Health Breakthroughs
March 30, 2006

Medical Bulletin for Men:  Urgent Information About Your PSA Test

By: Dr. Floyd Taub

 Introduction

            If you are a man over the age of 50, an annual PSA (Prostate Specific Antigen) test is highly recommended.  (If you have a personal or family history of prostate disease, your doctor may recommend annual screenings even earlier.)  

The good news is that the PSA is quick and relatively painless. Unfortunately, this test is widely misunderstood, resulting in a lot of unnecessary stress and anguish for some, and a false sense of security for others. In order to get the maximum benefit from this test, there are some vitally important things you must understand about the PSA. 

What is the PSA? 

The first thing you need to know about the PSA test is what it is not.  Contrary to what you may have been told, the PSA test is not a marker for cancer.  It does not detect or measure the presence of cancer in your prostate or anywhere else.  

So what is it? The PSA test measures the amount of prostate-specific antigen (PSA) that is circulating in your blood stream. PSA is an enzyme produced by a healthy prostate gland. Its function is to keep the seminal fluid liquefied after ejaculation, to allow the sperm to swim more easily.  

Most of the PSA produced in the prostate remains in the seminal fluid, but a small amount enters the bloodstream, and this is what we are measuring in a PSA test.  Certain conditions in the prostate can cause an elevation in the amount of PSA that is present in the blood. 

A normal reading for Total Serum (blood) PSA is between 0 and 4 ng/mL. Readings from 4-10 ng/ml are considered slightly elevated. A reading between 10 and 20 is considered moderately elevated, and over 20 is quite elevated. 

What Does It Mean If My PSA Is Elevated? 

          If your PSA is elevated it does not necessarily indicate that you have cancer.  In fact,most men with elevated PSA counts do not turn out to have cancer.  (This is more and more true as you get older). There are a number of things that can cause your PSA counts to be elevated: 

          If you have had sex (or ejaculated) within the last 48 hours, your PSA may be elevated. This is perfectly healthy and normal. Your PSA counts will return to normal on their own within 48 hours.  For this reason, however, you want to avoid ejaculating for at least a day (preferably 48 hours) before your PSA test in order to get the most accurate results.

        With age, most men experience benign (non-cancerous) growth of the prostate  gland, which can also elevate your PSA reading.  This condition, called BPH (Benign  Prostatic Hyperplasia) is often accompanied by symptoms such as painful or frequent urination. If the condition requires treatment, it can usually be resolved with natural or pharmaceutical medications.  (For more information on a safe, natural alternative to promote Prostate health click here)

           If you have a local infection or inflammation of the prostate gland (prostatitis), it will also temporarily elevate your PSA count.  Infections should be treated with antibiotics and are usually quickly resolved.  

            If you have an infection or inflammation anywhere in the general vicinity of the prostate (such as in the appendix, gall bladder, etc.), it can also cause an elevated PSA count. The PSA should return to normal on its own once the true source of the inflammation has been identified and treated.   

            Finally, cancerous growth within the prostate gland causes inflammation, and this will also elevate the PSA count.  If you have a sudden or dramatic elevation in your PSA count, your doctor will want to rule out the possibility of prostate cancer.   If you are already being treated or monitored for prostate cancer, your doctor will use the PSA test as one indicator of the progress of your treatment or your status. 

      A single elevated PSA test result, especially if it is only slightly or moderately elevated does not mean that you or your doctor need to spring into action.  PSA levels fluctuate over time. In other words, a PSA test is a single frame in a moving picture.   If you have no other symptoms (such as swelling or tenderness), your doctor may simply want to repeat the test after several weeks.   

      The reason it often makes sense to repeat the PSA test is to get a sense of the PSA level over time. Is it consistently high? Is it drifting steadily upwards? But even if your PSA counts are consistently high, or they are trending upward, here is what I want you to understand: 

A PSA Test Alone Is Not Enough 

      The PSA test alone is not enough to definitively diagnose (or rule out) prostate cancer or any other prostate concern.  Remember, all the PSA test tells us is whether inflammation is present. As we have seen, there are a number of reasons that your PSA may be elevated. Some are perfectly harmless or temporary, others are completely benign and easily treated.  

      In order to get a good idea of what is going on with your prostate, your doctor will also need to perform a digital exam annually. By manually examining the size and shape of your prostate, your doctor can detect any enlargement of the gland or any nodules that may be present.  Many doctors are now also using ultra-sound exams to further visualize the size and shape of the prostate if they are concerned about the possibility of cancer. 

      Ultimately, the only way to diagnose cancer is through a biopsy, in which the doctor withdraws some prostate cells and examines them under a microscope to determine if there are cancer cells present.  Although it is definitive, I don’t want to take a scalpel to any man’s prostate unless it is absolutely necessary. I’m sure you will agree with that logic. 

      The best way to avoid unnecessary biopsies is to have regular PSA tests, along with annual digital exams.  This gives your doctor the best chance to learn what is normal for you and to correctly interpret your results.  In the event that you do develop a problem, your doctor will be better able to catch it early and treat it effectively.  

  Improving the PSA Test 

            The biggest problem with the PSA test is that there is a very high incidence of false positives: men who have high PSA levels but turn out to have no cancer.  These false positives have many costs.  First, there is enormous mental stress associated with a “suspicious” result.  False positives can also trigger unnecessary and expensive procedures (such as biopsies), which can be painful and risky.  

            Researchers are trying to find ways to make the PSA test more useful, both by increasing the sensitivity and accuracy, but also by finding ways to distinguish between prostate cancer and other non-cancerous conditions. Some of these methods involve new tests, and some involve new ways of interpreting the old tests.   

PSA velocity.  Changes in PSA levels may be just as significant as the actual values. Researchers are working to develop statistically reliable interpretive guidelines that would weigh the rate of change along with the actual values to determine cancer risk.  

Age-adjusted PSA:  Because PSA levels normally go up as men age, the chance of false positives goes up for older men. Instead of having a one-size fits all scale, some doctors now advocate age-adjusted PSA.  For example, a relatively narrow range of 0-25. might be appropriate for younger men, while a range of 0 to 6.5 might be normal for older men.  While a good doctor will take your age into consideration when considering your results, researchers are still working on developing a statistically proven standard for this method.  

PSA density:  Some researchers argue that the size and weight of the prostate needs to be taken into consideration in interpreting PSA results.  For example, a man with an enlarged prostate due to BPH would probably have a higher PSA reading, although this does not necessarily indicate cancer. This method remains controversial, subject to further research. 

Free versus attached PSA: In the blood stream, PSA is found in two different forms. The “bound” or “complexed” form is tightly bound to protein molecules, while the free form is unattached.  One of the differences between benign and cancerous conditions is the ratio of free to bound PSA in the blood.  Those with benign prostate conditions tend to have a higher percentage of free PSA while those with cancer have a much higher percentage of the complexed PSA.   Tests which measure both forms and their ratios offer a better picture of what type of condition may be present.

 These statements have not been reviewed or evaluated by the U.S. Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease or illness.