostate cancer are found by a PSA blood test . Assess Your Risk for Prostate Cancer and 4 Other Common Cancers How Is The PSA Screening Test Done? The test involves drawing blood , usually from the arm. The results are usually sent to a lab and most often come back within several days. Prostate cancer screening: Should you get a PSA test? - Mayo Clinic Sign up now Prostate cancer screening: Should you get a PSA test? Making the decision to have a PSA test depends on a variety of factors. Here are some tips that can help you make a good decision. Prostate gland Cancer screening tests — including the prostate-specific antigen (PSA) test to look for signs of prostate cancer — can be a good idea. Prostate cancer screening can help identify cancer early on, when treatment is most effective. And a normal PSA test, combined with a digital rectal exam, can help reassure you that it's unlikely you have prostate cancer.

But getting a PSA test for prostate cancer may not be necessary for some men, especially men 70 and older. Professional organizations vary in their recommendations about who should — and who shouldn't — get a PSA screening test. While some have definitive guidelines, others leave the decision up to men and their doctors. Organizations that do recommend PSA screening generally encourage the test in men between the ages of 40 and 70, and in men with an increased risk of prostate cancer. Ultimately, whether you have a PSA test is something you should decide after discussing it with your doctor, considering your risk factors and weighing your personal preferences. Here's more information to help you prepare for a conversation with your doctor about PSA testing. Simple test, not-so-simple decision There are a number of pros and cons to the PSA test. Pros of PSA screening PSA screening may help you detect prostate cancer early. Some prostate cancers are slow growing and never spread beyond the prostate gland. Cancer is easier to treat and is more likely to be cured if it's diagnosed in the early stages of the disease. Not all prostate cancers need treatment. Treatment for prostate cancer may have risks and side effects, including urinary incontinence, erectile dysfunction or bowel dysfunction.

PSA testing can be done with a simple, widely available blood test. PSA tests aren't foolproof. It's possible for your PSA levels to be elevated when cancer isn't present, and to not be elevated when cancer is present. For some men, knowing is better than not knowing. Having the test can provide you with a certain amount of reassurance — either that you probably don't have prostate cancer or that you do have it and can now have it treated. A diagnosis of prostate cancer can provoke anxiety and confusion. Concern that the cancer may not be life-threatening can make decision-making complicated. The number of deaths from prostate cancer has gone down since PSA testing became available. PSA testing has lowered deaths, but the number may not be substantial enough to justify the cost and possibility of harm to the person undergoing the testing. What is PSA? Prostate-specific antigen (PSA) is a protein produced by both cancerous (malignant) and noncancerous (benign) prostate tissue. PSA helps liquefy the semen. A small amount of PSA normally enters the bloodstream. Prostate cancer cells usually make more PSA than do benign cells, causing PSA levels in your blood to rise.

But PSA levels can also be elevated in men with enlarged or inflamed prostate glands. Therefore, determining what a high PSA score means can be complicated. Besides the PSA number itself, your doctor will consider a number of other factors to evaluate your PSA scores: Your age The size of your prostate gland How quickly your PSA levels are changing Whether you're taking medications that affect PSA measurements, such as finasteride (Propecia, Proscar), dutasteride (Avodart) and even some herbal supplements When elevated PSA isn't cancer While high PSA levels can be a sign of prostate cancer, a number of conditions other than prostate cancer can cause PSA levels to rise. These other conditions could cause what's known as a "false-positive" — meaning a result that falsely indicates you might have prostate cancer when you don't. Conditions that could lead to an elevated PSA level in men who don't have prostate cancer include: Benign prostate enlargement (benign prostatic hyperplasia) A prostate infection (prostatitis) Other less common conditions False-positives are common. Only about 1 in 4 men with an abnormal PSA test result turns out to have prostate cancer.

When prostate cancer doesn't increase PSA Some prostate cancers, particularly those that grow quickly, may not produce much PSA. In this case, you might have what's known as a "false-negative" — a test result that incorrectly indicates you don't have prostate cancer when you do. Because of the complexity of these relating factors, it's important to have a doctor who is experienced in interpreting PSA levels evaluate your situation. What's the advantage of a PSA test? Detecting certain types of prostate cancer early can be critical. Elevated PSA results may reveal prostate cancer that's likely to spread to other parts of your body (metastasize), or they may reveal a quick-growing cancer that's likely to cause other problems. Early treatment can help catch the cancer before it becomes life-threatening or causes serious symptoms. In some cases, identifying cancer early means you will need less aggressive treatment — thus reducing your risk of certain side effects, such as erectile dysfunction and incontinence. Prostate-specific antigen (PSA) test. National Cancer Institute. Accessed July 15, 2015. American Cancer Society recommendations for prostate cancer early detection. American Cancer Society. Accessed July 15, 2015.

Moyer VA, et al. Screening for prostate cancer: U.S. Preventive Services Task Force recommendation statement. Annals of Internal Medicine 2012;157:120. Carter HB, et al. Early detection of prostate cancer: AUA guideline. American Urological Association Accessed July 15, 2015. Smith RA, et al. Cancer screening in the United States, 2015: A review of current American Cancer Society guidelines and current issues in cancer screening. CA: A Cancer Journal for Clinicians, 2015;65:30. AskMayoExpert. Screening recommendations for asymptomatic men. Prostate cancer. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2015. Prostate cancer: Risk factors and prevention. Cancer.Net. Accessed Aug. 2, 2015. Castle EP (expert opinion). Mayo Clinic. Scottsdale/Phoenix, Ariz. Aug. 10, 2015.

Prostate Cancer PSA and Other Screening Tests | Seattle Cancer Care Alliance Early Detection & Prevention Prostate Cancer PSA and Other Screening Tests One of the best ways to detect prostate cancer early is through screening, which can help find some types of cancer at an early stage, when they may have a better prognosis. Since the prostate-specific antigen (PSA) test was introduced in the late 1980s, it has been commonly used in conjunction with a digital rectal exam to screen for prostate cancer. What the PSA Test Measures The PSA test is a blood test that measures a protein released in the blood by the prostate gland. Both normal and malignant (cancerous) prostate cells secrete the protein. While there is no perfect screening test for prostate cancer, PSA is the best indicator available. That said, abnormal PSA results alone are not sufficient to diagnose prostate cancer . Elevated PSA levels are most often caused by noncancerous conditions of the prostate, such as benign prostatic hyperplasia (BPH), and some men who have prostate cancer do not have elevated PSA. The PSA test measures total PSA. The higher a man’s total PSA level, the more likely he is to have prostate cancer.

Most doctors consider a total PSA level of 4.0 ng/mL or lower to be normal in men age 60 or older and 2.5 ng/mL or lower to be normal in men younger than 60. Total PSA is used not only to screen for prostate cancer but also to monitor patients who’ve had prostate cancer to check for recurrence. Other Screening Tests If your total PSA test results are high or abnormal, your doctor may use other screening tests, including special types of PSA tests or a PCA3 test, to help determine if you need a biopsy, which is the only way to definitively diagnose prostate cancer. Free-PSA Level The free-PSA test checks for the amount of PSA in the blood that is not bound to other proteins. This is a subset of the total PSA. The test is usually ordered only if the total PSA is elevated. It can help your doctor determine whether you need further diagnostic tests. The free-PSA level is divided by the total PSA to get the percent of free PSA. A result of less than 10 percent means you have a higher risk for prostate cancer. The lower the percent, the higher the risk. Prostate Health Index (PHI) Approved by the U.S.

Food and Drug Administration in 2012, the PHI is a blood test to detect and predict the probability of prostate cancer. It uses two of the PSA subset values to create a cancer risk ratio that may help your doctors determine whether they should perform a biopsy. Studies of the accuracy of this test are ongoing. Urinary PCA3 Test This is a urine test for proteins that are specific to prostate cancer. Unlike PSA, PCA3 is only produced by prostate cancer cells, and the level is not affected by prostate size. This test can be used in addition to total and free PSA tests to help determine whether a biopsy is needed. It is not used as a stand-alone test, and it is used more commonly in men who’ve had a negative biopsy (meaning cancer was not detected) to determine whether another biopsy may be warranted. PSA Screening Risks & Benefits In recent years, PSA screening has come under fire because of concerns that it has led to overdiagnosis and overtreatment. In fact, in 2012 the U.S.

Preventive Services Task Force (USPSTF) recommended against routine PSA screening for prostate cancer because two studies did not show it substantially lowered death rates and because screening can result in harm from biopsies, from treatment of patients who may not be at risk of dying from prostate cancer, and from treatment-related side effects. 1 At Seattle Cancer Care Alliance (SCCA), we believe there are several good reasons to continue PSA screening. It helps detect early-stage disease. PSA screening has yielded a dramatic transformation in how prostate cancer patients present; more present with early-stage and potentially curable disease. Screening and treatment can be done selectively, based on a man’s individual situation. PSA screening is a beneficial test that has likely saved many lives, but it also uncovers many cases of prostate cancer that do not need to be treated. The main harm in screening is not the PSA test itself but the possibility that the results may lead to overtreatment of low-risk cancers in older men. Men who are younger and appear to be healthy are most likely to benefit from screening that leads to early detection and treatment. Some low-risk prostate cancers can be carefully followed with active surveillance rather than treated initially with more aggressive measures. There are limitations to the USPSTF recommendation.

The task force’s conclusion was based on studies that had limited follow-up and a lower death rate than expected in the absence of screening, which almost certainly understated the lives saved over the long term and produced an overly negative assessment of the screening benefit. In addition, the USPSTF overlooked several studies that reveal more substantial benefits for healthier, younger men. Screening works. Most importantly, there is no doubt that prostate cancer deaths have decreased by about 40 percent since the advent of PSA screening, as shown in a National Cancer Institute investigation. 2 If you have any questions about whether the PSA test is right for you, talk with your doctor about the benefits and risks of PSA testing. The SCCA prostate cancer team is well equipped to discuss the potential benefits and risks of screening and whether regular screenings are appropriate for you. AUA Guidelines for PSA Screening In 2013, the American Urological Association (AUA) released PSA screening guidelines for various groups of men based on their age, health, and risk profile. 3 SCCA’s prostate cancer specialists agree with the AUA’s guidelines, summarized here: Men under age 40: No PSA screening. Men 40 to 54 years old: No routine PSA screening.

Men 55 to 69 years old: Talk with your doctor about the risks and benefits of PSA screening for you. Men age 70 or older: No routine PSA screening; however, if you are in excellent health, talk with your doctor about the risks and benefits of PSA screening for you. Men with less than a 10- to 15-year life expectancy: No routine PSA screening in men with poor health. Men at higher risk: Talk with your doctor about the risks and benefits of PSA screening for you. 1. Screening for Prostate Cancer , U.S. Preventive Services Task Force, released May 2012. 2. Hans Lilja et al, “Prediction of Significant Prostate Cancer Diagnosed 20 to 30 Years Later with a Single Measure of Prostate-Specific Antigen at or Before Age 50,” Cancer 117 (2011): 1210-1219, doi: 10.1002/cncr.25568. Patient's Guide to Prostate Cancer: How is Prostate Cancer Detected?

| Patient Education | UCSF Medical Center Patient's Guide to Prostate Cancer: How is Prostate Cancer Detected? Prostate Cancer Symptoms In its early states, prostate cancer often doesn't produce any symptoms. Symptoms that may indicate prostate cancer — and should be followed up with a visit to the doctor — include: Frequent urination, especially at night Urgency in urinating Trouble starting your urine stream A weak or interrupted urine stream Pain or burning during urination A feeling that your bladder doesn't empty completely Blood in the urine A nagging pain in the back, hips or pelvis Although these symptoms can be caused by prostate cancer, they also can be caused by other conditions that are not cancer. A very common one is benign prostatic hyperplasia (BPH). As men age, the prostate often enlarges and can press on and block the urethra and bladder, producing some of the symptoms described above. BPH can be successfully treated with medication or surgery. Prostate Cancer Screening The two most commonly used methods for detecting prostate cancer are the digital rectal examination (DRE) and the prostate-specific antigen (PSA) test.

As a single screening method, the PSA test is more effective than the DRE, but using both increases the chance of detecting cancer when present. Digital Rectal Examination During a digital rectal examination , a doctor inserts a gloved, lubricated finger into a man's rectum to feel for any irregular or abnormally firm area in the prostate. Many, but not all, prostate cancers can be detected this way. The DRE also can be used to monitor the progress of treatment. Prostate-Specific Antigen Test Prostate-specific antigen (PSA) is a protein in the blood that is produced only by prostate cells. PSA reflects the volume of both benign and malignant prostate tissue. The higher the PSA level, the more likely it is that prostate cancer is present. PSA test results are reported as nanograms per milliliter (ng/ml). Results less than 4.0 ng/ml usually are considered normal; values over this are regarded as high. The average PSA level increases with age, so some values — even below 4.0 ng/ml for men younger than 60 — should be cause to seek a more thorough evaluation. Ask your doctor for acceptable values for your age.

Having a high PSA doesn't always mean that you have cancer. Certain activities and conditions can produce a high PSA, including benign prostatic hyperplasia; ejaculation up to three days prior to the testing; a recent prostate biopsy ; an acute urinary tract infection ; and prostatitis, an inflammation of the prostate that usually is treated successfully with antibiotics. Certain medications and herbal preparations may lower PSA levels, possibly masking the presence of early prostate cancer. These medications include finasteride (Proscar or Propecia); saw palmetto, an herb some men use to treat benign prostatic hyperplasia; and PC-SPES, an herbal mixture that contains saw palmetto. Tell your doctor if you are taking any of these. PSA levels may also be affected by activities such bicycle riding or other vigorous exercise. There are two modifications of the PSA test that can increase its effectiveness: Percent free-PSA — Also called PSA II, this test indicates how much PSA circulates unbound in the blood (free-PSA), and how much is bound together with other blood proteins. Men with prostate cancer are more likely to have low levels of free-PSA. A free-PSA score below 10 percent may indicate prostate cancer.

A score above 25 percent is more consistent with benign prostatic enlargement. Levels between 10 percent and 25 percent are indeterminate, but suggest the need for more monitoring or evaluation. The percent free-PSA measure appears most useful when the total PSA level is between 4 and 10. The range of the percent free-PSA can vary with the assay or testing procedure used by the laboratory. This test is primarily used for the detection of prostate cancer. PSA velocity — PSA velocity measures how quickly the PSA level rises over a period of time. Prostate cancer is more likely if the PSA rises more than 0.75 ng/ml per year. To be accurate, there should be a minimum of three tests over a period of 18 months or less to determine the velocity. While the PSA test is used mostly for early detection, it has value in other situations. Men with higher PSA scores are more likely to have cancer that has spread beyond the prostate. In such cases, localized treatments such as radical prostatectomy — an operation to remove the prostate — or radiation therapy are less likely to be successful. The PSA test also is used to monitor treatment effectiveness.

Rising PSA levels after surgery or radiation, or during hormonal treatment, can provide an early sign that the cancer is recurring or continuing to grow. The earlier and more rapid the rise of the PSA following localized treatment, the more likely the recurrence is due to cancer cells that are outside the prostate. However, some advanced cancers produce very little PSA, and other markers have to be used to monitor the status of the cancer. Continue Reading New Prostate Cancer Test Gives More Accurate Diagnosis - Robert H. Lurie Comprehensive Cancer Center of Northwestern University New Prostate Cancer Test Gives More Accurate Diagnosis April 2011 In a large multi-center clinical trial, a new PSA test to screen for prostate cancer more accurately identified men with prostate cancer -- particularly the aggressive form of the disease -- and substantially reduced false positives compared to the two currently available commercial PSA tests, according to newly published research from Northwestern University. The only Food and Drug Administration-approved screening tests for prostate cancer currently available result in a high number of false positives and lead to unnecessary biopsies and possible over-detection and over-treatment of indolent cancer, which never would have caused suffering or death.

PSA stands for prostate-specific antigen, a substance whose elevated levels can indicate prostate cancer but can also be caused by prostate inflammation or enlargement or other conditions. Its lack of specificity can result in unnecessary biopsies. "This new test is more specific and accurate than the currently available blood tests for early prostate cancer detection," said lead investigator William Catalona, MD , Director of the Clinical Prostate Cancer Program at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. "This will focus on the detection of more life-threatening prostate cancers and reduce unnecessary biopsies in men 50 years of age and older." Catalona, known as the father of the PSA screening, was the first to show in 1991 that a simple blood test measuring PSA levels could be used to detect prostate cancer. He is a professor of urology at Northwestern's Feinberg School of Medicine and a urologist at Northwestern Memorial Hospital. The study, which will be published in the May issue of the Journal of Urology, followed 900 patients from 10 sites, including Northwestern.

The results showed the new screening test, a simple blood test called the Pro-PSA test, is particularly useful for patients with a normal prostate exam whose PSA is 2 to 10, a range considered the diagnostic gray zone because most men with higher levels have prostate cancer and most men with lower levels do not. The Pro-PSA test measures a more specific PSA subform called (-2) Pro- PSA. The test becomes even more accurate when its results are analyzed with a mathematical formula that provides an overall Prostate Health Index. (The formula divides the Pro-PSA number by the free-PSA. Then the quotient of the two is multiplied by the square root of the total PSA. ) "The logic behind the formula is that the higher the Pro-PSA and the total PSA and the lower the free-PSA, the more likely the patient has aggressive prostate cancer," Catalona said. The new Pro-PSA test was recently approved for commercial use in Europe, Catalona noted. "The FDA is currently reviewing our data from the study, and I'm hopeful that it will be approved in the United States as well," he said.

Catalona conducted the study in collaboration with Beckman Coulter, Inc., a biomedical test developer and manufacturer, for which he serves as a paid consultant. The trial was supported by Beckman Coulter. Catalona's research also is supported by the National Cancer Institute and the Urological Research Foundation. (Last updated on June 21, 2013 ) What PCA3 is PCA3 is short for Prostate CAncer gene 3. Prostate cells have PCA3 genes that make the cells produce a small amount of a particular protein. Prostate cancer cells make much more of this protein than normal cells. When the level of PCA3 protein is high, it leaks into the urine. Researchers have been checking whether they can use PCA3 protein to diagnose prostate cancer. There have been several trials looking at whether PCA3 testing might be helpful for prostate cancer. But we don’t yet know exactly how well the test may work. Diagnosing prostate cancer At the moment, men with symptoms of prostate cancer have a number of tests to find out if they have cancer. The tests include a PSA (prostate specific antigen) blood test and a rectal examination . A PSA test is not a very accurate test for prostate cancer.

Some men with a high level of PSA in the blood have prostate cancer. But some men who have prostate cancer have a low PSA level. And PSA levels can also be raised by several other medical conditions not related to cancer. So, if you have a raised PSA, you need more tests to find out if you have prostate cancer. Usually, this means a biopsy of the prostate gland . Many men with raised levels of PSA who have biopsies don’t have cancer. Some men who continue to have raised PSA levels need to keep having biopsies. This isn’t very pleasant to go through and repeated biopsies can cause complications in some men. To avoid having to do prostate biopsies, researchers have been trying to find a more specific test to show who has cancer and who doesn’t. They hope that a simple PCA3 urine test may be able to pick up prostate cancers. Research into PCA3 Research so far into PCA3 looks quite promising. It seems as though it may be able to pick up more cancers than the PSA test. But we need more research to find exactly how much PCA3 in the urine is a sign of prostate cancer. The PCA3 test isn’t yet accurate enough to be used on its own as a test for prostate cancer.

It is more likely to be used as well as a PSA test, to help your doctor decide whether you need a prostate biopsy. How you have the PCA3 test The test is in two parts. You have a rectal examination and then a urine test. You need to have a rectal examination because this massages the prostate gland and helps the PCA3 to go into the urine. You have to give the urine sample straight after the rectal examination. You normally get the results within a few days. The PCA3 test is not available through the NHS at the moment. It is being assessed by the National Institute for Health and Care Excellence (NICE) . It is available in a few private hospitals and clinics. The cost is between £300 and £400. You could talk to your doctor about whether it is an option for you.

Question: A PSA test is used to detect what?
Answer: Prostate cancer