Should You Have The PSA Test?

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.

What Is The Significance Of High Serum Levels Of PSA?

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;

• Ongoing acute/chronic inflammation of prostate gland due to an infection (also referred to as prostatitis)
• Moderate to severe injury of prostate gland
• Age related fluctuations
• Benign enlargement of prostate gland (also known as benign prostatic hyperplasia)

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.

What Are Some Factors That Must Be Considered While Analyzing PSA Levels?

As suggested earlier, several factors are considered while deriving important inferences from the PSA test; these include:

• Size and morphology of the prostate gland (on ultrasound and local examination).
• Age of the patient (PSA levels fluctuates with physiological aging)
• How quickly PSA levels are altered in between the tests.
• If alteration in PSA levels can be explained by a physiological or pathological mechanism (such as consumption herbal supplements or certain pharmacological agents such as Finasteride or Dutasteride).

Should You Have The PSA Test?

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:

• Elevated levels of PSA doesn’t necessarily mean that you have prostate cancer. In other words, sensitivity of this test is low.
• There are certain conditions (discussed above) in which the PSA levels are raised due to ‘false positive’ reasons (such that you do not have prostate cancer but test results indicates that you may have cancer).

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.

Who Should Opt For Prostate Cancer Screening By PSA Levels?

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,

• Family history: The risk of developing prostate cancer is high if your first degree relatives like brothers or father were diagnosed with the malignancy of prostate gland before 65.
• Age: Like most malignancies, the risk of developing prostate cancer increases with advancing age. Therefore, you should consider PSA assessment after 40 years of age.
• Race: Black men are more at risk of developing prostate cancer.
• Diet: Risk of prostate cancer increases if you are obese or have high intake of fatty diet.

References

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.