RECENT NEWS ABOUT PSA TESTS AND EARLY DETECTION

Do You Need a PSA Test?

The PSA test is a simple blood test to measure how much PSA (prostate specific antigen) a man has in his bloodstream at a given time. The PSA test is the most effective test currently available for the early detection of prostate cancer. University of Pittsburgh Cancer Institute says that PSA testing and the digital rectal examination (DRE) "are crucial in detecting prostate cancer in its early stages, when it usually produces no physical symptoms. PSA testing is also used to monitor the progress of prostate cancer which has already been diagnosed."

Since the PSA test came into use in the United States, the death rate for prostate cancer has fallen.

Many US guidelines for prostate cancer screening recommend annual PSA and digital rectal exam (DRE)

• At age 40 for African American men and all men with family history of prostate cancer or a mother with breast cancer. Many survivor advocates urge testing from age 35 up for men at high risk.
• At age 50 - 70 for all men. Men in their seventies and eighties may wish to continue annual testing to protect themselves against advanced prostate cancer in their final years.

Another recommended approach is to ask for a test by age 40, with biopsy if PSA is 2.5 ng/mL; if you have no special risk, retest every two years.

Two ways of using the PSA test are laid out in our CHECK UP FLOWCHART 1 and CHART #2 USING "free" PSA. Also see October 2003 report on "complexed" or "cPSA."

What is PSA, anyway?

The prostate in men, like the breast in a woman, is a gland that produces and secretes fluid.

Cells lining the prostate gland make some of the semen that comes out of the penis at the time of sexual climax (orgasm). Prostate-specific antigen (PSA) helps to keep the semen in its liquid form ( more details at What is PSA? AFUD)

PSA is an enzyme in the form of a glycoprotein produced primarily by the epithelial cells lining the acini and ducts of the prostate gland. (Acini are parts of any gland where fluid is produced.)

"PSA is concentrated in prostatic tissue, and serum PSA levels are normally very low. Disruption of the normal prostatic architecture, such as by prostatic disease, allows greater amounts of PSA to enter the general circulation." From Prostate-Specific Antigen (PSA) Best Practice Policy, Oncology Vol 14, No 2 (February 2000) ( American Urological Association).

High PSA levels in the blood may be a sign of any prostate problem, PSA rise may indicate infection. It may indicate benign growth or swelling of the prostate. Or it may indicate prostate cancer.

Aside from prostate problems, some physical events and procedures can affect PSA levels. Sexual ejaculation, prostate digital examination and biopsy can raise the PSA. The blood test should not be taken soon after orgasm, and should be taken before rectal exam or biopsy.

OncoTip: Prostate Specific Antigen (PSA) Author: James Metz, MD Affiliations: University of Pennsylvania Cancer Center Posted Date: September 24, 1998

Prostate Specific Antigen Testing (PSA Test) 1996 article from Access Health. With Audio Health Library tape accessible on Real player.

Does Screening for Prostate Cancer Make Sense?

Scientific American, September 1996 by by GERALD E. HANKS AND PETER T. SCARDINO, who specialize in prostate cancer research. Hanks is chair of the department of radiation oncology at the Fox Chase Cancer Center, Philadelphia. Scardino is chair of urology at Baylor College of Medicine, Houston.

See also Prostate Cancer, in the series Twelve Major Cancers, Scientific American September 1996.

Is Screening for Prostate Cancer Cost Effective? (reprinted by Dr. Jonathan Oppenheimer)