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What is PSA Test?
Prostate-specific antigen is a protein secreted by normal and malignant prostate cells in a man. It acts as a diagnostic marker to detect prostate cancer. However, the PSA is secreted by the non-cancerous and cancerous cells and in conditions like prostatitis and benign prostatic hypertrophy resulting in imprecise results. Despite these factors mentioned above, the PSA test is still considered an important biological marker for the preliminary screening and early detection of prostatic cancer. In most cases, the early stage of the disease does not show any symptoms in men. Prostate cancer is the second most common solid cancer in the world. Therefore, early screening for prostate cancer will prevent morbidity and mortality as prostate cancer often shows symptoms and gets detected in the later stages of the disease.
PSA is a serine protease enzyme produced by the columnar epithelium of prostatic tissue, which enters the blood circulation after secretion. Physiologically, PSA prevents the clumping of seminal fluid and hence helps in impregnation.
Can PSA tests solely predict prostatic malignancy?
The PSA test is a preliminary screening procedure with a tendency for false-positive and false-negative results. It is also seen in conditions like trauma, infections and benign prostatic hypertrophy(BPH), leading to low specificity. Hence the PSA test is always accompanied by digital rectal examination and Magnetic Resonance Imaging (MRI).
How do you interpret the PSA test?
The total serum PSA test exists in three different isoforms: intact PSA, pro-PSA, BPH associated PSA.BPH associated PSA is elevated in hypertrophic prostatic tissue. Pro PSA is more commonly seen in aggressive prostate cancer.
Frequently Asked Questions:
What is the normal range in a PSA test?
A PSA test value greater than 4ng/dl is generally accepted as the standard for further prostate cancer evaluation. However, there is no reference to a higher limit—any increase in blood PSA advocates for further evaluation for prostate cancer.
Why is a PSA test so important?
PSA stands as an important screening tool for early diagnosis and further evaluation of prostate cancer, significantly reducing the chances of death.
What is the specimen required for a PSA test?
A PSA test is done from a sample of blood. PSA is usually evaluated in a medical laboratory following the advice of your health care provider.
What should I do if I have an elevated serum PSA Level?
Consult a urologist for further physical evaluation and diagnostic procedures.
Does the PSA range increase with age?
Yes, studies show a direct correlation of increased PSA range concerning age with an average increase of 3.2% per year.
Is there any risk associated with PSA testing?
There is no potential risk associated with the PSA test other than an increased chance of bleeding or infection, which is rarely seen while collecting blood samples.
What are the health benefits associated with the PSA test?
Although the PSA test remains uncertain and controversial, the medical professionals advise the screening of men above the age of 55 after explaining the outcomes of the test and considering the patient's interest to reduce the morbidity and mortality likely to occur from an aggressive prostate cancer detected in a later stage.
Is there any correlation between age and PSA?
Yes, there is a direct correlation between age and PSA. Studies show a 3.2% increased PSA corresponding to the age of the patient.
What is the positive predictive value for the metastatic skeletal involvement in the PSA test?
Serum PSA value greater than or equal to 20mg per decilitre is a positive predictive value of metastatic skeletal involvement or the spread of the tumour to the bones.
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References:
- David MK, Leslie SW. Prostate-Specific Antigen. [Updated 2021 May 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan
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