Definition

A total PSA (Prostate-Specific Antigen) test measures PSA levels in the blood. PSA is a protein produced by prostate cells in the male reproductive system. The prostate gland, located below the bladder, contributes to seminal fluid production.

Under normal conditions, PSA levels in the blood are low. Elevated PSA levels may indicate potential prostate cancer, which is common among men. However, increased PSA levels can also result from other conditions such as infections or benign prostate enlargement.

The PSA test is commonly used to screen for prostate cancer. Early detection allows for timely intervention and treatment. Doctors typically recommend this test when patients present with symptoms such as:

• Painful urination.
• Frequent urination.
• Pain in the lower back or hips.
• Difficulty urinating.
• Interrupted urinary flow.

Indications

A PSA test is primarily performed as a screening tool for prostate cancer, particularly in men with the following risk factors:

• A family history of prostate cancer (e.g., father or brother).
• African-American ethnicity.
• Men aged over 50.

In addition to screening, the PSA test is used to monitor prostate cancer treatment efficacy in patients already diagnosed with the condition.

Contraindications

There are no contraindications preventing someone from undergoing a PSA test.

Preparation Prior to Test

Certain preparations are required before a PSA test. Individuals are requested to refrain from sexual intercourse or masturbation for at least 24 hours before the test, as the release of semen can temporarily elevate PSA levels.

This test can be performed without fasting. It is recommended to consult your doctor before undergoing the test, especially if you are taking medications or have conditions that may affect PSA levels. This ensures the test results accurately reflect your condition.

Test Procedure

The PSA test requires a blood serum sample of 0.25–0.5 mL. The sample is drawn from a vein and collected in a special tube. Laboratory staff wear gloves and other Personal Protective Equipment (PPE) to ensure safety during the procedure.

Before the blood sample is taken, an elastic band is applied around the upper arm to make the vein more visible. Usually, the skin at the needle insertion site, usually in the elbow crease, is cleaned with antiseptic gauze. Blood is subsequently drawn with a sterile syringe and placed in a special tube. After that, the elastic band is removed, and the punctured skin is pressed and cleaned with antiseptic gauze. This procedure typically takes only a few minutes. The collected sample is sent to the laboratory, and results are usually available within a few hours.

Normal and Abnormal Values

The normal PSA value range depends on age. Below are general reference values:

PSA levels above the aforementioned normal range are considered high. However, each laboratory may have slightly different reference values depending on the machines and guidelines they use.

Results and Recommendations (Follow-up Tests)

Normal

Normal PSA levels indicate a low likelihood of prostate cancer, especially in the absence of specific symptoms. To maintain prostate health, you can be advised to continue with a healthy lifestyle. Men at high risk (e.g., family history of prostate cancer) should consider repeat PSA tests every three months.

High

If your PSA test results are high, you should consult a doctor. High PSA levels may indicate a higher risk of prostate cancer, especially if accompanied by symptoms. However, other conditions can also lead to elevated PSA levels, including:

• Enlarged prostate.
• Prostate infection (prostatitis).
• Urinary tract infection.
• Recent invasive prostate procedures (e.g., biopsy).
• Recent sexual activity.
• Colonoscopy.

To confirm a diagnosis, the doctor may conduct more in-depth medical interviews, physical examination, and follow-up laboratory or imaging, to help establishing the diagnosis of your actual conditions related to high PSA levels.

The doctor could ask detailed questions about your symptoms and history. Physical examination including a digital rectal exam (DRE), where the doctor inserts a finger into the rectum to assess the prostate's condition and enlargement, can also be conducted.

Other diagnostic tests that can be carried out include:

• Prostate Biopsy

A minimally invasive procedure where a small tissue sample is taken from the prostate for microscopic examination to detect cancer cells.

• Free PSA Test

Measures the percentage of unbound PSA in the blood. Lower free PSA values are associated with a higher risk of prostate cancer.

• Imaging

An imaging test that your doctor might recommend is an MRI (magnetic resonance imaging) of the prostate gland. This imaging procedure is particularly useful for identifying areas of the prostate that are challenging to reach during a biopsy.

If your PSA test results are elevated, it is crucial to prioritize sufficient rest and maintain a healthy lifestyle. This includes consuming a balanced, nutritious diet, engaging in regular exercise, managing stress effectively, and avoiding habits such as smoking and alcohol consumption.

Despite a high PSA value, it is essential not to self-diagnose. Consulting a doctor for professional medical advice and undergoing a physical examination is necessary, especially if there are specific symptoms or signs of concern.

Consult the Right Doctor

Adults with PSA test results should consult a general practitioner to pursue further testing or initiate appropriate therapy. For more specialized advice, patients can consult a urologist to address PSA-related concerns comprehensively.

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