Prostate-Specific Antigen (PSA): Testing and Its Importance

What Is Prostate-Specific Antigen (PSA)?

Prostate-specific antigen (PSA) is a protein made by the prostate, a small gland in the male reproductive system located below the bladder. Most PSA is found in semen, but a small amount is also present in the blood.

It helps make semen fluid so sperm can move easily. In healthy individuals, blood PSA levels are usually low.

PSA is an important marker for prostate health and is used to:

• Detect early signs of prostate cancer.
• Diagnose non-cancerous prostate issues like an enlarged or inflamed prostate.
• Track prostate cancer progression and the success of treatments.

When Is PSA Testing Recommended?

PSA testing is often recommended for screening or monitoring prostate health. Your doctor may suggest this test if you:

• Are being screened for prostate cancer, especially if you are 50 or older or at higher risk due to family history or ethnicity.
• Have symptoms such as painful or frequent urination, blood in urine or semen, or pelvic pain.
• Are monitoring prostate cancer to assess the effectiveness of treatments or check for recurrence after treatment.

How Is PSA Testing Conducted?

PSA testing is a simple blood test. A healthcare professional draws a small blood sample from a vein in your arm, which is then sent to a laboratory for analysis.

Types of PSA Tests

• Total PSA: Measures the overall level of PSA in the blood.
• Free PSA: Measures PSA not bound to proteins. It provides additional insights, especially when total PSA levels are borderline.

Preparations for the Test

To ensure accurate results:

• Avoid sexual activity (e.g., ejaculation) for at least 24 hours before the test.
• Inform your doctor about any medications or supplements you take, as certain drugs can affect PSA levels.
• Refrain from strenuous exercise or activities like cycling, which may temporarily elevate PSA levels.

Interpreting PSA Test Results

PSA results are measured in nanograms per milliliter (ng/mL). There is no universally "normal" PSA level. What is considered normal can vary based on age, overall health, and other factors. 

Some sources suggest that levels below 4.0 ng/mL are standard for most men, but this is not definitive. Men with levels below 4.0 ng/mL can still have prostate cancer, and those with higher levels may not.

What Happens if PSA Levels Are Elevated?

Even though elevated PSA levels alone do not provide a clear diagnosis, they can indicate the need for further investigation. 

Here are some common follow-up procedures your doctor may recommend:

• Re-testing: A second PSA test may be conducted to rule out temporary fluctuations.
• Digital Rectal Exam (DRE): In this physical exam, your doctor inserts a gloved, lubricated finger into your rectum to feel the prostate. The goal is to check for abnormalities such as lumps, hard areas, or unusual enlargement. 
• Imaging Tests: MRI or ultrasound may be used to assess the prostate's condition.
• Prostate Biopsy: If other tests suggest cancer, a biopsy may be performed to confirm the diagnosis.

Note: PSA levels may naturally rise with age. Doctors often monitor PSA trends over time rather than relying on a single test result to make decisions

Which Specialist Should You Consult?

For PSA-related concerns, consult the following specialists:

• Urologist: Specializes in diagnosing and treating prostate conditions, including elevated PSA levels.
• Oncologist: If cancer is diagnosed, an oncologist provides treatment options such as radiation or chemotherapy.
• Primary Care Physician: Can guide you through the initial testing and refer you to a specialist if needed.

Recommendations for Prostate Health

Keeping PSA levels in check and supporting prostate health can be done with medical care and simple lifestyle changes:

• Follow your doctor’s advice and complete any follow-up tests they recommend. Talk about options like monitoring if your PSA levels are only slightly high.
• Eat a healthy diet with plenty of fruits, vegetables, and whole grains. Try to cut down on red meat and high-fat dairy.
• Stay active by exercising regularly to keep your body healthy.
• Avoid things that might irritate your prostate, like too much caffeine or spicy foods.
• Keep talking to your doctor about your PSA levels and any treatments that might help.