PSA Testing for Prostate Cancer

What is prostate-specific antigen (also known as PSA)? 
First of all, what is the prostate? The prostate is a gland in people that were born male. It’s found below the bladder (where urine is stored) and in front of the rectum (back passage), and its job is to make fluids that form part of semen. In younger people, the prostate is around the size of a walnut. It tends to grow with age.

Prostate-specific antigen, also known as PSA, is a protein made in cells of the prostate gland – it is made by both normal, healthy prostate cells and prostate cancer cells. PSA is mostly found in the semen and small amounts are found in the bloodstream.

As with other parts of the body, cancer can develop in the prostate. Prostate cancer happens when prostate cells grow and divide in an uncontrolled way. Increasing levels of PSA may indicate that someone has prostate cancer. Testing for PSA in the bloodstream is a way to monitor prostate health.

What is a PSA test? 
The PSA test is a specific type of test to see how much PSA is in the bloodstream. Most people with a prostate start talking with their doctor about PSA testing at the age of 50. However, for people with an increased risk for developing prostate cancer, this may happen sooner: *

• For people who have a first-degree relative (such as a father or brother) diagnosed with prostate cancer at an earlier age (younger than 65 years old), PSA tests may start at age 45
• For people who have a higher risk due to more than one first-degree relative (such as brother and father) diagnosed with prostate cancer at an earlier age (younger than 65 years old), PSA tests may start at age 40

During the PSA test, a nurse or medical technician will use a small needle to take blood from one of your veins. Usually this is a vein in the arm. The blood sample is then sent away to be tested in a lab. 

*Anyone considering PSA screening should discuss the risks and benefits with their doctors before making a decision.

What do my PSA test results mean? 
There is no single threshold that separates a normal PSA result from an abnormal PSA result. What's normal for you will depend on a few things. This includes your age, how big your prostate is, and your family history.

In general, a PSA level above 4.0 ng/mL is considered abnormal and may mean additional tests or procedures are needed. However, because PSA levels increase with age, different cut offs may be applied.

The measurement for PSA is how many nanograms of PSA are in milliliter of blood – this is what ng/ml means.

If you have concerns about your prostate health, getting tested regularly and as recommended by your doctor allows you to understand what your normal PSA range looks like. Your doctor will be able to identify any changes in your PSA level and work out the rate of change, meaning how quickly the changes are happening over time.

You may have a higher-than-normal PSA reading for a few different reasons – it doesn’t always mean cancer. Having an infection or swollen prostate can increase PSA levels, as can vigorously exercising and ejaculation. Your doctor may recommend avoiding activities that can raise PSA levels for a couple of days before testing.

Why is PSA important when living with prostate cancer?
If you have been diagnosed with prostate cancer, keeping track of your PSA scores is more important than ever. The score is an important indicator of your prostate health and helps your care team monitor any changes in your prostate after diagnosis or treatment.

You may hear the term ‘doubling time’. This means how quickly PSA levels are increasing in the body. If you have already received treatment for prostate cancer, doubling time can help assess if the cancer has returned and how quickly it’s growing. Doubling time supports treatment decisions if the cancer has returned.

When was the last time you had a PSA test?
If you are eligible for PSA testing, it’s important to make sure you are having a test as often as you are recommended to. If your most recent PSA level was less than 2.5 ng/ml, then you may only need to have a test every 2 years. If your most recent test result was 2.5 ng/ml or higher, then you should be tested yearly. Speak to your healthcare provider if you believe you are due to have a PSA test.

Remember, PSA testing is important for all men over a certain age. The exact age that it becomes important will depend on your medical history and other factors. If you are living with prostate cancer, or you have an increased risk of developing prostate cancer, testing and knowing your PSA score over time may help to guide treatment decisions and monitor your prostate health.