Prostate Specific Antigen

Prostate specific antigen (PSA) is a blood test used for screening of prostate cancer. Unfortunately, PSA is not specific to prostate cancer, but it is currently the best and most cost effective lab test available for screening for prostate cancer.

Any of the following factors can influence PSA levels:

  • Prostate cancer
  • Prostate infection or inflammation
  • Medications such as Proscar/Finasteride
  • Recent urethral catheterization
  • Recent urethral instrumentation (i.e. cystoscopy)
  • Recent ejaculation

The "normal" PSA level is patient specific and depends on patient's age and prostate size. Therefore, the same PSA level in two patients may mean different risks of prostate cancer. Using your PSA level and the clinical digital rectal exam (DRE), your urologist can discuss your risk of having prostate cancer and explain if a prostate biopsy is recommended.

The American Urologic Association panel has the following recommendations for routine PSA screening:

  • Recommends¬†against PSA screening in men under age of 40 years
  • Does not recommend routine screening in men with average risk for prostate cancer who are between 40-54 years of age. African american men, or men with family history of prostate cancer are at increased risk and should consider PSA testing.
  • Men between 55-69 years of age may consider PSA screening based on shared decision making between patient and their physician.
  • Men >70 years of age with good health status and life expectancy >10-15 years may consider continuing PSA screening.
  • Does not recommend PSAscreening in men >70 years of age with <10-15 year life expectancy.

An elevated PSA, persistently rising PSA or abnormal rectal exam may prompt your urologist to recommend a prostate biopsy. A biopsy is the only way to determine if cancer is present, and to better understand the type of cancer cells. The biopsy results and further evaluation with imaging will determine which treatement options is available to you. (See prostate cancer)