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The Prostate Specific Antigen (PSA) Blood Test

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Recent findings emphasis the importance of PSA velocity or "annual rate of change" CLICK HERE to print a PSA Tracker.

PSA or Prostate Specific Antigen is a protein originating from the prostate that can be detected in blood. PSA testing detects elevated PSA levels. Elevated or rising PSA levels are used as a signal that there is something wrong with the prostate.

-Judd W. Moul, MD, FACS, Chief, Director Duke Prostate Center

The 2006 National Comprehensive Cancer Network (NCCN) guidelines (PDF) point out that the PSA threshold of 4.0 ng/mL will miss a significant number of potentially curable tumors. Recent studies of the incidence of cancer in men whose PSA is in the range of 2.5 to 4.0 ng/mL have shown that a substantial number of men in this group will have prostate cancer. 2004 NCCN guidelines reference a study of 332 screened men with PSA in this range, in which 22% of them were found to have prostate cancer. Experts estimate that lowering the PSA threshold to 2.5 ng/mL would significantly increase the rate of detecting cancer in men younger than 60 years old with little loss of specificity. At this lower threshold, some studies have shown that the cPSA test can be more predictive of prostate cancer and can result in fewer false diagnoses and unnecessary biopsies compared to the PSA test.

Additional studies continue to show the importance of PSA velocity (annual rate of change).

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A study published in the Urology Times, describes how researchers are finding that normal PSA ranges vary with both race and age. Joseph E. Oesterling, director of the Michigan Prostate Institute and urologist-in-chief at the Medical Center, devised a breakdown showing the upper limit of normal PSA levels for a variety of age and race combinations (see below).

PSA levels can also be increased shortly after bicycling, within 24 hours from an ejaculation, when there is a presence of high rheumatic factors in the blood and after a DRE or a biopsy. When scheduling a PSA or planning to attend a free screening these factors should be taken into account or avoided.