PSA

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Prostate Specific Antigen (PSA) is produced exclusively by cells of the prostate gland. PSA, used in conjunction with the digital rectal examination, is a useful screening test for benign prostate enlargement, prostatitis, and prostate cancer development.

What is a PSA test and why is it important?

A PSA test measures the level of prostate-specific antigen in a man's blood. This test is crucial for detecting prostate cancer early, when treatment is most effective. It can also help monitor prostate health and detect other conditions like prostatitis or an enlarged prostate.

Only cells from the prostate gland are capable of producing prostate-specific antigen (PSA). PSA, used in conjunction with the digital rectal examination, is a useful screening test for benign prostate enlargement, prostatitis, and prostate cancer development.

Only cells from the prostate gland are capable of producing PSA. PSA, used in conjunction with the digital rectal examination, is a useful screening test for benign prostate enlargement, prostatitis, and prostate cancer development.

There are some things a man should not do before having a PSA test. This list of “don’ts” will help ensure your test results are as accurate as possible.

Prior to a PSA Test: Don’t Do These Activities

• Participate in vigorous exercise and activities that stimulate or “jostle” the prostate, such as bike riding, motorcycling, and riding a horse, ATV, or tractor, or getting a prostatic massage for 48 hours before your test.
• Participate in sexual activity that involves ejaculation for 48 hours before your test. Ejaculation within this time frame may affect PSA results, especially in younger men.
• Schedule your PSA test to be done for at least six weeks after undergoing any of the following procedures: prostate biopsy, transurethral resection of the prostate (TURP) for BPH, urethral catheter, cystoscopy, or any other procedure that involves the prostate. If you are in doubt about the possible impact of any procedure on your PSA test, talk to your doctor.
• Schedule a PSA test if you have a urinary tract infection. A bacterial infection in the urinary tract can cause PSA levels to rise temporarily. If you are not sure if you have a urinary tract infection, have a urine test before your PSA test to make sure. If you do have a urinary tract infection, you should wait at least six weeks after you have completed your antibiotic treatment before you have your PSA test.
• Schedule a digital rectal examination (DRE) before your PSA test. Although a DRE should not have an impact on PSA levels, having the PSA test first is a precaution.

For more information, read this blog article: Essential Tips for PSA Test Preparation

Don’t forget to tell your doctor these facts if you are going to get a PSA test:

• If you undergoing chemotherapy, as these drugs can cause an elevated PSA level
• If you are taking any medications, especially statins, nonsteroidal anti-inflammatory drugs, or medications that control urinary problems, such as dutasteride or finasteride,. All of these substances have the potential to affect PSA levels.
• If you have undergone urinary tract or prostate surgery recently, or if you have suffered a pelvic injury or sports injury,.
• If you have prostatitis or BPH,.

When Should Prostate Cancer Patients Be Treated? What to do?

Men receiving prostate cancer diagnoses and treatment have sharply increased as a result of widespread prostate cancer screening utilizing the prostate-specific antigen (PSA) test over the past 30 years in the United States. However, as more was learned about the benefits and harms of prostate cancer screening, a number of professional medical organizations, including the American Cancer Society and the American Urological Association, began to caution against routine population screening with the PSA test. Most organizations recommend that individuals who are considering PSA screening first discuss the risks and benefits with their doctors, including the possible benefits of finding cancer early as a sign of prostate cancer treatment. However, it is important to note that high PSA levels do not necessarily mean a diagnosis of prostate cancer, but they do indicate a higher risk and may require additional testing and observation for conditions such as benign prostatic hyperplasia and prostate cancer cells.

With the benefits of greater screening in doubt, doctors must decide whether and how often to screen, as well as what to do if cancer is found. The difficulty we currently face with prostate cancer is that we have become almost too proficient in screening, as Dr. Judd W. Moul, Director, Duke Prostate Center, Duke University Medical Center, notes. It is important for patients to understand their personal risk factors for prostate cancer, such as a family history of prostate cancer, and discuss them with their doctor when considering screening and treatment options, including the potential impact on erectile dysfunction and urinary incontinence. This includes understanding the risk of prostate cancer and when to begin screening based on age and other factors, such as life expectancy. According to the National Cancer Institute, regular screenings for prostate cancer are recommended for men over the age of 50 or earlier for those with a family history or other risk factors. It is important for patients to work closely with their doctors and the National Cancer Institute to determine the best course of treatment for their individual case.

PSA Presentation: Unlocking the Pandora's Box

According to Dr. Moul, the PSA test might produce as many questions as it can resolve. It almost appears like we're detecting prostate cancer too early in many guys, he adds, mainly because many prostate tumors don't become fatal for a very, very long time. "Screening is all about early diagnosis," he says. However, it is important to consider the limitations and potential harms of the PSA test, including false-positive results that may lead to unnecessary medical procedures and potential side effects such as prostate infection. This "overdiagnosis" and the treatment that follows could pose excessive risk and unnecessarily lower quality of life for those with prostate conditions. It is recommended that the PSA test be done along with a digital rectal exam (DRE), PSA velocity, PSA doubling time, and additional tests for a more accurate assessment of prostate health, including the withdrawal of a small amount of blood for analysis.

A biopsy, which has risks, is required to confirm the diagnosis since increased PSA levels do not always indicate the existence of prostate cancer and because there is currently no "man mammography" to reliably assess the intra-glandular extent of a tumor. Even then, there is still some doubt because prostate needle biopsy pathology has sampling error, which could lead to an underestimation of the cancer's grade in 30–40% of cases. However, a biopsy is the only way to diagnose prostate cancer and determine its stage, making it the most effective method for early detection and treatment.

PSA as a Baseline Test: A Useful Instrument

When used as a baseline test at age 40, the PSA test is unquestionably helpful for younger men, especially for those at higher risk of prostate cancer. Dr. Moul notes that despite the PSA test now being included in both the National Comprehensive Cancer Network's (NCCN) and the American Urological Association's (AUA) guidelines, there is still little knowledge of and use of it in this manner. The doctor can assess a patient's future risk for prostate cancer, including those at higher risk, and how aggressive or nonaggressive to be with screening over the following 10–20 years by getting a PSA value at age 40. Additionally, healthcare professionals frequently use PSA testing (along with a DRE) to help them identify the nature of the issue in patients who report prostate symptoms, including family members who may have a history of prostate cancer. However, it is important to note that the recommendations for when to get tested vary, with the American Cancer Society suggesting age 50 for those at average risk. It is crucial to have a discussion with your doctor about your individual risk factors, including any potential for a higher risk of prostate cancer, and the amount of PSA in your blood, before deciding when to get tested for further testing.

Active surveillance versus treatment

Physicians and patients must decide between therapy and active surveillance once a biopsy reveals malignancy. What should we do if a biopsy finds very little cancer or an ambiguous malignancy? is a dilemma Dr. Moul struggles with. Should we risk lowering his quality of life right away or wait a little before performing a radical prostatectomy on him?

Given the paucity of reliable clinical trial data to determine therapy or identify individuals for active surveillance, there are no clear criteria for decision-making. According to Dr. Moul, "The patient's gut instinct and final decision are what matter most."

It is not nearly as frequent a strategy as active treatment because there is little agreement among doctors over the frequency and intensity of "active surveillance" and patient worry over the potential presence of the malignancy.

Dr. Moul believes that improving the active surveillance procedure for patients with early-stage illness is the way to go.

Doctors will be better able to assess when active surveillance is necessary with more robust longitudinal data.

appropriate. Further research would also shed light on the ideal window of time for biopsies and how closely to monitor a patient following the initial PSA test.

The Potential of Diagnostic Developments

To help guide treatment or decide on a strategy for additional biopsies, a more accurate diagnosis is required. Dr. Moul hopes that an imaging test that reliably assesses the size and aggressiveness of prostate tumors will be developed because there is now no imaging test comparable to those that are available for breast cancer.

Newer ultrasound or MRI technologies that improve images of the glandular system inside the prostate may be used as a base for focal-gland treatments like focal cryotherapy and high-intensity focused ultrasound (HIFU).

The most promising technological advancements are those in molecular diagnostics, which are still in the works. These comprise ongoing investigations into novel biomarkers and advancements in genetic testing, including the PCA3 urine test. The clinical community will have to wait till clinical trials validate them.

References

Prostate Cancer Facts & Figures 2023, American Cancer Society.

Resources and Articles:

Why Your High PSA Test May Not Be Prostate Cancer