The PSA blood test is an important marker of prostate cancer though it is not cancer specific.
Normally, the PSA level in the blood increase as a man’s prostate enlarges with age, but also sexual activity (ejaculation), inflammation of the prostate gland (prostatitis), or prostate cancer, can cause the PSA level in the blood to go up. There is also a bit of normal “day-to-day” variation in the level.
Usually early prostate cancer does not cause any obvious symptoms, so the PSA test may help in early detection of prostate cancer.
Clearly prostate cancer is not the only cause of a raised PSA, so sensible decisions need to be made about the result of the test.
PSA is useful to assess whether a man’s risk of having prostate cancer is more than the average risk for his age.
“Normal” or expected values for PSA blood test results are available for different age groups, and these expected levels go up with age. Levels lying well above these “normal” values at a particular age, or rapid changes in PSA, suggest that there is a higher risk of having prostate cancer. Men below the median (or average) level of PSA for their age are probably at low risk.
Additional blood tests, such as the ratio of “free” PSA to “bound” PSA, the rate of change of the PSA, in addition to new blood tests like Prostatic Health Index (PHI), can be used, along with the standard PSA, to allocate a patient into a “risk category”.
Typically, a digital rectal examination (DRE) of the prostate will be used to help to define that “risk category” for an individual patient also, as well as providing information about the size and hardness of the prostate.
A family history of prostate cancer can also be significant in determining an individual’s risk.
To further help to assess the risk of the man having prostate cancer more investigation using multi-parameter MRI scans of the prostate, and, ultimately, prostate biopsy, where samples of the prostate are taken for analysis, may be recommended.
In addition to helping to provide early diagnosis, PSA levels may also help to choose the right treatment option, when a cancer is diagnosed
The PSA test is also used to evaluate effectiveness of treatment procedures and to monitor improvement in the patient’s condition.
In some unusual cases, patients may have prostate cancer with a normal PSA level in the blood. Therefore, the best way to monitor for early detection of prostate cancer is to have both the PSA test and digital rectal examination (DRE) performed.
PSA can also be used to monitor the recovery from other prostate conditions, like infection, as it goes up with infection and comes back down with successful treatment.
Treatment of prostate cancer is complex and the decision on the most appropriate treatment involves many factors including patient age and health, tumour characteristics and, importantly, patient preference.
The choices are watchful waiting, radical prostatectomy (robotic or otherwise), radiotherapy, brachytherapy, hormone therapy and chemotherapy.
Decisions regarding the most appropriate treatment require detailed discussion and consultation with your urologist.
If you are concerned about any issues with your prostate, including prostate cancer, please make an appointment for a consultation with Dr Love.
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