What is PSA?
Every year, thousands of men are told they have a high PSA level after undergoing a routine screening test. The most important and most concerning cause of an elevated PSA is prostate cancer. However, prostate cancer is only one of many potential causes of an elevated PSA. Virtually anything that irritates the prostate will cause your PSA to rise, at least temporarily.?
What exactly is PSA? PSA or Prostate-specific antigen is a protein produced by the prostate and found in the blood.
A PSA blood test can detect prostate cancer early, which makes it seem like a no-brainer to get tested.
Many prostate cancers grow slowly, so a PSA test may save the lives of some men whose prostate cancer would go undetected otherwise.
However, there is a downside to testing for PSA as quite frequently there is no real health risk even though somenone's PSA-levels are elevated. Some men will undergo unnecessary surgeries or radiation treatments, which could cause lifelong problems such as erectile dysfunction or incontinence.
Things every man should know before undergoing a PSA-test
Low PSA is good
Low PSA—usually about 4 nanograms per milliliter of blood or less—suggests that a man does not have prostate cancer.
A high PSA-level may possibly indicate the presence of cancer.
There are so many factors influence PSA that a single test is never enough to diagnose prostate cancer.
A high PSA is not always bad news
Swelling of the prostate gland, infection, and recent ejaculation, among other things, can elevate PSA levels. These factors, however, have nothing to do with prostate cancer. Benign prostatic hyperplasia, or enlarged prostate, which is one of the most common conditions that affect men as they age, also can raise PSA.
Reasons why PSA can be elevated
Benign Prostatic Hyperplasia (BPH): This benign (non-cancerous) condition, also known as an enlarged prostate, is extremely common in older men. Unlike cancer, BPH has no risk of spreading throughout the body.
Prostatitis: Prostatitis is a condition where the prostate becomes inflamed due to an infection or another cause. Most cases of this condition are acute, or come and go away again over a short period of time, but some men also can have chronic prostatitis. This condition, if due to a bacterial infection, can be treated with antibiotics. Or use the same probiotics (e.g. Fem Dophilus) that women use when treating chronic bladder infections.
Prostate biopsy: Men who have recently undergone a prostate biopsy will usually have artificially elevated PSA levels. Because of this, most physicians will draw blood for the PSA test before any biopsies are done. Also, after a biopsy, most physicians will wait a few weeks before taking a repeat PSA level in order to let the level drop back to a baseline level.
Recent ejaculation: Ejaculation (the ejecting of semen from the penis) can cause a mild increase in the PSA level. Because of this, most physicians will advise you to avoid any sexual activity for at least a couple of days before your PSA blood test.
Digital Rectal Exam: The digital rectal exam may cause a small increase in the PSA level. Therefore, blood for the PSA test is usually drawn prior to this exam.
Bicycle riding: Some studies have shown that strenuous bicycle riding can mildly elevate the PSA level over the short term. Because of this, you should avoid this activity for a few days prior to the PSA test.
Getting a False Positive Result
It is also possible to get a false-positive–a false result that says your PSA is high when it is not. If your PSA is high without a known cause, your doctor will likely recommend an additional PSA test. Other items that can cause a falsely elevated PSA level include a recent urinary tract infection (UTI), recent catheterization (a thin tube inserted into the bladder through the urethra to drain urine from the bladder in men who have severe difficulties urinating), and a recent cystoscopy (the insertion of a thin instrument with a camera into the bladder).
If your PSA is elevated, your doctor may first address other issues, such as treating an infection, and then test you again to see if the levels go down. If that doesn't happen, a biopsy may be done to exclude prostate cancer.
Other risk factors are important
If your PSA is high, your doctor will look at other risk factors to decide if you need additional testing. These risk factors include race (black men are more prone to prostate cancer), age (prostate-cancer risk increases with age), and family medical history (men who have an immediate family member with prostate cancer are at increased risk).
If, however, your prostate-cancer risk is low—if, for example, you have no risk factors and a digital rectal exam reveals no abnormal-feeling areas in your prostate—your doctor may decide to forego a biopsy and instead do another PSA test a few months or so down the road.
Most biopsies don't show cancer
If you need a biopsy, this office-based procedure is used to collect samples of your prostate tissue via a hollow needle.
Approximately three out of four men who have biopsies after positive PSA tests are cancer-free, according to one large study. What's more, there's about a 3% chance of having a bad infection from the biopsy.
Experts don't agree on when to start
Most experts agree it is a good idea to start with PSA-tests at age 50, and perhaps as early as 40 with a family history of prostate cancer. Current guidelines state it isn't necessary to get a PSA-test unless they have prostate-cancer symptoms, but that may be too late.
What experts DO agree on is how the PSA-test isn't an optimal way to test for prostate cancer and should be replaced by another test, ideally one that tests on urine.
Testing has a psychological impact
Even if your biopsy results show you're cancer-free, you may experience some psychological aftereffects. One study that tracked men for up to three months after they received a negative biopsy found that the men were still anxious about cancer, and many had symptoms of depression.
Healthy men over 75 can skip the test
At age 65, you may want to consider having regular PSA tests for a few more years—if you're in good health.
Everyone who gets to age 75 with a normal exam and a normal PSA may stop undergoing PSA-tests as older men are likely to outlive any prostate cancer identified after that point.
Rate of rising PSA is important
Doctors may use the rate at which a man's PSA levels change over time to determine if he should undergo further testing.
For example, men who are undergoing "watchful waiting"—the monitoring of low-risk prostate tumors before resorting to treatment—may be candidates for treatment if their PSA rises more than 0.75 ng/mL each year.
Test or not? It's your decision
The decision to get screened is yours.
If you're not anxious about prostate cancer but you are concerned about the side effects of testing and treatment, for example, it may make sense for you to skip screening.
On the other hand, if you know all these side effects and are concerned about prostate-cancer risk, especially when you have relatives who developed prostate cancer, you should get screened.
What can I do to keep my prostate healthy?
As with most tumors, decreasing the amount of free radicals in your life (smoking!) and increasing the amount of anti-oxidants from vegetables and fruits is the best way to limit development of tumor cells.
For the prostate specifically, benefits have been found in broccoli, green tea, lycopene, and saw palmetto. Essential minerals like selenium and zinc are also vital for prostate health.