Understanding PSA Levels
What is PSA?
The prostate specific antigen (PSA) is a chemical released by the prostate gland into the blood stream. It has been used as a screening test for prostate cancer to drive the decision on whether to proceed with a diagnostic biopsy to rule out prostate cancer.
PSA testing is widely utilized as a screening test for prostate cancer in men. In recent years there has been debate about the benefits of PSA screening in certain populations. The United States Preventive Services Task Force (USPSTF) changed guidance in 2018 advising men between 55-69 years to make an informed choice and discuss with their doctor whether PSA screening is right for them, while recommending against screening for men over 70 years of age.
Known Limitations of PSA screening include:
- Low sensitivity and specificity for prostate cancer
- Common conditions that lead to an increase of PSA such as benign prostatic hyperplasia (BPH) and inflammation of the prostate
- PSA results must be used in combination with other factors such as age, family history and ethnicity
- PSA cannot distinguish high grade from low grade prostate cancer
Importantly, the increased detection of Prostate Cancer has led to over-diagnosis of clinically insignificant or indolent prostate cancer and consequent overtreatment with surgery or radiation.
What does a High PSA Level mean?
There are many reasons that could lead to an elevated PSA level, and it is important to know the potential reasons why PSA levels are elevated as well as patient-specific risk factors for prostate cancer. Elevated levels of PSA can occur due to:
- Enlarged prostate (benign prostate hyperplasia or BPH)
- Urinary tract infection
- Recent ejaculation
- Prostate massage
- Vigorous exercise
What do PSA numbers mean?
PSA levels generally increase with age. Generally speaking, PSA numbers may be interpreted as identified below. However, this is by no means intended to be a definitive guide and should be taken in conjunction with a patient’s medical history, risk profile, race and other clinical factors when attempting to assess risk. The EPI-CE Test may be able to help provide additional information for men who want to better understand their risk for aggressive or clinically significant prostate cancer.
There is no widely acceptable limit for justifying a biopsy in PSA range of 2 to 10 ng/mL. This is where The EPI-CE test can provide additional helpful information that allows doctors and patients to understand the risk of having clinically significant prostate cancer on biopsy.