Introduction

Prostate-specific antigen (PSA) is a glycoprotein produced almost exclusively in the prostate gland.  PSA is detectable in the blood stream normally in small quantities.  Abnormalities within the prostate gland such as chronic inflammation, benign prostatic hyperplasia and prostate cancer may cause the blood level of PSA to become elevated.  Therefore, PSA has become an important “marker” for prostatic disease.

Use of PSA for early detection of prostate Cancer

Prostate cancer is the most common cancer, excluding skin cancer, and is the second leading cause of cancer death in men.  About 200,000 men are diagnosed with prostate cancer every year.  Since PSA testing has become available there has been a steady decline in prostate cancer mortality.  PSA testing is responsible for early detection of prostate cancer and more effective treatment reducing mortality risk.

Who should be screened for prostate cancer with PSA testing?

Men age 50 and older who have a life expectancy of 10 years or greater should have annual PSA testing along with digital rectal examination (DRE).  Men in their late 70’s or men with chronic illnesses that may limit life expectancy may not need annual PSA testing.

High-risk men should have annual PSA screening along with DRE beginning age 40.  The most significant risk factor for prostate cancer is a family history of prostate cancer.  If a father, fraternal uncle or brother has been diagnosed with prostate cancer, screening at age 40 would be advised.  African American men are in a slightly higher risk group than Caucasian men.  Early screening should be considered.

PSA and Prostate Cancer

PSA testing is a useful tool or “marker” for following patients diagnosed with prostate cancer.  Whether a patient has been treated or on active surveillance, PSA levels will indicate success of treatment or progress of the disease. 

How reliable is PSA testing?

PSA alone is not sufficient to diagnose or exclude prostate cancer.  PSA along with DRE is necessary for screening.  Prostate ultrasound and ultrasound guided biopsy is the definitive test in those patients who either have abnormal elevations of PSA or abnormal DRE.

What are the best options for men with elevated PSA testing?

A qualified urologist is the best medical specialist for evaluation of PSA abnormalities.  Prostate disorders, procedures and evaluations may be offered by different medical practitioners but ultimately, an urologist is a patient’s best choice.  Insist on a qualified urologist.*
                                                                                                                            American Urological Association Guidelines of Best Practice 2009