May 12th, 2016
PSA or prostate specific antigen, is an endogenous protein which is secreted by both malignant (cancerous) and benign (non-cancerous) tissues of the prostate gland. Normal levels of PSA are required for the liquefaction of semen. It is imperative to mention that under normal circumstances, very little amount of PSA is present in the blood stream.
Abnormally high serum levels of this antigen are usually suggestive of an ongoing ailment in the reproductive system. This is mainly because cancerous cells produce more PSA as compared to non-cancerous cells (and is indicated by high PSA level in the blood of cancer patient). However, PSA levels can also rise due to non-malignant reasons such as;
Therefore, PSA is just regarded as a screening test in high-risk subjects. More sensitive and specific tests are needed to determine the exact cause of increased PSA levels.
As suggested earlier, several factors are considered while deriving important inferences from the PSA test; these include:
There has been a lot of debate on this topic. A lot of investigators believe that PSA test should be performed after 40 years of age in all men (especially those who are at high risk of developing prostate cancer). But some investigators believe that PSA is a rather unnecessary test due to following reasons:
So although low sensitivity and specificity of this test may cause undue stress, agitation and frustration in men; it is one of the safest and non-invasive screening test that has a strong role in cancer diagnosis and management.
American Urological Association (AUA) also recommends that men (over the age of 55 years) should consult a doctor and discuss whether they should go for PSA screening or not. However, AUA doesn’t recommend PSA tests for men who are above 70 years or have life expectancy of less than 10-15 years.
If you know your risk factors, it will be easier for you to decide if/when you need PSA screening. Risk factors for prostate cancer includes,
1. Moyer, V. A. (2012). Screening for prostate cancer: US Preventive Services Task Force recommendation statement. Annals of internal medicine, 157(2), 120-134.
2. Hayat Roshanai, A., Nordin, K., & Berglund, G. (2013). Factors influencing primary care physicians’ decision to order prostate-specific antigen (PSA) test for men without prostate cancer. Acta Oncologica, 52(8), 1602-1608.
3. Bell, N., Gorber, S. C., Shane, A., Joffres, M., Singh, H., Dickinson, J., … & Canadian Task Force on Preventive Health Care. (2014). Recommendations on screening for prostate cancer with the prostate-specific antigen test. Canadian Medical Association Journal, 186(16), 1225-1234.
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