KNOW YOUR PSA!
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The Gov't task force recommend against PSA's, in 2012; should you or shouldn't you? Go to UsTOO.org

Why you should say "NO" to sex the night before your PSA test...

...and other things you probably don't know about your prostate health, but should!

 What is PSA?

Prostate-specific antigen (PSA) is a protein that starts out in semen, the fluid that carries sperm. Normally, PSA is made in the prostate in epithelial cells. Epithelial cells make some of the semen that comes out of the penis at the time of sexual climax (orgasm). PSA helps to keep the semen in its liquid form. The prostate-specific antigen (PSA) test was developed and approved by the FDA in 1986 to help detect prostate cancer. A doctor can identify a number of prostate problems by testing the levels of PSA circulating in the bloodstream. This test is performed using a small blood sample taken from the arm.In July 2003, Martin I. Resnick, M.D., president of the American Urological Association, said: "Prior experience has indicated that earlier diagnosis of localized prostate cancer can increase the likelihood of curable disease. Prior to the use of the PSA test, tumors were found mostly in advanced" and less treatable             stages, giving patients far fewer options for treatment. The issue of lowering the prostate-specific antigen biopsy threshold is not a new thought. However, to simply lower the threshold based on PSA level alone could possibly lead to an increase in unnecessary biopsies. This study shows that this is not as significant as once thought. The authors have used key clinical variables such as age, race and family history and suggest that this comprehensive approach would lead to better-informed decisions by doctors and patients about a need for biopsy. This is a very compelling methodology.

The American Urological Association strongly supports informed patient decision-making and believes that all men over 50 and those at high risk, such as African-Americans and men with a family history of prostate cancer  should consider the test and discuss its benefits and limitations with their physicians. Men at high risk should begin testing at age 45.

What is a normal PSA level?

On this site we use the term "normal PSA" but do so with a warning. Everything to do with PSA hinges on the word "normal." Yet there is no absolute normal.Just because a blood test shows you have "normal" PSA does not mean you are guaranteed free from prostate cancer. And just because you have "higher than normal" PSA does not necessarily mean you do have anything wrong with your prostate.Low level PSA (from 0-3.9 nanograms per milliliter of blood) is generally considered normal - because normally it indicates that a man is free of prostate cancer or other prostate disease. PSA levels higher than 3.9 ng/ml can indicate a problem with the prostate, including inflammation, infection, enlargement or cancer. But 20% of prostate cancers develop while PSA levels are in the 'normal' range. And it is important to note, some men without any prostate problems show PSA levels higher than normal. In fact only about 1 out of 3 men with elevated PSA levels have cancer. Some men can be healthy and well despite an elevated PSA.Given this lack of a strict absolute "normal" level, medical professionals have varying opinions on the value of PSA testing. The test itself is not perfect and it carries with it some risks and benefits. Benefits of the PSA test include: §   detecting prostate cancer long before any symptoms present themselves §   early detection before the cancer has spread outside the gland makes treating the cancer easier and offers the only hope for cure §   the test has contributed to a significant reduction in prostate cancer deaths Drawbacks of the PSA test include: §   in approximately 20% of cases, PSA tests show 'normal' PSA levels in men with early prostate cancer (false-positive) §   the test itself does not distinguish between prostate cancer and other commoner prostate problems like infection (prostatitis) or benign overgrowth of the prostate (benign prostatic hypertrophy, or BPH). §   2 out of 3 of those with elevated levels of PSA do not have prostate cancer, causing undue worry §   men over the age of 75 may not benefit from the test, as treating prostate cancer in men past age 75 is less likely to lengthen lifespan.

           PSA Screening; Should you or shouldn't you? How often?

In 2013 a bit of a controversy began on the benefits of PSA screening. The PSA test lacks precision in identifying early prostate cancers, and this can result in unnecessary diagnostic tests and treatments, some with potentially significant side effects.  We survivors can confirm that!  Almost every one of us, no matter what treatment we chose, now live with a degree of ongoing incontinence and dexual dysfunction.  So, we here locally, stick with: first screening at age 45 for caucasions, 40 for African Americans. If all normal, go five years and begin annual testing.  Make sure you ask your doctor to do both a PSA and a DRE exam.

Other tests beyond PSA and before biopsy

Although the PSA test is not foolproof, it is an extremely effective test when used together with a digital rectal examination and, when necessary, transrectal ultrasound and biopsy. Even if your prostate feels okay to your doctor during your rectal exam, he may still order a biopsy if he considers your PSA level to be high. And because some men with PSA levels under 4 have prostate cancer, some doctors recommend that the normal level of PSA (and the point at which doctors should consider doing biopsies of the prostate) should be lowered to 2.5 or 3 so that even more cases of cancer can be caught before they become invasive. In addition, PSA-related measurement and newer forms of the PSA test may be used to distinguish between signs of prostate cancer and other conditions.Your doctor may take into account your PSA velocity, which is how fast your PSA levels go up. If your PSA level was 1.0 last year, and now it's 2.4, your doctor has cause for concern, and more frequent testing (and even a biopsy) may be advised. Your doctor may consider the size of your prostate gland compared to your PSA level. This comparison is called PSA density. Generally, a high PSA level in a man with a small prostate is more disturbing than the same PSA level in a man with a large prostate. Newer blood tests include the "free" PSA test (fPSA), the "complexed" PSA test (cPSA), the "pro" PSA test (pPSA) and human kallikrein 2 (hK2). In the PSA 2.0 to 4.0 ng/ml range, these newer tests are used to increase specificity and to avoid unnecessary biopsies. Measurement of the ratio between percent of free PSA and bound or total PSA in patients with a PSA level between 4 and 10 ng/ml can help tell the difference between cancer and benign disease and so decreases the number of negative biopsies.Some studies show that complexed PSA is another test more specific thatn regular PSA and that PSA ratios (fPSA/cPSA) further increase diagnostic accuracy.Pro prostate specific antigen (pPSA) is a "precursor form" more often found in tumor compared to benign prostate tissues. It is a still more specific serum marker for prostate cancer, which may be useful for early detection in the 2.5-4.0 ng/ml total psa range. Researchers at Johns Hopkins say (Urology. Feb 2003): "In the 2.5 to 4.0 ng/mL total PSA range, 75% of [prostate] cancers can potentially be detected with 59% of unnecessary biopsies being spared using %pPSA; use of %fPSA would result in sparing only 33% of unnecessary biopsies. A large prospective clinical trial is needed to confirm these preliminary findings."Researchers at Louisiana State Health Sciences Center (Prostate Cancer Prostatic Dis. 2004 Mar 9) say "percent free PSA offered the best performance and highest specificity in prostate cancer detection in African-American males over the entire range of tPSA. hK2/fPSA may offer modest improvement in the PSA range of 4.0-10 ng/ml."

 



 

  We urge you to get a PSA and DRE; white men over 44; black men over 39.