Prostate-specific antigen (PSA) is a protein produced by cells of the prostate gland. The PSA test is a blood test that measures the level of PSA in the blood.
It is normal for men to have a low level of PSA in their blood. However, prostate cancer or benign (non- cancerous) conditions can increase a man’s PSA level. A man’s PSA level alone does not give doctors enough information to distinguish between benign prostate conditions and cancer.
The result is used, in conjunction with a clinical assessment and perhaps other tests, in deciding whether a biopsy (put link to prostate biopsy) is needed.
The goal of the PSA screening test is help to detect significant, life threatening cancers whilst they are still curable. Also, the vast majority of curable prostate cancers do not cause any symptoms.
However, the problem with the PSA test is that it screens for all prostate cancers, both the aggressive ones and the ones that are unlikely to ever cause any problems.
This can be a difficult question to answer and does depend on many factors. To help you decide, several major organizations have put together a brochure. Click here to read it.
PSA test results show the level of PSA detected in the blood. The results are usually reported as nanograms of PSA per millilitre (ng/mL) of blood. In the past, doctors considered a PSA level below 4.0 ng/mL as normal but more frequently, age-related ranges are being used. This means that for some men, a reading of less than 4.0 may be significant, whilst for others it is not.
There can be different reasons for an elevated PSA level besides prostate cancer, including benign prostate enlargement, inflammation, infection, age, and race. Some of these conditions can cause fluctuations in PSA, so it is important to check the PSA more than once if it is elevated on one reading.
Consequently, one abnormal PSA test result does not necessarily indicate the need for a prostate biopsy.
In general, the higher a man’s PSA level, the more likely it is that cancer is present. Furthermore, if a man’s PSA level continues to rise over time, other tests may be indicated.
You doctor will discuss with you the pros and cons of doing a prostate biopsy or a specialised MRI of the prostate.
Sometimes you may need an “MRI fusion biopsy” which helps to target any suspicious areas seen on the MRI of the prostate.