Prostate-Specific Antigen (PSA): What To Think About

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What To Think About

• When combined with a digital rectal exam, the prostate-specific antigen (PSA) test increases the chance of detecting prostate cancer. For more information, see the medical test Digital Rectal Examination (DRE).
• A PSA level within the normal ranges does not mean that prostate cancer is not present. Some men with prostate cancer have normal PSA levels.
• The American Cancer Society (ACS) advises doctors about when to offer the PSA test and DRE:
  • Offer these tests to men ages 50 and older who are expected to live more than 10 years.
  • Offer these tests to men starting at age 45 if they are at high risk for prostate cancer. This group includes African-American men and men who have a father, brother, or son who was diagnosed with prostate cancer before age 65.
  • Offer these tests to men starting at age 40 if they are at an even higher risk for prostate cancer. This group includes men who have several close relatives who had prostate cancer at an early age.
• The U.S. Preventive Services Task Force (USPSTF) advises doctors about when to test for prostate cancer:
  • No testing is advised for men age 75 and older.
  • Before any tests, it is important for men younger than 75 to talk with a doctor about the pros and cons of PSA testing.
  • Men younger than 75 who have long-term medical problems or who are expected to live less than 10 years are not likely to benefit from testing.
• Some experts do not advise yearly testing. They say the high rate of false-negative and false-positive results and the costs and risks of further tests outweigh the benefits of yearly screening tests.
• Experts disagree about the type of testing that is appropriate if the PSA level is high. The decision may depend on:
  • Results of your digital rectal exam.
  • Results of any PSA tests you have had in the past. If your PSA level gets higher in a short amount of time, follow-up testing may be recommended.
  • Your age and health.
  • The costs and risks of more tests and treatments.
• Other prostate tests are being evaluated to determine how well they tell the difference between prostate cancer and benign prostatic hypertrophy.
  • The prostate-specific antigen density (PSAD) test compares the PSA value to the size of the prostate gland. The size of the prostate is measured using transrectal ultrasound (TRUS).
  • The PSA velocity test is a measure of how rapidly PSA levels increase over time. PSA levels increase more rapidly in men with prostate cancer and more slowly in men with prostate enlargement (benign prostatic hypertrophy).
• Complexed prostate-specific antigen (cPSA) when used in combination with a digital rectal exam can detect prostate cancer. The cPSA test currently is not widely available.

Last updated:	May 15, 2007
Author:	Ralph Poore
Reviewed By:	Martin Gabica, MD - Family Medicine, Christopher G. Wood, MD, FACS - Urology/Oncology
Editors:	Susan Van Houten, RN, BSN, MBA, Tracy Landauer