Feb 24, 2024 By Nancy Miller
Healthy and cancerous prostate cells generate the prostate-specific antigen (PSA). The PSA test may determine the blood PSA level. This evaluation requires the submission of a blood sample for laboratory examination. Nuclear gamma (ng/mL) is the standard reporting unit for PSA levels in blood.
Since 1986, the FDA has permitted the PSA test to follow prostate cancer development in males with elevated PSA levels. In 1994, the FDA approved the PSA test for use in men over 50 to enhance digital rectal examinations (DREs) for prostate cancer detection. Until 2008, medical authorities and business associations recommended PSA testing at 50 for prostate cancer screening. Doctors may request PSA tests and a DRE to diagnose prostate pain. Prostatitis and BPH are two of numerous benign (non-cancerous) prostate conditions that may raise PSA. These illnesses may cause prostate cancer, although neither is proven to cause it.
In 2008, when the advantages and downsides of PSA prostate cancer screening became clearer, numerous medical associations advised against frequent population screening. Everyone believes patients should discuss the merits and cons of PSA screening with their doctors before undergoing it. Some associations recommend PSA testing for prostate cancer-prone men at 40 or 45. African-American men, men with BRCA2 (and BRCA1) germline mutations, and men with a family history of prostate cancer are at higher risk.
USPSTF changed the prostate cancer screening recommendation statement for males 55 to 69 from "D" (not recommended) to "C" (selectively giving PSA-based screening based on professional judgment and patient preferences) in 2018. (The USPSTF still advises against PSA screening for males over 70.) Even individuals at risk due to race, ethnicity, or family history should follow the amended recommendation:
There is no hard and fast rule on a normal or abnormal blood PSA level. Levels of 4.0 ng per milliliter or less were once considered typical for PSA. Although many men with PSA levels between four and ten ng/mL are not diagnosed with prostate cancer, some have the disease with levels below 4.0 ng per milliliter.
Additionally, the normal PSA test range might alter for many causes. Higher PSA levels are linked to larger prostates, inflammation, and advanced age. In addition to recent prostate biopsies, vigorous physical exercise like cycling two days before testing may elevate PSA values. Benign prostatic hyperplasia drugs like Propecia and dutasteride lower PSA. PSA levels raise men's prostate cancer risk on average.
If a patient without prostate cancer symptoms wants a PSA test, a doctor may recommend a second one to confirm the initial result. The doctor may recommend frequent digital rectal exams (DREs) and PSA testing if PSA levels remain high.
The doctor may recommend further testing if the PSA level rises or a suspicious bulge is seen during a DRE. This includes MRIs and high-resolution micro-ultrasounds. A prostate biopsy may be recommended by the doctor. Inserting and withdrawing hollow needles into the prostate collects tissue samples. The perineum and rectum walls are the most frequent biopsy needle entrance sites. Pathologists analyze the tissue under a microscope. Ultrasonography helps clinicians view the prostate during both kinds of biopsies, but it cannot analyze prostate cancer.
Doctors used to provide medicines to individuals with high PSA levels who had no other symptoms to rule out an infection. In symptom-free males, antibiotics may reduce PSA. The American Urological Association claims this procedure lacks research.
Researchers are trying to improve the PSA test so doctors can distinguish benign from malignant diseases and slow-growing, lethal cancers. Other prostate cancer indicators are being studied. There is no evidence that these diagnostics decrease prostate cancer mortality. Methods that are currently under investigation include