Prostate Specific Antigen (or PSA) testing is utilized to determine a man’s risk of having prostate cancer. This is a protein that is secreted from the prostate and can be detected in the blood. The difficulty with evaluating and understanding PSA levels is that in reality, there no normal or abnormal PSA. Sometimes patients are told that levels below 4.0 ng/ml mean that there is no need for further evaluation, but even with a PSA <2, patients still have a 15% risk of having prostate cancer. And in patients with a PSA >4, the risk of not having cancer is as high as 70%.
PSA was initially developed to follow patients after their treatment for prostate cancer. It’s a very sensitive and specific test for patients after treatment, however it becomes much more complicated when the prostate is still in place. The PSA can be elevated following an infection, due to recent intercourse or trauma and these can variations in the PSA level can be difficult to interpret, particularly if there is a large jump between numbers. Sometimes the PSA by itself isn’t the most important factor. This is just one number however the trend in PSA as it increases and how quickly it does this and tell us much more about what is actually going on in the prostate.
The reason there is so much controversy on PSA testing is the concern that we could diagnose patients with prostate cancer who might not need treatment. Overtreatment of prostate cancer remains a concern as there are side effects from treatment including difficulties with controlling urine or erectile problems. However, overtreatment needs to be weighed against the risk of missing prostate cancer when it’s potentially curable.
At Tulane we have urologists who understand the nuances with PSA. Our faculty specializing in prostate cancer have trained at the most prestigious cancer institutions in the nation (Memorial Sloan Kettering in New York or the National Cancer Institute in Bethesda) where many of the PSA studies were performed. We have developed expertise in understanding these tests and have published multiple peer reviewed manuscripts educating other physicians in how to interpret this test. If you have questions about your PSA levels or would like to discuss PSA screening with one of our urologists please call the clinic at 504-891-8454 and we will see you that week to discuss your care.