What Is PSA Test?

Getting yourself examined for any potential disease is always a good idea. In the last few decades, there has been a spike in the number of diagnosed cancer cases around the world (especially in developed countries like United States). A lot of scientific data points that to unhealthy lifestyle and toxic exposure to chemicals; whereas researchers attribute that to advanced diagnostic tools and screening tests that enable doctors to detect concealed early disease.

Regardless, it is a fact that cancer has become quite common and therefore, many healthcare experts recommends periodic cancer screening tests. Cancer screening tests including prostate-specific antigen (PSA) test (a screening tool that is helpful in diagnosing prostate cancer at an early stage), when effective treatment is possible. PSA test along with digital rectal examination reassures lesser probability of developing advanced prostate cancer. But, deciding whether to take PSA test, is not that easy! There are several factors which should be considered.

Men aged 70 or above may not require PSA for prostate cancer screening. Different healthcare organizations have different guidelines regarding who should and who should not take PSA test. Some leave the choice on the doctors and the patient himself while others have generated proper guidelines. Those with definite guidelines, usually encourage men aged between 40 and 70 or those who are at risk of developing prostate cancer.

Whether you should opt for PSA test is something that you must discuss with your doctor. Your risk factors and personal choices matters a lot!

Here is some detailed information about PSA that will be helpful in making decision and will allow you to have a better discussion with your doctor.

What Is PSA?

Both benign (non-cancerous) and malignant (cancerous) prostate tissues produce proteins called, prostate specific antigens. This protein is responsible for the liquefication of semen. Some amount of PSA goes into the blood stream as well. The malignant cells makes more PSA than benign prostate cells. However, raised PSA levels does not necessarily mean prostate cancer! Sometimes PSA increases due to inflamed or enlarged prostate. Thus, interpreting high PSA levels is crucial! For evaluation of high PSA score, many other factors are also considered, such as:

Age
Prostate gland size
How quickly PSA levels are fluctuating
Intake of medicines that affect PSA levels such as, Dutasteride, Finasteride and few other herbal supplements

When High PSA Score Is Not Cancer

There are certain conditions that gives “false positive” results i.e. you do not have prostate cancer or enlargement but your PSA levels are high due to other reasons. False positive PSA results are much common! Only one out of four with high PSA scores actually have prostate cancer. Other than prostate cancer, conditions that increase PSA levels are:

Prostatitis (infection in prostate)
Benign prostatic hyperplasia (enlarged prostate)

When Prostate Cancer Doesn’t Increase PSA

Sometimes PSA doesn’t rise even if someone is suffering from active prostate cancer, also known as “false negative” results. This usually happens when there is speedy cancer growth.

PSA Test: Advantages

It helps in early diagnosis
Allows early and effective treatment, with better chances of curing
It is a simple blood test
It provides reassurance, either you don’t have prostate cancer or you will get to know it earlier; thereby giving you enough time for treatment
With the wide availability of PSA test, mortality rate due to prostate cancer has significantly decreased in the US

PSA Test: Disadvantages

Some prostate cancers grow slowly and never spread beyond the gland
Not all prostate cancers require to be treated
Prostate cancer treatment may involve risks such as urinary incontinence, bowel dysfunction or erectile dysfunction
PSA tests are not infallible i.e. false positive and false negative results are common
Diagnosis can lead to confusion and anxiety; thereby making decision making process difficult
The decreased mortality rate is not enough to defend the potential psychological anxiety and distress to a person undergoing PSA test.

Due to complex interpretation and mind wearying decisions, it is important to consult a doctor who is expert and knows what he is doing!

References

Whiting, P. F., Rutjes, A. W., Westwood, M. E., Mallett, S., & QUADAS-2 Steering Group. (2013). A systematic review classifies sources of bias and variation in diagnostic test accuracy studies. Journal of clinical epidemiology, 66(10), 1093-1104.
Schoots, I. G., Roobol, M. J., Nieboer, D., Bangma, C. H., Steyerberg, E. W., & Hunink, M. M. (2015). Magnetic resonance imaging–targeted biopsy may enhance the diagnostic accuracy of significant prostate cancer detection compared to standard transrectal ultrasound-guided biopsy: a systematic review and meta-analysis. European urology, 68(3), 438-450.