prostate specific antigen (psa) (free / complex / total) Test

PSA is a protein secreted by the prostate gland cells. In men with healthy prostates, it is found in minimal quantities in their serum. PSA is present in the blood in two forms: free (not bound) and complexed (cPSA, bound to protein).

A PSA test is the total PSA that analyses the sum of free PSA and cPSA in the blood. Increased amounts of PSA are a sign of prostate cancer BPH, prostatitis, and other prostate disorders. This test helps monitor prostate cancer.

Ideally, for most men, the PSA levels are under four (ng/mL); hence this what the cutoff value has been determined for prostate cancer. Most men with prostate cancer, have known to have PSA levels higher than four; however, prostate cancer is possible at any PSA level. Most of the reports that have been published have mentioned that, if the prostate gland feels normal on examination and the PSA is less than 4, then there is only a 15% chance of having prostate cancer. On the other hand, for PSA between 4 and 10, the probability of having prostate cancer increases to 25%, while for a PSA greater 10, there is an increase in the risk and it can be as high as 67%.

PSA test is ordered to scan and diagnose asymptomatic and symptomatic men for prostate cancer, to help establish the necessity for a biopsy of the prostate, to monitor the effectiveness of treatment for prostate cancer and to detect recurrence of prostate cancer.

Symptoms observed are:

• Difficult, painful, and/or frequent urination

• Back pain

• Pelvic pain

• Blood in the urine

• Blood in the semen

• Erectile dysfunction (impotence)

• Bone pain (especially in the lower back, hips, or ribs)

• Loss of bladder control.

• Delayed or slow start of urination

• Dribbling or leakage of urine, most often after urinating

It’s important for men to discuss with their doctors about the benefits, risks and limitations of the prostate cancer screening, this would even before the decision is made whether to be tested or not. Ideally, till this discussion happens, the prostate-specific antigen (PSA) blood testing should not occur. Most men who are at average risk for prostate cancer, initiate the discussion around the age of 50 and those with a higher risk, would initiate the discussion earlier.

Men aged between 55 to 69 and who are considering the screening should ideally have a talk with their doctors about the risks and benefits of testing; however, they should make their decision based on their personal values and preferences.

For men under the age of 40, PSA screening is not recommended. Even for men aged 40 – 54 at average risk are not recommended to undergo routine screening. Post a discussion with the doctor; once the person has decided to undergo annual screening, the routine screening interval is advised to be 2 years or more, mainly to reduce the harms of screening. The screening interval of 2 years reserve the benefits and reduce overdiagnosis.

Any men with a less than 10-15-year life expectancy are not recommended to go through the Routine PSA screening.

In case post the PSA test or rectal exam, if the doctor is concerned that there is a possibility of prostate cancer, a biopsy (a lab testing of a small amount of tissue from the prostate) would be the next step. The only way to positively identify the presence of cancer is through a biopsy.

The PSA test results can be expected to take about a week to two, so about close to 10 days is what can be expected.

PSA blood tests costs $20-$50. Please note that this just the cost of the test and doesn’t cover visit charges to the doctor, which would be additional.

Further, there are also home blood tests that can be used. Basically, the kit comes with a lancet, where the one needs to prick the finger, squeeze out a sample of blood and store it in the kit provided. There is a bandage to dress the puncture site, once the blood has been collected. This sample of blood needs to be kept in the prepaid mailer and sent to the laboratory for further testing. However, please be aware that not all available homes kits are recommended. The FDA website would provide the details about which home tests can be used.

The PSA test might symbolize a critical screening test for prostate cancer. However, the procedure for acquiring the blood for the procedure is similar to a regular blood test. Where the vein on your hand is wiped, and an elastic band is tied around the arm. The elastic band helps move the blood faster to fill the vein. A needle with a sterile vial attached to it is used to draw blood from the vein. The blood is stored in the sterile vial and sent to the laboratory for further testing. The entire procedure doesn’t take more than a couple of minutes. The only problem that might be faced is locating the vein, which varies from person to person. In the end, the puncture site is covered with gauze or an adhesive bandage to help stop the blood flow.

There are rarely any risks involved since we are talking about a simple blood test. In rare case scenarios, one of the following might occur due to the needle being used to puncture the vein and obtain the blood for the tests –

• pain

• bleeding

• bruising

• infection

In case you start feeling nauseous or light-headed when the blood is being drawn, please inform the same to the doctor right way.

Preparatory instructions before the test:

Avoid physical activities which apply unnatural pressure on the genitals.

Stop activities like cycling and horseback riding for three days before the PSA test. Pressure on the prostate can falsely increase the PSA test results.

Avoid ejaculation at least 24 hours before sample collection.

The sample should be collected before the digital rectal exam and before (or several weeks after) a prostate biopsy.

Specimen type: Serum (Blood Sample),

Specimen collection procedure: Venipuncture (Collection of blood from a vein, usually from the arm)

Most doctors have considered the normal PSA level to be about 4.0 ng/mL. Hence anything lower than 4.0 ng/mL is considered normal. In case the PSA level is elevated to above 4.0 ng/mL, the doctor would further recommend a biopsy to confirm whether the person is suffering from prostate cancer or not. Also, certain studies have shown that even men with lower PSA level, have been detected with prostate cancer and men with high PSA level did not have prostate cancer. This enables us to understand that there are other factors which affect the PSA levels in men. Prostatitis or a urinary tract infection are known to cause a man’s PSA level to increase. Further, there are drugs like finasteride and dutasteride, which are known to lower PSA levels.