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What is PSA? PSA stands for prostate-specific antigen and the test measures the amount of prostate-specific antigen in the blood. PSA is released into a man's blood through the prostate gland. Healthy men usually have low levels of PSA in their blood. The amount of PSA in the blood normally increases as a man's prostate enlarges with increasing age. PSA can also increase due to inflammation of the prostate gland (prostatitis) or prostate cancer (more rarely). An injury, examination of the rectum, sexual activity (ejaculation) or if you cycle everyday can also raise the PSA level in the short term. Why analyse PSA? The PSA Test is primarily done to screen men for prostate cancer but the test is not diagnostic. If a PSA test is used for screening, it is usually done for men older than 50 or for those at high risk of prostate cancer, mainly men with a hereditary predisposition to prostate cancer. Because other common medical conditions, e.g. benign prostatic hyperplasia (BPH) and prostatitis (inflammation of the prostate), can cause high PSA levels, a rectal exam or an ultrasound may be done if the doctor suspects prostate cancer. Furthermore, a tissue biopsy can also be taken, but this is not without complications. PSA is found in both normal and pathological (diseased) prostate tissue. The PSA value is generally correlated to the amount of prostate tissue, but it is not a completely reliable value. The highest values are seen in metastatic prostate cancer. In prostatitis, values up to 40–50 µg/L can be seen. However, these decrease when the inflammation process recedes. It is in the "border area" from 4 - 10 µg/L that the risk of malignancy is seen at increased values. Normally, men under the age of 50 should not have a PSA value above 2.5 µg/L, while men over the age of 70 with benign hyperplasia (benign prostate enlargement) may have values up to 6.5 µg/L. Testing PSA is a helpful tool and the response should be evaluated against other clinical findings, symptoms and age. Drug treatment of benign prostatic hyperplasia with Finasteride/Propecia reduces the size of the prostate and thus lowers the PSA value. Finding prostate cancer early and treating it can prevent some health problems and reduce the risk of dying from cancer. But some treatments for prostate cancer can also cause other problems, e.g. incontinence or erectile dysfunction. Some men may choose not to treat prostate cancer if they are found to have the disease. An older man who has no troublesome symptoms of prostate cancer may choose not to treat the cancer because many die of natural aging before the cancer itself is fatal. What does a high PSA value mean? High PSA levels can indicate cancer, but in most cases it is not a cause for serious concern. PSA levels may be elevated in benign prostate enlargement or inflammation of the prostate (prostatitis). To confirm a cancer diagnosis, a transrectal ultrasound (TRUS) and prostate biopsy are needed. There is some support that pressure against the prostate can give misleadingly elevated levels, so avoid cycling before sampling. Sexual activity that results in ejaculation can also produce temporarily elevated levels, but it is unclear how long an ejaculation affects test results. For that reason, you should avoid sexual activity and ejaculation at least 24 hours before taking the test.
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