The PSA test is a blood analysis used for the early detection of prostate cancer.
PSA test might be abnormal when the prostate enlarges (benign prostate enlargement), or when inflames (prostatitis).
It means that increased PSA does not necessarily mean you have prostate cancer.
The higher the PSA, the greater the likelihood of having prostate cancer.
Above 10 ng/ml, PSA is highly suggestive for prostate cancer.
PSA stands for Prostate Specific Antigen that is a protein.
The prostate gland actively excretes this protein in the semen to capacitate sperms and contribute to semen liquefaction and fertility.
However, we can find a small percentage of PSA in the blood.
Here the PSA does exist in two forms: complexed PSA, linked to serum proteins, and “free” PSA.
Prostate cancer is the most frequent neoplasm and second cancer killer in men.
This tumour is usually silent for a long time before giving symptoms.
In the early no-symptomatic stage, we can radically cure it with good recovery of the quality of life.
If you have no-symptomatic prostate cancer, the only way to get an early diagnosis is to do PSA test.
Unfortunately, PSA is not the perfect marker for prostate cancer.
Its abnormality can reflect other benign diseases like prostate enlargement and prostatitis.
European and American Urological guidelines on prostate cancer screening recommend starting screening at 50.
However, men with a family history of prostate cancer should do it earlier at 45.
Moreover, we recommend PSA test to any men aware about risks and benefits of screening or in patients with other conditions in whom we need to rule out a potential malignant prostate disease.
In men under 50, the baseline PSA tell us about the risk of having prostate cancer in the following 20 years of life.
PSA below 1 ng/ml means that the patient is at low risk and can be screened less strictly (every 2-4 years).
PSA higher than 1 ng/ml means increased risk, and the patient should receive early screening.
However, there is a slight increase in average PSA values by age.
It means that we have to evaluate the cancer risk taking into consideration the patient age at the time of the screening.
There are three reasons for elevated blood PSA.
PSA levels between 2.5 and 10 ng/ml are confounding.
In this range PSA reflects also benign prostate enlargement and prostatitis besides prostate cancer.
It means that between these values, the PSA is not a useful marker for prostate cancer.
Levels of more than 10 ng/ml are more specific: patients with PSA higher than 10 ng/ml most likely have prostate cancer.
Early no-symptomatic stage of prostate cancer has the best prognosis. It can be cured radically with good quality of life after treatment.
Early stage of prostate cancer is usually associated to PSA value less than 10 ng/ml (good prognosis).
PSA values more than 10 ng/ml mean poor prognosis.
That is why it is vital to diagnose early-stage prostate cancer with PSA lower than 10 ng/ml.
Unfortunately, the prevalence of benign prostate enlargement and prostatitis in the PSA range 2.5-10 ng/ml do act as confounding factors.
In these “grey shaded” PSA range, we need to discriminate who has prostate cancer and who has a simple prostate benign disease.
For this purpose, we can use the PSA test confirmation, PSA density, PSA velocity, Multiparametric MRI and sometimes the PCA3, before exposing the patient to the reasonable risks of prostate biopsy.