The first step in prostate cancer early detection is the prostate-specific antigen test or PSA test.
What is the PSA test?
The test detects the prostate-specific antigen, which is a protein produced by cells in the prostate gland, both normal and malignant cells. Men who have prostate cancer often have elevated PSA levels. A blood sample is taken for analysis and results are read as nanogram of PSA per milliliter of blood (ng/mL). The PSA test was first approved by the FDA in 1986 to monitor protein levels in men who were suspected of having prostate cancer.
What is the PSA normal range?
Normal PSA levels are 4.0 ng/mL and lower. Anything above that is considered abnormal and further testing is recommended, which may include another PSA test, a prostate exam or prostate biopsy to determine if cancer is present.
Typically, but not always, when cancer is diagnosed after a PSA test, it is detected early enough to treat successfully. This is not always the case as some patients may seek testing too late. With regular screening at the recommended times, prostate cancer is often diagnosed early.
What is a high PSA level?
Normal PSA levels range from 0 to 4 ng/mL. Levels below 2.5 ng/mL are considered safe and those PSA levels over 4.0 ng/mL require further testing or monitoring.
Conducting a PSA test when it is not necessary or called for may lead to over-diagnosis, according to the American Cancer Society. Sometimes PSA tests can lead to false positives, pointing to abnormalities when none exist. This can further lead to unnecessary treatment.
Even in the case when a man has cancer, there are some slow-growing prostate cancers that would lead to no serious symptoms; however, it can sometimes lead to unnecessary testament for cancers that do not pose a risk. Typically, slow-growing cancers are best approached with active surveillance, ensuring the cancer does not grow and waiting to see if it does before initiating treatment.
What is a dangerous PSA level?
PSA levels above 10 ng/mL are considered especially risky. Patients should consult their doctor immediately, as there is a chance of prostate cancer. Elevated PSA levels may indicate cancer or other types of infections or conditions.
Note that other factors may cause increased levels, such as prostatitis and urinary tract infections. Similarly, certain drugs can also increase levels.
Unfortunately, most studies of PSA levels are conducted primarily on populations of white men and do not include a range of men from various demographics including other ethnic groups, which may have other factors affecting their PSA levels. In general, though, higher levels are considered a risk and should call for further testing.
What are some other prostate tests?
Elevated PSA levels require further testing. Initially, many doctors may order another PSA test to confirm findings from the initial test. Another test that may be ordered is a digital rectal exam (DRE). The doctor conducts an exam using a gloved hand and lubricated finger and inserts the finger into the rectum to feel the prostate gland to determine if it is enlarged. DREs may be recommended at regular intervals to monitor changes.
Other tests may also be recommended initially or after monitoring reveals further abnormalities. Tests include checking for infections and other imaging like ultrasound, x-rays and cystoscopy. If a physical exam or imaging detects a lump, a biopsy may be recommended. During a biopsy the doctor inserts a hollow needle into the prostate and withdraws samples of tissue to detect cancer.
What happens if testing confirms a prostate cancer diagnosis?
At this point your doctor will recommend a specific course of treatment depending on how far the cancer has progressed.
Treatment options may include surgery, radiation and chemotherapy; however, it is not a one-size-fits-all situation and each case must be evaluated by a specialist.
How often should patients get screened?
In 2018, the U.S. Preventive Services Task Force (USPSTF), an independent panel of national experts, changed their PSA guidelines to indicate men ages 50 to 69 should discuss their risk of prostate cancer with their doctor before undergoing a PSA test. It is not blatantly recommended for every man over the age of 50 but should be decided on an individual basis while weighing the benefits and the risks. The USPSTF also does not recommend PSA testing for men over the age of 70.
Because prostate cancer is a risk for some men, it is important to talk to a doctor about when and how often to be screened. Discuss your family history and risk factors to ensure prostate cancer screening is done when it is appropriate.