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What’s the Buzz on PSA Testing?

What is PSA?

Prostate Specific Antigen (PSA) is a protein found in the blood and semen of men with normal prostate tissue and those with prostate cancer. It is produced by prostate cells, whether benign or malignant. PSA keeps semen in a liquid state to facilitate fertility. It is not affected by diet or usual activity.
 

Who should get a PSA, and why does it matter?

Most men will develop some form of a prostate problem in their lifetime. Symptoms can range from mild inconveniences to invasive cancers. Early prostate screening and testing is critical when it comes to the detection and management of prostate conditions, especially prostate cancer. 

PSA is a common blood test routinely performed in men between the ages of 40-75.  A PSA test can help detect prostrate cancer by measuring the PSA in the blood. 

The timing of a PSA test and subsequent screenings depends on several factors, including age, individual risk factors, and personal preferences:

• High-Risk Males, age 40-49: Men at higher risk for prostate cancer, such as those with a family history of the disease (especially if a close relative was diagnosed at a young age) or certain genetic mutations, should consider discussing PSA testing with their healthcare provider starting as early as age 40.
• Average-Risk Males, age 50+: For men without pre-determined risk factors, PSA screening discussions typically begin around age 50. At this age, many healthcare providers offer baseline PSA testing to establish a comparison for future tests.

Early detection and treatment can prevent prostate cancer from spreading beyond the prostate. According to Johns Hopkins Medicine, approximately 85% of individuals with prostate cancers that are detected and treated in the local or regional stages (stages I, II and III) will be disease-free after five years. Prostate cancers detected at the distant stage (stage IV) have an average five-year survival rate of only 28%.
 

What is a normal PSA level?

“Normal” has several definitions when it comes to PSA. The Vail Health lab uses 0.0-4.0 ng/ml as the normal range. Additionally, there are normal ranges described by age: 
The age-related values reflect normal prostatic growth with time to a large extent. We know that prostatic size, in a given individual, can create a “normal” that is different from the values above. For instance, a PSA of 10ng/ml might be normal for a 100 gm prostate and a PSA of 2ng/ml may be normal in a fellow with a small prostate. Finally, PSA values will vary with each draw. Urologists look for overall stability. Rising PSA, even rising up to these “normal,” can indicate a problem.
 

Why did my PSA level increase?

There are conditions, or issues, that can cause the PSA to rise to levels of concern. Cancer is one. Any manipulation, such as a foley catheter, cystoscopy, prostate biopsy or vigorous massage will raise the PSA level for a short time. A urinary infection or prostatitis will cause a dramatic PSA bump that may require antibiotics and 4-6 weeks recovery to return to baseline. Men who are taking finasteride or dutasteride, and stop those medications, will see their PSA levels double.
 

Why did my PSA level decrease?

There are also circumstances in which a PSA level will fall. Finasteride or dutasteride are medications that shrink the prostate, and we expect PSA to drop by about 40% without preventing prostate cancer. Operations performed that remove portions of the prostate like TURP or Holep will cause a drop in PSA, typically. Emperic antibiotics taken because of a bump in PSA will drop those levels, but they are discouraged in patients without symptoms as they cloud the interpretation of trends in PSA and delay diagnosis and treatment of cancer if present. Hormone treatments, radical prostatectomy, and radiation therapy for cancer also cause a drop the PSA levels.
 

What do I do next?

Judgement is required by patients and their primary care providers when it comes to the use and interpretations of any blood test, including PSA.  If you're a male age 40+, it's important to see a urologist or your primary care provider to determine when and how often you should complete this preventative screening. Colorado Mountain Medical’s urology team offers state-of-the-art screening tools for the early detection of prostate cancer.