PSA is one half of prostate cancer screening, which should be performed annually in all men from age 50 to 70. In some men it should be started earlier if they have a strong family history of prostate cancer.
PSA stands for prostate specific antigen. It is an enzyme produced by the prostate tissue cells that is important in making semen less thick and gel-like.
When we talk about PSA for men we’re really referring to a blood test that measures the level of this enzyme floating around in your blood. The reason this test is important is that it can give us a clue as to your prostate health. Having a low PSA is never a bad thing, but having a high PSA could signal a problem.
There are several conditions that could cause your PSA to be high. The most important, of course, is prostate cancer. This is the whole reason we perform the test in the first place. We’re trying to detect prostate cancer early to make it more curable.
Prostate cancer isn’t the only issue that can cause a high PSA, though. Prostate inflammation or infection, which often has no symptoms, can cause an elevation. So can simply having a large prostate. Other things can also do it, such as a recent urine infection, urinary catheter, urinary retention, or camera exam of the bladder. If you ejaculate within 24 hours to the blood test, this can also cause a slight elevation of the PSA.
One of the things I mentioned that can increase your PSA is having a big prostate. This is important because as men age, their prostates grow. So it is normal and natural to see your PSA increase as you age. This is why what’s considered a “normal” PSA changes as you get older.
For a male in his 50s the PSA should be less than 2.5. In your 60s it should be less than 4.5. Once you’re in your 70s it should be less than 10.
It’s also important to keep an eye on the rate of change of the PSA as well. What I mean by this is that if you’re 60 and your PSA is 0.5, but next year it’s 1.2, and the following year it’s 3.5, that could be a problem. Even though that 3.5 is less than 4.5, the rapid increase in the PSA can hint at a problem.
When the PSA is high or is changing rapidly your doctor should refer you to a urologist. Your urologist will then suggest some additional testing. This could include some more specialized blood tests, such as a prostate health index score, a 4kscore, or free PSA percentage. Alternatively, a prostate MRI, a type of imaging scan, could be useful in select cases. Most commonly, though, the next step is a prostate biopsy, a test that samples the prostate tissue for cancer cells.
The most important thing to understand about PSA is that it isn’t a perfect test. A high PSA doesn’t mean there is cancer. Don’t panic if your PSA is high, but definitely see a urologist.
I hope that this information on PSA has been helpful and allows you to better understand your blood. If you’re ever unsure of what your next step should be, see a urologist for more information. It’s better to be safe than sorry.
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