February 16th, 2016
Prostate-specific antigen (also known as PSA) is a unique biological protein that is secreted by the cells of male prostate gland. As part of the normal metabolism, part of this secretion also seeps in the blood; thus forming the basis of PSA test.
PSA test measures the levels of prostate-specific antigen in the blood (nanograms per milliliter or ng/mL). FDA has approved PSA test as a reliable test to detect the progression of prostate cancer in 1986. Since early detection of prostate cancer is associated with an excellent prognosis, it is suggested that screening of prostate cancer by PSA test, should be started at the age of 50. In addition, males who are at risk of developing prostate cancer (such as African American males, ore men who have a strong family history of prostate cancer) should opt for early screening at the age of 40 or 45 years.
PSA test is usually performed as part of the workup for Prostate cancer. It has been observed that males with prostate malignancy produce significantly high levels of this protein. Although the sensitivity and specificity of PSA test is fairly high; it is imperative to keep in mind that:
The normal PSA levels vary with the age of a person. Generally, PSA levels of 4.0 ng/mL or less are considered normal (or ideal) in an adult male. In other words, if PSA levels are higher than 4.0 ng/mL; your doctor may advise either of the following:
Besides cancer detection, other indications of conducting repeat PSA test are:
Research and clinical data indicates that repeat PSA test can influence physical and sexual health in males significantly. For example, data indicates that abnormal PSA test (requiring repeat testing) can cause erectile dysfunction, poor libido and declining sexual vigor due to anxiety and depression. Other adverse effects include:
However, the effects are not always devastating. According to a new study reported in European Urology journal (3), investigators explained that a repeat PSA test within 7 weeks from an initial assessment of 3.0–19.99 ng/ml (that was obtained from a sample of 54,087 men; age range 50 – 70 years) helped physicians in making a decision regarding further invasive testing to detect cancer (such as biopsy).
1. Barry MJ. Clinical practice. Prostate-specific-antigen testing for early diagnosis of prostate cancer. New England Journal of Medicine 2001;344(18):1373-1377.
2. Thompson IM, Pauler DK, Goodman PJ, et al. Prevalence of prostate cancer among men with a prostate-specific antigen level < or =4.0 ng per milliliter. New England Journal of Medicine 2004;350(22):2239-2246
3. Rosario, D. J., Lane, J. A., Metcalfe, C., Catto, J. W., Dedman, D., Donovan, J. L., … & ProtecT Study Group. (2008). Contribution of a single repeat PSA test to prostate cancer risk assessment: experience from the ProtecT study. european urology, 53(4), 777-784.
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