Know Your Number: Prostate-Specific Antigen Testing and Cancer
Every baby boy is born with a prostate gland, but many guys are well into adulthood before they learn about the prostate and what it does.
The prostate gland is part of the male reproductive system. It makes a protein called prostate-specific antigen (PSA). Measuring the level of PSA in your blood may help detect prostate cancer. To fully understand the meaning of a PSA test, however, you first need to know more about the regular function of the prostate and common prostate issues.
A PSA screening test, also called a total PSA test, is a blood test that measures the amount of PSA in your body.
Prostate Function and Prostate-Specific Antigen
The prostate’s job is to make semen, the fluid that carries sperm from the testicles and out of the penis. It sits just below the bladder and surrounds the urethra, the tube that urine passes through as it leaves the body. The cells of the prostate gland also make PSA.
Cancerous cells in the prostate glands can also produce PSA. Because of this, a high PSA level may be a sign of prostate cancer—but not always. Noncancerous health conditions, age, genetics, certain medications and even your activity level can also raise PSA levels.
In the United States, prostate cancer is the second-most common type of cancer in men, right behind skin cancer. In most cases, prostate cancer grows very slowly and does not become a serious health threat. Men may have prostate cancer for 20 years or longer before having any symptoms. Because of this, doctors may recommend active surveillance of the cancer instead of treatments such as radiation or surgery to remove the cancer.
Still, the American Cancer Society estimates prostate cancer will be responsible for nearly 35,000 deaths in 2023.
The chance of developing prostate cancer may be higher in certain men. Risk factors include:
- Being African American or Caribbean with African ancestry
- Being age 50 or older
- Certain inherited conditions, such as Lynch syndrome, or gene mutations, such as mutations to the BRCA1 or BRCA2 genes
- Having a brother or father who was diagnosed with prostate cancer
Symptoms of prostate cancer are similar to other common, noncancerous prostate conditions. Without testing, it can be challenging to tell the difference between them. Screening tests may help discover prostate cancer at an early stage before it spreads to other parts of the body.
What a Prostate-Specific Antigen Test Tells You
The PSA screening test, or total PSA test, has been approved by the U.S. Food and Drug Administration to help detect prostate cancer in men 50 and older.
Because PSA levels change with age, test results are given in age-adjusted normal ranges. Approximate normal ranges are:
- 5 ng/mL or less for men ages 40 to 49
- 5 ng/mL or less in men ages 50 to 59
- 5 ng/mL or less in men ages 60 to 69
- 5 ng/mL or less in men ages 70 to 79
PSA screening tests are generally not recommended for men ages 75 and older.
In all age ranges, the higher number, the higher the chances of having prostate cancer. A PSA level between 4.0 and 10.0 ng/mL indicates a roughly 25% chance of prostate cancer. Men with a total PSA result of more than 10.0 ng/mL have a higher than 50% chance of having prostate cancer.
Still, a higher total PSA test result doesn’t necessarily mean that you have prostate cancer. Because high PSA levels can be affected by so many things, your doctor may order additional tests, such as a biopsy, before confirming a diagnosis.
Who Should Have a PSA Screening Test?
Professional opinions about who needs prostate cancer screening and when vary by organization.
The American Cancer Society doesn’t make recommendations for when men should get prostate cancer screenings. Instead, it says that men should discuss prostate cancer screenings with their doctors to determine when, or if, prostate cancer screenings are right for them. Discussions should begin at:
- Age 50—Men at average risk for prostate cancer who have at least a 10-year life expectancy
- Age 45—Men who are at high risk for prostate cancer because they are African American or because they had a father or brother who was diagnosed with prostate cancer before age 65
- Age 40—Men who are at the highest risk because they have multiple first-degree relatives (father or brothers) with prostate cancer diagnoses before age 65
The American Urological Association and the National Comprehensive Cancer Network recommend all men between ages 40 and 45 get a baseline PSA screening test. This test can be compared to later tests to see how your PSA level changes over time. These organizations also recommend annual total PSA testing for men who have a high risk of developing prostate cancer. An increase of more than 25% or more between yearly PSA screening tests may be a sign of prostate cancer.
To help get an accurate test result, avoid intense exercise and sexual activity, including masturbation, during the 48 hours before your test.
The Next Steps
If your PSA level is normal but you’re bothered by prostate-related symptoms, your doctor may recommend a DRE to get more information. They may also refer you to a urologist, a doctor who specializes in treating urinary and bladder conditions.
If your PSA level result is high, your doctor may also order additional lab tests, a digital rectal exam or a prostate biopsy to check for other potential signs of cancer.
Ready to know your PSA level? Schedule an appointment for a PSA test with the Direct Access Lab at River’s Edge Hospital and Clinic.
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