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Prostate Specific Antigen Testing

What Men Need to Know About Prostate Specific Antigen (PSA)

As men age, it’s likely their doctors will ask them to undergo a few more tests during their routine checkups than they’re accustomed to. One of those tests might involve the prostate-specific antigen, or PSA, blood screening. This simple procedure isn’t always recommended, but when it is it can provide physicians with a great deal of information about a patient’s prostate health. It can also prove to be a lifesaver if prostate cancer is detected.

About PSA Testing

The PSA test is designed to gauge the level of prostate-specific antigen proteins in a man’s blood. This protein is produced naturally in the prostate gland. At certain levels, PSA is considered perfectly normal. Elevated levels, however, may indicate a medical concern, such as inflammation in the prostate or the presence of prostate cancer.

Undergoing the test is relatively painless. It involves only a simple blood draw that is then sent to a laboratory for analysis. If high levels are detected, it’s not necessarily a cause for panic. Elevations in PSA may also be caused by urinary tract infections, prostatitis and benign prostatic hyperplasia, among other concerns. Should elevated levels be detected, follow-up tests to pinpoint the cause may be ordered and repeat PSA procedures may also be suggested to track levels for continued increases.

When is PSA Testing Suggested?

Screening recommendations recently changed for the PSA, taking the procedure off the table of routine tests for men who are at low risk of developing prostate cancer. Even so, some doctors continue to recommend its use for men starting around the age of 50 because of the insights it offers. Men who are at higher risk, such as those of African-American descent and men with a family history of cancer will find the recommendation is to begin PSA testing around the age of 40.

PSA testing recommendations changed because of the number of false positives the test produces. After all, elevated PSA levels can have many other causes. Even so, many doctors value the insights offered by the PSA and fear some men may now be suffering from undetected prostate cancer as a result of recommendation changes.  This concern has led some physicians to continue recommending this test as a way to screen for prostate cancer early.

Elevated PSA: What Does it Mean?

While there isn’t a specific magic number to indicate an elevated PSA, the normal level is typically about 4.0 ng/mL or lower. When a test comes back with results above this threshold, a doctor may recommend screening for concerns such as urinary tract infections. In many cases, a single elevated PSA will result in follow-up PSAs to track elevation levels. Should the numbers continue to rise, an X-ray, cystoscopy or ultrasound may be ordered. In some cases, a prostate biopsy might be indicated. Since biopsies come with their share of risks, such as infection, bleeding and pain, most doctors will recommend this as a last resort when suspicion of prostate cancer is especially high.

Is PSA Testing Worth It?

The PSA isn’t without its share of problems, but it remains the gold standard for helping detect prostate cancer in its earliest, most treatable forms. With that in mind, many doctors do still recommend this test and men can request it, as well. It is important, however, that men discuss this screening procedure and its results carefully with their healthcare providers so they can make informed decisions on how best to proceed.

What Determines if a Prostate Cancer Treatment is Successful?

Any man who undergoes prostate cancer treatment wants the effort to yield results. Defining those results, however, can get a little tricky. While some may measure the success of prostate cancer treatment by survival, the team at the Prostate Cancer Institute relies on a higher standard. We define successful treatment as one that makes the cancer go away … for good.

To help patients better understand how treatment success is measured, the following information is presented in question-and-answer format.

How is a successful prostate cancer treatment determined?

The standard Prostate Specific Antigen (PSA) test is one of the most valuable tools available for determining the success of prostate cancer treatment. This is because no matter what treatment is used, this basic blood draw will be taken every time a patient has a visit with the doctor. This is the test patients and doctors rely upon to determine if cancer has been controlled or not.

When PSA levels rise after treatment, the elevation signifies that the need for more testing and possibly more treatment is present. Keep in mind that testing and procedures that may follow an elevated post-treatment PSA level may significantly impact quality of life. This means it is very important for men to carefully review initial treatment options so that they have an understanding of how well a course of action is likely to control cancer. Men should understand the chance they face of needing further treatment. Taking a look at PSA progression rates can provide a valid way to compare possible treatment options.

The standard PSA test is used as a screening tool before a diagnosis, but it becomes a valuable monitoring tool after treatment. It also serves as the warning system for determining if cancer has recurred.

Why are PSA results more important than measuring survival?

When survival is used as the yardstick for determining the success of a treatment, it doesn’t tell the full story. Survival does not tell if the cancer has gone away. The PSA is the tool that can do that. Should an initial treatment fail, it is possible to live with prostate cancer for years, depending on the aggressiveness of the tumor. A treatment may have, for example, a control rate of about 80 percent, but because patients tend to live a long time, its survival rate might be 90 percent. Patients need to be very aware of the likelihood for requiring additional treatment based on the initial intervention selected and the effects additional treatments may have on their quality of life.

Considering the importance of ridding a patient of cancerous cells, the measure the Prostate Seed Institute focuses on for success is known as the “Percent PSA Progression Free.” This is a pre-treatment estimate of a treatment’s failure rate and the potential it provides for patients to not require additional treatment. Survival rates do not provide this critical information. It is important to remember that even treatments with similar survival rates may not have equal cancer control rates, side effect risks or impacts on quality of life.

Why isn’t survival a strong measure of success?

Once an initial treatment is performed, PSA levels indicate success or failure of the intervention. That is why the PSA is such a valuable indicator of prostate cancer treatment success. When survival rates are considered, they may reflect not only cancer-related deaths, but also all other causes for death. A study, for example, that compares a surgical group with mainly younger patients against an older group undergoing radiation may not reveal the whole story. The members of the older group undergoing radiation may, for example, suffer from a number of comorbidities. That means their survival rate may not have anything to do with the success or failure of their chosen prostate cancer treatment. It is not uncommon for researchers to fail to reveal that patients are much younger and in generally better health than the group used for comparison.

Why do some studies and treatment centers only focus on sharing survival rates rather than PSA control?

While most researchers who publish articles and papers do have PSA testing results for their patients available, it’s not uncommon for PSA-based results to not be reported. Unfortunately, this information may be withheld or overlooked because PSA results may not be stellar. Reporting on survival rates simply makes results look more positive. Since authors are not required to follow any specific set of rules when reporting results and medical literature is voluntary, bad results are only rarely publicized.