When do you need a PSA test?

The prostate-specific antigen (PSA) test is a blood test performed to screen for prostate cancer. It measures the level of PSA in blood—a protein made only in the prostate gland. After production in the prostate, the PSA finds its way into blood. But the level of PSA in blood depends on age and on the health of the prostate.

What is the normal level of the PSA in blood?

The amount of PSA in blood is measured in nanograms per milliliter of blood (ng/ml).  For men aged 40 to 50 years, a PSA level above 2.5 nanograms per milliliter is considered abnormal. The normal range for men of this age is usually 0.6 to 0.7 nanograms per milliliter. 

And for men aged 50 to 70 years, a PSA score greater than 4.0 nanograms per milliliter is considered abnormal.  The normal PSA range for men in this age is 1.0 to 1.5 nanograms per milliliter.

Besides, any rapid increase or a continuous rise in PSA level over a period of time is considered abnormal. For instance, a rise of more 0.35 nanograms per milliliter of blood within one year is abnormal. 

Nevertheless, not every increased PSA level is an indicator of prostate cancer. In fact, 3 in 4 men with elevated PSA do not have the cancer. Apart from prostate cancer, an elevated PSA level in your blood may be due to prostatitis, an enlarged prostate, and urinary tract infection.

So when should you get screened for prostate cancer?

The time to begin having PSA tests depends on a number of factors. According to new guidelines, men with no family history or known illness should undergo the PSA test starting from age 54 to 70 years. The reason for this is that it is at this age that they can benefit the most from screening. 

It is from the age of 54 to 70 when:

  1. You are more likely to develop prostate cancer.
  2. Treatment of diagnosed prostate cancer makes most sense—the benefits of treating the cancer outweigh any possible risks of treating side effects.

However, there are some men who may need screening earlier, between the ages of 40 and 54 years. Your doctor may recommend that you get screened this early if you:

  1. Have a positive family history of prostate cancer. That is if you have at least one first-degree relative, like a brother or father, who has had the cancer.
  2. Have at least two extended family members who have had prostate cancer.
  3. Are African-American; an ethnicity that has a higher risk of developing a more aggressive form of prostate cancer. 

But for men who are 70 years or older, taking the PSA test is not usually recommended. That’s because the benefits of treatment may not outweigh the adverse effects. Also, the cancer may not grow or spread to a life-threatening stage in the patient’s lifetime. Though, men above 70 years may undergo the PSA test if they have a life-expectancy greater than 10 years.

Choosing to get the PSA test

As you grow older, your risk of having prostate cancer increases. Hence, you will need to undergo screening to help you detect the cancer early should you have it. For most men, it is recommended that they undergo regular PSA tests after the age of 54 years.

However, you should ask your doctor for advice on when to start having screening tests and how frequently you should be screened. If you are 54 years or older, your doctor may advise that you have a PSA test every 2-3 years. The doctor will also explain to you the harms and benefits of screening for prostate cancer.

What next after an abnormal PSA test?

If your PSA level falls in the abnormal range, your doctor may make the following recommendations:

  1. Repeat the PSA test. If the level is still higher after the repeat, your doctor may recommend monitoring the PSA level over a period of time to see how it changes.
  2. A digital rectal examination to feel for the changes in your prostate gland that may help to detect prostate cancer.
  3. A biopsy, which involves taking small samples from the prostate and checking them for cancer cells.

If it is confirmed that you have prostate cancer, your doctor will want to know whether the cancer is indolent or aggressive. An indolent cancer is slow-growing and has only a minimal chance of spreading to other organs.  With such a cancer, you may not be treated, but may be placed under watchful waiting and active surveillance.

An aggressive cancer grows rapidly and has the potential to spread to other parts of the body. Your doctor will consider your age and other factors when weighing the risks and benefits of treatment.  Eventually, you’ll undergo a personalized treatment that may include radiotherapy and radical prostatectomy.

Do you have fears that you may be at risk for prostate cancer? Would you like to speak with a knowledgeable, experienced urologist to know your risk level and when to begin your prostate cancer screening? Contact Advanced Urology Institute today to book your consultation session with a urologist who will give you the best possible advice. For more information on prostate cancer screening, diagnosis and treatment, visit the site “Advanced Urology institute.”

What can cause an elevated PSA?

Key takeaways

  • The PSA test measures the quantity of a protein produced by cells of the prostate gland in a blood sample. It is typically used to screen for and monitor prostate cancer in men.
  • Elevated PSA levels can also be caused by non-cancerous conditions such as age, prostatitis, benign prostatic hyperplasia (BPH), and urinary tract infections.
  • To use an elevated PSA as the basis for ordering a prostate biopsy, it is now recommended that the level of PSA is monitored over time and any changes are monitored regularly, with a suspicious lump detected during a DRE being a more accurate basis for suspecting prostate cancer.

Prostate-specific antigen (PSA) is a protein produced by cells of the prostate gland. It is synthesized by both normal and malignant cells and released in blood. The PSA test measures the quantity of this protein in a blood sample, which is then reported in nanograms of PSA per milliliter (ng/mL) of blood. A PSA level of 4.0 ng/mL and below is often considered normal.

What causes an elevated PSA level?

The blood PSA level is typically elevated in men with prostate cancer. Therefore, the test is usually ordered in conjunction with the digital rectal exam (DRE) to screen men that are asymptomatic for prostate cancer. It is also recommended for monitoring the progression of prostate cancer in men already diagnosed with the disease, and to test men with prostate symptoms to find out the nature of their problem.

Apart from prostate cancer, there are a number of conditions that may increase the PSA level. For instance, PSA is elevated with age, usually due to enlargement of prostate tissue over the years. Prostatitis (inflammation of the prostate), which is a condition common in men under 50 years due to bacterial infection, tends to result in increased PSA level. Other conditions that lead to increased PSA level include benign prostatic hyperplasia (BPH), urinary tract infections, prostate injury, recent ejaculation, high parathyroid hormone, and surgical procedures.

Normal versus abnormal PSA level

Although a PSA level of 4.0 ng/mL or below is often considered normal, the level of the protein can vary over time in the blood of the same man, making what is usually taken as the normal range less accurate. In fact, studies have indicated that some men with PSA level below 4.0 ng/mL have prostate cancer while many men with levels above 4.0 ng/mL have been found free of the cancer.

Besides, due to the various factors that may cause a fluctuation of PSA level, such as age, prostatitis, BPH, and urinary tract infections, having a fixed normal range for all men is unreliable in some cases. Equally, since PSA test results vary from one laboratory to another and because drugs like Dutasteride (Avodart) and Finasteride (Proscar) that are used to treat BPH tend to lower PSA level, a single elevated PSA may not be very helpful.

Therefore, to use an elevated PSA as the basis for ordering a prostate biopsy to ascertain whether prostate cancer is present, it is now recommended that the level of PSA is monitored over time. A continuous trend of increasing PSA in blood over a prolonged period of time, together with a suspicious lump detected via the DRE, is a more accurate basis for suspecting prostate cancer and ordering for a prostate biopsy.

Elevated PSA in prostate cancer screening

For men without symptoms of prostate cancer, an elevated PSA level may be followed by a repeat PSA test to confirm the original finding. And if the PSA level is still high, the urologist may recommend that more PSA tests and digital rectal exams be done at regular intervals so that any changes can be monitored over time. If the PSA level continues to rise or if a suspicious lump is found during a digital rectal exam, the doctor may now order for confirmatory tests.

For example, a urine test may be requested to establish if the rising PSA level is due to a urinary tract infection. Likewise, imaging tests like cystoscopy, x-rays or transrectal ultrasound may help to show the size and nature of any lump.

And if the tests show there could be prostate cancer, the urologist will recommend a prostate biopsy.  Multiple samples of prostate tissue are collected by inserting hollow needles into the prostate through the wall of the rectum. The samples are examined by a pathologist to confirm whether the cells are cancerous or not.

Elevated PSA in monitoring prostate cancer treatment

After treatment for prostate cancer, the urologist will want to continue to monitor the PSA level to establish whether the disease is recurring or not. An elevated PSA level after treatment is usually the first sign that the cancer is recurring. In fact, an elevated PSA after treatment often happens many months or years before the signs and symptoms of prostate cancer recurrence show.

A single elevated PSA test isn’t enough to conclude that the cancer has recurred. So the urologist will recommend that the test be repeated a number of times, and be done together with other tests, to check for evidence of prostate cancer recurrence. Repeated PSA tests help the doctor to establish a trend over time instead of relying on a single elevated PSA level.

At Advanced Urology Institute, we are committed to the highest standards of urologic care. We make sure to use the right diagnostic and treatment tests, techniques and procedures to deliver the best possible outcomes for our patients. That is why when it comes to the PSA test, we do not rely on a single elevated result to draw conclusions about your prostate health.

It is our practice to monitor elevated PSA for a prolonged period of time and to use the test alongside risks factors (age and family history) and other tests like the digital rectal exam, before we can make conclusions regarding your prostate health. We believe that an elevated PSA level is a valuable tool for early detection of prostate cancer and for successful treatment of the condition if the test is used properly. For more information on prostate cancer diagnosis and treatment, visit the site “Advanced Urology Institute.”

References

When Is the Right Time for a PSA Test, According to Dr. Yaser Bassel?

KEY TAKEAWAYS:

  • Men with a family history of prostate cancer or African-American males should start screening at age 40.
  • For the general population, the American Urological Association recommends screening at age 55.
  • The PSA test is an important tool for the early detection of prostate cancer.

Prostate-specific antigen (PSA) test is a common test used to screen for prostate cancer. However, there has been controversy over when men should start getting tested for this type of cancer. In this article, we will discuss the right time for a PSA test according to Dr. Yaser Bassel, a board-certified urologist in Tampa, FL, and a member of Advanced Urology Institute.

Who Should Start Screening at Age 40?

Dr. Yaser Bassel recommends that men with a family history of prostate cancer or African-American males should start screening at age 40. This is because they are at higher risk of developing prostate cancer. African-American men are twice as likely to die from prostate cancer than white men, and they are more likely to be diagnosed with prostate cancer at an earlier age. Additionally, men with a family history of prostate cancer have a higher risk of developing the disease themselves.

What Does the Screening Involve?

The screening process for prostate cancer typically involves a PSA blood test and a digital rectal exam. The PSA blood test measures the level of PSA in the blood. PSA is a protein produced by the prostate gland, and high levels of PSA can be an indication of prostate cancer. The digital rectal exam involves a doctor inserting a lubricated, gloved finger into the rectum to feel the prostate gland and check for any abnormalities.

When Should the General Population Start Screening?

For the general population, the American Urological Association recommends screening at age 55. This is because the risk of developing prostate cancer increases with age. However, if a man has a family history of prostate cancer or other risk factors, such as African-American heritage, he may need to start screening earlier.

The Importance of Early Detection

The PSA test is an important tool for the early detection of prostate cancer. When caught early, prostate cancer is often treatable, and the chances of survival are high. However, if prostate cancer is not detected early, it can spread to other parts of the body and become more difficult to treat. Therefore, it is important for men to talk to their doctor about the right time for them to start getting screened for prostate cancer.

Advanced Urology Institute

Advanced Urology Institute is the largest urology practice in Florida, with multiple locations throughout the state, including Tampa. They offer a wide range of urological services, including prostate cancer screenings, and their team of experienced urologists is dedicated to providing the highest quality care to their patients. If you are in need of urological care, we highly recommend scheduling an appointment with Advanced Urology Institute.

TRANSCRIPTION:

My name is Yaser Bassel. I’m a board-certified urologist with Advanced Urology Institute. 

In particular, it’s important for men with a family history of prostate cancer or African-American males to start screening at age 40. And again, that’s typically done with an annual PSA blood test and also a digital rectal exam. For the general population, the American Urological Association now recommends screening at age 55. It’s pretty simple. It involves really just a simple blood test that’s done once a year and then also a prostate exam or a digital rectal exam.

REFERENCES:

When Should You Get A PSA Test?

The prostate gland is a critical component of the male reproductive system. Located just underneath the bladder and in front of the rectum, the tiny walnut-sized gland helps to make semen — the fluid that carries sperm. But as men age, the prostate increases in size, becomes enlarged and begins to cause problems.The most common prostate problems include:

  1. Bacterial infection
  2. Dribbling after urination
  3. Increased need to pass urine (especially at night)
  4. Enlarged prostate, called benign prostatic hyperplasia (BPH)
  5. Prostate cancer

One of the most common cancers

The second most frequent cancer in American men, after skin cancer, prostate cancer typically grows slowly and shows very few early symptoms. So doctors usually recommend that men go for screening to ensure the cancer is spotted early even before symptoms arise and prior to the cancer getting more advanced. During screening tests, doctors perform prostate exams to detect any abnormalities that may indicate an issue, such as cancer. But the exams are not recommended for everyone and are often only necessary when the benefits outweigh the risks.

The PSA (Prostate-Specific Antigen) Test

The prostate-specific antigen test, simply called PSA, is a blood test for detecting prostate cancer and one of the most frequently used screening tests for the cancer. When there is an elevated level of the PSA in the blood, it might indicate that you have cancer. However, it’s not always that straightforward. In fact, there is a raging controversy about the PSA test, with many people questioning whether or not it’s necessary for younger men who are otherwise healthy. For instance, there is the argument that if there is a false positive PSA result, it may cause a lot of unnecessary anxiety and could even cloud a person’s decision regarding future treatment. False positive results are relatively low with the PSA test, but they may still occur.

The biggest argument against the PSA test is that treatment isn’t necessary for many prostate cancers. The cancer tends to grow and spread slowly and rarely causes serious effects during a man’s lifetime. While, in some cases, the cancer can be really aggressive and the PSA test may detect it when it’s still small and easier to treat, the side effects of cancer treatment are monetarily and physically too costly. So a lot of precaution is necessary when deciding who should or should not get treatment — there is no reason for treating a cancer that has little or no chance at all of progressing.

So when should you get your first PSA?

It is important to discuss the benefits, risks and uncertainties of the PSA (prostate-specific antigen) test with your doctor before getting it. If you are a man of average risk, you should get your first PSA at the age of 50. But for men at high-risk of developing prostate cancer, such as African-American men, men of Caribbean descent and men with a first-degree relative (brother, father or son)
who had the cancer before age 60, then the first PSA should be at 45. And for men who are at higher risk, such as those who have more than one first-degree relative who had the cancer at an earlier age (younger than 50), the first PSA test should be at the age of 40.

Establishing the baseline with first PSA

At Advanced Urology Institute, we recommend that men get their first PSA test before the age of 50 so that a baseline can be established and used to make the decision as to whether or not they’ll need further tests. If it’s very low, then your regular PSA tests can be put off. But in cases where the PSA is elevated, we conduct other tests to ensure that it is prostate cancer we’re dealing with and not a prostate infection or an enlarged prostate. Depending on the PSA test result, we may repeat your PSA every 6 months to assess whether the first was a false positive or there is an upward trend.

The main thing with the PSA test is the changes in the level of PSA. Some men can have normal PSA but still have prostate cancer. So monitoring the changes and trends in your PSA is critical for cancer diagnosis. That’s why we encourage people to get their first PSA test early to establish a baseline for monitoring their PSA level. You don’t have to undergo a prostate biopsy just because you have done a PSA. If it’s found that your PSA is where it should be, you’ll not need a biopsy. That’s why we always want to be sure of the trends in your PSA.

Are you at high-risk of prostate cancer? Or are you experiencing symptoms of what could be a prostate problem, such as painful or frequent urination or blood in urine? At Advanced Urology Institute, we exhaustively discuss the pros and cons of the PSA test with our patients before making any decisions. We understand that PSA screening has both benefits and risks and we try to make the best possible decisions for our patients. For more information on the PSA test, prostate exams, diagnosis and treatment of prostate cancer, visit the “Advanced Urology Institute” site.

The PSA Test, The Best Tool for Prostate Cancer Screening – Dr Matthew Merrell

Video: The PSA Test, The Best Tool for Prostate Cancer Screening – Dr Matthew Merrell


PSA exam is a blood test to determine the levels of prostate specific antigens. The tests measure the level of PSA in your body, which is then compared to the expected amount for your age. Contact a urologist now to know more about this procedure. [Read Full Article…]

The PSA Test, Is it Still Recommended? – Dr. Stephen Weiss

Video: The PSA Test, Is it Still Recommended? – Dr. Stephen Weiss


Symptoms of Prostatitis are similar to those of benign prostatic hyperplasia so a PSA Test is still recommended by Urology Specialist to thoroughly detect this type of condition. Contact a urologist now and get treatment for this condition as soon as possible. [Read Full Article…]

What’s the Debate About PSA Testing? Dr. Edward King Clarifies the Controversial PSA Test

KEY TAKEAWAYS:

  • The PSA test is a controversial method of prostate cancer screening due to its lack of specificity.
  • Individualized screening is essential, with men aged 55 to 70 and those in high-risk groups being encouraged to undergo screening.
  • The decision to undergo prostate cancer screening should be made between the patient and their physician, considering individual risk factors.

The Purpose of PSA Testing

Edward D. King, MD, FACS, a urologist in Oxford, FL, explains that the PSA (prostate-specific antigen) is an enzyme found in the bloodstream. While the PSA itself is harmless, it serves as a marker for prostate cancer. In cancerous cases, more PSA tends to leak into the bloodstream, resulting in higher PSA levels. However, the PSA test is not highly specific, leading to controversy around its use in prostate cancer screening.

The Controversy Surrounding PSA Testing

According to Dr. King, among men with slightly elevated PSAs, the risk of finding cancer is about one in four. Due to this lack of specificity, other tests are often used alongside the PSA test to identify patients with elevated PSAs but no cancer. The U.S. Preventive Services Task Force has recommended against routine prostate cancer screening, which Dr. King believes is a mistake. Prostate cancer is the second leading cause of cancer deaths in the United States, tied with colon cancer, and some groups are at higher risk for developing and dying from prostate cancer.

Individualized Screening for Prostate Cancer

Dr. King emphasizes the importance of individualized screening for prostate cancer. He suggests that men aged 55 to 70, especially those in high-risk groups, should be screened. Men with low PSAs and no family history of prostate cancer may not need screening after the age of 70. Ultimately, the decision to undergo prostate cancer screening should be made between the patient and their physician, taking individual risk factors into account.

Advanced Urology Institute: Your Trusted Source for Prostate Cancer Screening

The Advanced Urology Institute, the largest urology practice in Florida, offers state-of-the-art prostate cancer screening and treatment options. Dr. Edward King and his team of expert urologists are dedicated to providing personalized care to ensure the best possible outcomes for their patients.

TRANSCRIPTION:

My name is Dr. Edward King, I’m a urologist at the Advanced Urology Institute.

The PSA is an enzyme that floats in the bloodstream. The PSA in and of itself doesn’t harm you, it only serves as a marker for prostate cancer.
In cancers, more of the PSA tends to leak into the bloodstream, and so the PSA tends to be higher. But the PSA is not real specific, and that’s the problem.

Among men with slightly elevated PSAs, the risk of finding cancer is about one in four. So we have other tests that we also use along with the PSA to try to weed out patients whose PSAs may be slightly elevated but who don’t have cancer. It is controversial, the U.S. Preventive Services Task Force recommended against routine prostate cancer screening in men.

I think that that was a mistake because prostate cancer is the second leading cause of cancer deaths in this country. It’s tied with colon cancers, and there are some groups that are higher risk for developing prostate cancer and dying from it.

So the screening has to be individualized, so it’s a choice between made with the patient makes with his physician. Typically men who have low PSAs, no family history of prostate cancer, probably don’t need to be screened after the age of 70, but I do think that men between the ages of
55 and 70, especially men in high risk groups, do need to be screened.

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