The PSA test measures the level or amount of PSA (prostate-specific antigen) in blood. The prostate-specific antigen is a protein synthesized by both non-cancerous and cancerous tissue in the prostate — a tiny gland found below the bladder in men. After it is produced, the PSA finds its way into semen and in small quantities in the blood. But since cancerous cells produce more PSA than non-cancerous cells, the test is carried out to detect high levels of PSA in blood, which may indicate the existence of prostate cancer.

What are the benefits of the PSA test?

Early detection of certain types of prostate cancer is critical for successful treatment and recovery. When the PSA test shows elevated levels of the antigen in blood, it may help to identify prostate cancer that is likely to grow quickly or spread to other parts of the body. In turn, the test helps to catch and treat such cancers early before they begin causing serious symptoms or become life-threatening. Also, by enabling early detection of prostate cancer when the necessary treatment is less aggressive, the test reduces the risk of certain adverse effects of treatment, such as urinary incontinence and erectile dysfunction.

What are the risks associated with the PSA test?

Carrying out the test itself comes with very little risk. It requires only a simple drawing of blood used to run the test in a laboratory. However, once the results of the test are out, there are a number of potential downsides involved. For instance, since false positives are quite common and elevated PSA results may have other causes other than prostate cancer, including prostate infection (prostatitis) and enlarged prostate (BPH), the test results may expose some patients to unnecessary or inappropriate treatments.

Some types of prostate cancer don’t produce much PSA, which means that a test may incorrectly indicate that you don’t have the cancer (a false negative). And follow-up tests for checking out the underlying causes of an elevated PSA test are often stressful, invasive, time-consuming or expensive. Furthermore, living with a localized or slow-growing prostate cancer — one that doesn’t require treatment — can cause stress and anxiety.

When should you get your first PSA test?

Before you get the first PSA test, it is recommended that you discuss the benefits and risks of the test with your doctor. During the discussion, a comprehensive review of your risk factors and preferences is done. For example, the urologist will consider your age, race, size of your prostate, medications you are taking (dutasteride and finasteride affect PSA levels), and how frequently your PSA levels change when making a decision about getting the test.

At St. Pete Urology, we advise men who are at higher risk of the disease, such as African American men and those with a brother or father who have had the cancer, to get their first test at the age of 40-45. Having the test before you reach 50 helps us to establish your PSA baseline and thereafter monitor the changes in your PSA levels to determine whether or not you’ll need annual PSA screening and prostate biopsy. If your blood PSA level is very low, we’ll put off any further PSA tests. But if you are a man of moderate to low risk of the disease, we recommend you get your first PSA test at age 50 or older (generally between 55 and 70).

What happens if your first PSA test result is high?

If you don’t have symptoms of prostate cancer, another PSA test may be recommended if your first test showed an elevated PSA level. The second test is used to confirm the validity of the original finding. But if the second PSA test still gives elevated PSA level, the urologist may direct that you continue with more PSA blood tests and digital rectal exams (DREs) at frequent intervals to monitor any changes in your prostate over time.

If your blood PSA level continues to rise over time or the urologist finds a suspicious lump in your prostate during a DRE, additional tests may be suggested to establish the nature of the problem. For example, a urine test may be run to find out if you have a UTI (urinary tract infection). Imaging tests like X-rays, cystoscopy or transrectal ultrasound also may be recommended. Then if prostate cancer is suspected, the urologist carries out a prostate biopsy — collecting multiple samples of tissue from your prostate by inserting hollow needles into the gland and withdrawing tissue. The tissues are examined under a microscope by a pathologist to confirm the cancer.

Treatment of prostate cancer

The type of treatment recommended for prostate cancer usually depends on whether it is early-stage or advanced-stage disease. For early-stage cancer the options include watchful waiting, radical prostatectomy, brachytherapy, conformal radiotherapy and intensity-modulated radiation therapy. At St Pete Urology, watchful waiting means no immediate treatment is offered but the cancer is closely monitored through regular PSA tests. Prostatectomy involves surgically removing part of or the entire prostate; brachytherapy involves implantation of radioactive seeds into the prostate to deliver specific amounts of radiation to the tumor. Conformal and intensity modulated radiotherapies deliver targeted amounts of radiation to the tumor with minimal damage or exposure of healthy tissues.

For advanced-stage prostate cancer, which is typically a more aggressive tumor that grows quickly and spreads faster to other areas of the body, treatment includes chemotherapy and androgen deprivation therapy. Chemotherapy can eliminate cancer cells that have spread to other parts of the body. Likewise, androgen deprivation therapy (androgen suppression therapy or ADT) is used to reduce the effect of androgens — male hormones that stimulate cancer growth — thereby slowing down or stopping cancer growth.

At St Pete Urology, we talk to our patients openly and candidly about the risks and benefits of the PSA test before we can advise them to get it. We also discuss the results of the tests, give our recommendations for those with positive results and typically repeat the PSA test for those with negative results. Our patients have always told us that our attention to detail, quality of interactions and efficiency during their visits is unmatched. If you would like to know more about the PSA test, visit the “St Pete Urology” site.

Prostate cancer is the most frequently diagnosed non-skin cancer in men in the United States, currently carrying a lifetime risk for diagnosis of around 15.9 percent. In most cases, prostate cancer shows a good prognosis even when not treated, though some may be quite aggressive. Presently, the lifetime risk of death due to prostate cancer is 2.8 percent, and the condition is quite rare in men younger than 50. In fact, very few men die of the cancer before age 60, and more than 70 percent of the deaths due to the cancer occur after age 75.

Even though prostate cancer typically grows very slowly or not at all, it is still advisable to start screening early before the symptoms appear. Early prostate cancer screening may help to discover any aggressive type of the cancer and ensure prompt treatment. Today, there two most effective and recommended tests for screening are prostate specific antigen (PSA) test and digital rectal exam (DRE).

PSA

All contemporary recommendations for prostate cancer screening incorporate the prostate specific antigen (PSA) levels in serum because there is convincing evidence that PSA-based screening detects many cases of asymptomatic prostate cancer. Studies also have shown that a vast majority of men who have asymptomatic cancer detected through the PSA test have tumors that either will fail to progress or will grow so slowly that they would have shown no symptoms for the patient’s lifetime. If your PSA level is high, your urologist will recommend either waiting for a period and then repeating the test or doing a prostate biopsy to confirm if you have the cancer. When interpreting your PSA results, your urologist will consider many factors, such as race, age and family history.

Digital Rectal Exam (DRE)

During DRE, the urologist inserts a gloved, lubricated finger into the rectum to feel for any hard areas or bumps on the prostate, which might indicate cancer. The exam may be slightly uncomfortable, but is never painful and just takes a short time. While the digital rectal exam may be less effective than the PSA in detecting prostate cancer, it sometimes can detect cancer in men with normal PSA levels. For this reason it is a critical component of prostate cancer screening.

What next after screening?

PSA and DRE tests are simply used to detect the warning signs of prostate cancer, but in reality they do not actually confirm if you have cancer. If the test results are abnormal, your urologist will use a prostate biopsy for confirmation. If there is cancer, a prostate biopsy also will help determine the aggressiveness and influence the urologist’s decision as to whether or not you need treatment. Not every patient must be treated and those with non-aggressive cancer will just be actively monitored. The decision on whether you get treated is very important and is usually based on results of these tests. For more information on early prostate cancer diagnosis and treatment, visit the site, St Pete urology.

When should you take the Prostate-Specific Antigen (PSA) test? The question of screening is typically a personal and complex issue that requires a consultation with a urologist. Currently, the medical community does not share a unanimous opinion regarding the benefits of prostate cancer screening.

Most physician-led groups, like the American Urological Association and the American Society of Clinical Oncology, insist that PSA screening ought to be considered within the context of a man’s life expectancy and level of risk given other prior or existing medical conditions. Other groups have advised that PSA screening for healthy men under 40 comes with a risk of harm that may outweigh the benefits depending on the patient’s medical history.

When should you start screening?

The decision on when to start screening should depend on your overall health, level of risk, life expectancy, and desire for treatment should you be diagnosed with prostate cancer. While the time to start screening depends on individual factors, the age of 40 years is a reasonable time to begin, particularly for those with genetic predispositions or a family history of cancer. Likewise, for healthy men at high risk, such as African American men with a family history of prostate cancer, starting at age 40 is advisable.

For men at average risk, a urologist may recommend the initial DRE or PSA test at age 40 or 45, while some urologists may recommend starting at age 50. In general, most men have discussed PSA testing with their doctor by the time they reach age 50. This means that men above 40 years should consider discussing PSA screening with their urologist to determine if and when the test is right for them. All men should develop a proactive prostate health plan based on their family history and lifestyle.

When should you visit a urologist?

The above recommendations are specific to prostate cancer screening for healthy men showing no symptoms. If you are diagnosed with prostate cancer and a confirmation is made using a biopsy, your urologist may recommend routine PSA testing for risk assessment and post-treatment monitoring.

The right time to start PSA screening is an individual decision that depends on your risk level and family history. Visit your urologist to discuss the timing of this important medical test for men. For more information on the screening and treatment of prostate cancer, visit St Pete Urology in St Petersburg, Florida.