What is the PSA test.

It’s a simple blood test, a needle is inserted into a vein, and blood is drawn into a vial. We’re all pretty used to that. A few days later we get a number called a PSA. Conventional practice says if it’s less than 4.0 your fine, if it’s 4.0 or higher then lets look farther. It’s normally performed in conjunction with a Digital Rectal Exam (DRE) or the “finger wave”. If the doctor can feel abnormal tissue (normally a hard bump) then again that means more or quicker response is required.

 More recent data is recommending that if you’re 50 and have a PSA of 3.9 that’s bad, so they are recommending a graduated scale where the “alert level” is 2.0 for a 50 year old climbing to 4.0 for a 70 year old, so at 60 it should be less than 3.0.

 My belief is like all other blood tests, we are all different, and have different “normal values”. I believe we should have a baseline drawn early in life (in our 40’s, earlier if there is a family history of prostate cancer) and all subsequent tests should be compared to the baseline. What I really look for is if it is climbing, and how quickly is it climbing.

 So what are the down sides to the PSA test.

 What happens if your PSA is high but you don’t have cancer. This can be caused by prostate infections or BPH (Benign Prostatic Hypertrophy). Normally when an increase in PSA is detected, the doctor will perform a DRE to see if they can feel an enlarged prostate and/or put you on antibiotics and see if it lowers. If it does it’s probably not cancer so you just repeat the PSA in 4-6 months.

Our PSA recommendations:

  • Have a baseline PSA performed at 40, earlier if there is a family history of prostate cancer (in your 20’s is fine)
  • Have a subsequent PSA drawn, either annually or following an abnormal result. Preferably they are performed using the same diagnostic testing technique. If it has risen, calculate the time it is going to take to double. If it’s less than a year then something is going on and follow-up (other than a PSA) is required.

 

PSA test