When do you need a PSA test?

By: Robin Vasan, MD

A man’s prostate gland makes more than just the fluid that carries semen; it also makes a special kind of protein, or antigen. And that antigen can reveal much about your prostate’s health.

Prostate-specific antigens (PSAs) are like markers that alert your immune system of something foreign and potentially harmful in the prostate, such as cancer. After the prostate produces PSA, the protein works its way into your blood, providing a reading, or score, of how much is produced.

The PSA test, as well as an advanced version of the screening called an IsoPSA, measures these antigen levels in the blood, therefore detecting such abnormalities.

Learn more about the symptoms and risks of prostate cancer.

However, a PSA reading can have variables. For example, as men age, their PSA levels tend to naturally climb. Further, overall prostate health can alter PSA production – some conditions besides cancer might cause it to rise.

In those cases, the IsoPSA test can detect such distinctions. This is because in addition to gauging PSA levels, the IsoPSA test breaks down antigen structure to identify if something else is elevating the numbers.

September Is Prostate Cancer Awareness Month

Because September is dedicated to raising awareness of prostate cancer and its symptoms, plenty of information is available about the benefits of a PSA screening.

We want to contribute to the awareness. The following information is designed to answer the top questions we hear from patients regarding what makes a “normal” prostate score, when you should consult a doctor about getting your first or next PSA test, and your testing options.

What is a “Normal” Amount of PSA in My Blood?

The amount of PSA in blood is measured in nanograms of antigen per milliliter of blood (ng/mL). This number rises with age:

For men in their 40s and into their 50s, a PSA level above 2.5 nanograms per milliliter of blood is clinically considered higher than normal. The median range for men of this age is usually 0.6 to 0.7ng/mL.

For men ages 50 to 60, a PSA score of 2.5 to 3.5 ng/mL is determined normal, and a reading higher than 3.5 ng/mL is not.

And for men in their 60s, a PSA score greater than 4.0 ng/mL has traditionally been considered abnormal. The normal PSA range for men in their 60s is 1.0 to 1.5 ng/mL.

What Other Factors Determine ‘Normal’ PSA Levels?

A rapid increase or continuous rise in your PSA level is considered a red flag of a potential problem in the prostate. Specifically, a gain of more than 0.75 of a point within one year signals an irregularity. Read our blog on the importance one point can make.

That said, not every increased PSA level is an indicator of prostate cancer.

In fact, three of every four men with an elevated PSA score have no evidence of cancer. Rather, an elevated PSA level in your bloodmay be due to prostatitis, an enlarged prostate, and/or a urinary tract infection. Even physical activity and ejaculation can temporarily increase PSA levels.

When Should I Get a Prostate Cancer Screening?

The time to begin having PSA tests depends on a number of factors. According to new guidelines, men with no family history or known illness should consider undergoing the PSA test starting from ages 55 to 69, when researchers believe they can benefit the most from screening.

However, some men younger than 55 or older than 69 might be advised to undergo PSA testing under certain circumstances. Here’s a breakdown:

Get a PSA screening from the age of 54 to 70 when:

• You carry risks of developing prostate cancer.
• The benefits of treating the cancer outweigh any possible risks of treatment side effects. (The treatment of diagnosed prostate cancer makes most sense.)

Ask about a PSA screening from ages of 40 and 54 years if you:

• Have a family history of prostate cancer, meaning at least one first-degree relative, like a brother or father, who has had the disease.
• Have at least two extended family members who have had prostate cancer.
• Are African-American; an ethnicity that has a higher risk of developing a more aggressive form of prostate cancer.

Ask about an IsoPSA screening if:

• If you are older than 50.
• If your PSA reading is higher than 4 ng/mL.

Ask about any PSA screening after age 70 if:

• You have a life expectancy of more than 10 years.
• You and your doctor agree the benefits of cancer treatment would outweigh the adverse side effects.

Note: PSA tests are not usually recommended for men who are 70 years or older due to harmful treatment side effects and because the cancer might not grow or spread to a life-threatening stage in the patient’s lifetime.

How Often Should I Get a PSA Test to Detect Prostate Cancer?

The answer to this question depends on your age, risk factors, and baseline PSA score. Because the risk of cancer increases as men grow older, so does the need for testing.

For example, just one in 350 men younger than 50 are diagnosed with prostate cancer, but that figure escalates to one in every 52 men by ages 50 to 59. Nearly 60% of prostate cancers are detected in men older than 65, according to the American Cancer Society.

Overall, prostate cancer develops in nearly 13% of all men across all ages.

Doctors recommend most men start undergoing regular PSA tests after age 54. You should ask your doctor for advice regarding when and how frequently the tests should be repeated before and after that 54th birthday. If you are 54 years or older, your doctor may advise that you have a PSA test every two or three years.

However, it might make sense to ask your doctor about getting an IsoPSA test if you are older than 50 and have a PSA reading that is higher than 4 ng/mL. Like the standard PSA test, an IsoPSA screening scans your blood for antigen levels, but takes the analysis further by analyzing cell composition. This breakdown can help your physician specify if the elevated reading is due to cancer (even early cancer) or something else, such as an enlarged prostate, infections, or even exercise.

Such screening can spare you of a potentially unnecessary biopsy. According to clinical studies, doctors avoided 55% of biopsies in patients with no risk of prostate cancer by using IsoPSA analysis.

Your doctor can also explain the risks and benefits of each form of screening for prostate cancer.

What Should I Expect If I Have a High PSA Score?

If your PSA level rises above the normal range for your age and overall health, your doctor may make the following recommendations:

1. Repeat the PSA test. If the reading is still higher after the repeat, your doctor may recommend continued monitoring over a period of time to see if and how your PSA level changes.
2. Suggest an IsoPSA test to rule out cancer and/or narrow down the cause of the higher reading.
3. A digital rectal exam to feel for changes in your prostate gland that may help to detect prostate cancer.
4. A biopsy, which involves taking small tissue samples from the prostate and examining them for cancer cells.

If follow-up tests indicate prostate cancer, your doctor will perform further analyses to determine whether the cancer is slow growing (indolent) or aggressive. Slow-growing cancer might only require active surveillance, or watching and waiting, because it has a minimal chance of spreading to other organs. An aggressive cancer requires more immediate attention because it grows rapidly and has the potential to spread to other parts of the body, including nearby lymph nodes, rectum, and bones.

Your doctor will consider your age and other factors when weighing the risks and benefits of treatment. Eventually, you’ll undergo a personalized care approach that might include radiation therapy and partial or complete prostate removal.

Do You Have Questions About Prostate Cancer? We’re Here.

You can speak with one of our 130 knowledgeable, experienced urologists about your prostate cancer risk level and when to begin your prostate screening. Contact Advanced Urology Institute today to book a consultation with a urologist who will give you instructive, helpful advice.