PSA test

Overview:

PSA test detects prostate-specific antigens (PSA) in the blood of males. A PSA test is prescribed when there is a suspicion of prostate cancer. Prostate cancer is the cancer of the prostate gland and is the common cancer in men. The prostate gland belongs to the male reproductive organs. It is situated just below the urinary bladder in men.

The prostate gland produces the prostate-specific antigen. PSA is secreted in semen, but minute amounts are seen in blood. Apart from the prostate gland, cancerous tissues in the prostate gland also produce PSA. This leads to increased PSA levels.  

Indications:

PSA test is used to detect abnormalities with the prostate gland. It is used to detect cancerous and non-cancerous conditions of the prostate. Elevated levels of PSA are seen

• In the diagnosis of prostate cancer 
• It is used in prostate cancer screening
• It is used in inflammatory conditions of the prostate called prostatitis
• In conditions like enlargements of the prostate (benign prostate enlargement)
• It is also used to know the effectiveness of the treatment done for prostate conditions 
• It can also be used to detect recurrences of cancer 

Recommendations for PSA screening:

Males and individuals assigned male at birth are advised to undergo screening for prostate cancer by the age of 40 or 45. For individuals aged 55 to 69 years, a PSA test can be done based on their individual preferences. PSA test is not recommended for those who are older than 70 years. 

Advantages: 

PSA test helps to detect the PSA at an earlier stage than other cancers. It can also be used to differentiate cancer from other types of benign tumors and also differentiate it from other prostate disorders. 

Before the procedure:

Before undergoing a PSA test, an individual should understand the importance and necessity of the test by discussing it with the healthcare provider (HCP). All the medications taken by the individual should be informed to the HCP along with the history of previous diseases, infections, surgeries, and allergies. Certain medications taken for prostate enlargements, and hair loss can influence the test results. 

Previous catheterizations and urinary tract infections can also affect the condition. Hence it is necessary to inform the HCP. It is advisable to not engage in any sexual activity or masturbation as they may alter the test results. Vigorous physical exercise can also alter the test results hence it is advisable to refrain from any exercises before undergoing the PSA test. 

During the procedure:

The skin at the site where the blood will be withdrawn is carefully swabbed with alcohol. An elastic band is put around the arm. An individual has to fold the fist to allow the easy flow of blood. Blood will be drawn from a vein by using a small needle. The required amount of blood is collected in a vial and sent to the lab for evaluation. The area is bandaged. 

After the procedure: 

One can continue daily activities after the test. The result values will depend on the laboratory standards. Based on the results further investigations will be done to confirm the diagnosis and medications will be prescribed. 

Interpretation:

PSA results are mentioned in the units of nanograms per milliliter of blood. PSA test can also be used to distinguish cancerous from non-cancerous lesions. A PSA level between 4 and 10 shows a mild chance of having prostate cancer. Any level greater than 10 indicates a much higher risk of having prostate cancer. Various tests that are done as part of PSA include: 

• Free vs total PSA: Free PSA is the amount of PSA that is not bound to any proteins and is freely flowing in the blood. Any increased level of free PSA from the normal indicates the aggressiveness of the cancer. Total PSA is the totality of free and bound PSA levels. 
• Density of PSA: The density of PSA is calculated by dividing the amount of PSA by the volume of the prostate gland. This is more reliable in detecting prostate cancer. PSA density 
• The velocity of PSA and doubling time: The rate of change in the PSA level over some time is measured by the PSA velocity and the time over which it doubles is called the doubling time. These indicate the biochemical recurrence of prostate cancer following surgery or radiation. 
• Pro-PSA: Pros-PSA are inactive types of PSA that help to find out the difference between prostate cancer and benign prostate enlargement. 
• IsoPSA: Iso PSA are the various types of PSA that occur in different structural forms in the blood. This helps to single out individuals who are at high risk of developing high-grade prostate cancer who need to undergo biopsy. 

4Kscore test: 4Kscore test is a combination of different types of specific biomarkers that help to assess the risk of aggressive prostate cancer in men with an abnormal prostate cancer screening test. 

Side effects:

Side effects associated with the procedure include fatigue, dizziness, nausea, vomiting, bleeding, and bruising at the site of withdrawal. 

Risks and complications: 

Some risks and complications associated with the test include the risk of inaccurate results. Factors like medications, infections, and liver diseases can lead to inaccurate results leading to misdiagnosis. Elevated PSA levels can sometimes be misleading as they do not necessarily mean having cancer every time. Overdiagnosis leads to unnecessary further investigations causing stress to the individuals. False-positive results can occur that can cause anxiety and distress among individuals who do not have cancer. 

Conclusion: 

PSA test is used to find prostate cancer in individuals who are at risk. It is a protein produced by both the normal and cancerous cells in the body. Screening for PSA helps in the early diagnosis of cancer which can increase the survival chance in individuals. 

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