Prostate-Specific Antigen (PSA) Test

Dr Png Keng Siang
Dr Png Keng Siang
Senior Consultant Urologist & Robotic Surgeon

The Prostate-Specific Antigen (PSA) test measures the level of PSA in a man’s blood. PSA is a protein produced by both normal and malignant cells of the prostate gland. The test is primarily used to screen for prostate cancer, monitor patients who have been diagnosed with prostate cancer, and check for cancer recurrence after treatment.

Purpose of the PSA Test

The PSA test serves several key purposes:

Screening for Prostate Cancer

Helps in the early detection of prostate cancer in men without symptoms by measuring the level of prostate-specific antigen (PSA) in the blood. Elevated levels may indicate the presence of cancer, prompting further investigation.

Monitoring Prostate Cancer

Used to monitor the progress of prostate cancer in men who have been diagnosed with the disease. Regular PSA tests can help track how well the cancer is responding to treatment.

Checking for Recurrence

Evaluates the recurrence of cancer in men who have undergone treatment. Rising PSA levels after treatment can indicate that the cancer has returned, allowing for timely intervention.

Who Should Consider a PSA Test?

The PSA test may be recommended for various groups based on age, risk factors, and symptoms. Understanding who should consider a PSA test can help in early detection and effective management of prostate health:

Men aged 50 and older are generally recommended to discuss the possibility of PSA testing with their doctor as part of routine health screening. This is because the risk of prostate cancer increases with age.

Men with a family history of prostate cancer (especially if a father, brother, or son has been diagnosed) are at higher risk and may benefit from starting PSA screening earlier, typically at age 45. Genetic predispositions, such as mutations in the BRCA1 or BRCA2 genes, can also increase risk.

Men experiencing symptoms that might indicate prostate problems, such as difficulty urinating, frequent urination (especially at night), weak urine flow, pain or burning during urination, blood in the urine or semen, or persistent pain in the back, hips, or pelvis, should consult their doctor about PSA testing. These symptoms can be associated with prostate cancer, benign prostatic hyperplasia (BPH), or prostatitis.

Men who have previously had elevated PSA levels but no confirmed prostate cancer may undergo regular monitoring to detect any changes or increases in PSA levels over time. This helps in identifying potential issues early.

Preparation for the PSA Test

Preparation for the PSA test involves the following steps to ensure accurate results:

  • Diet and Medication: No special dietary restrictions are required before the PSA test. However, certain medications, such as finasteride or dutasteride, can affect PSA levels. It’s important to inform your doctor about any medications or supplements you are taking so they can provide specific instructions and consider any necessary adjustments.
  • Avoiding Activities: Strenuous activities, particularly those that put pressure on the prostate, such as cycling or heavy lifting, should be avoided for 24-48 hours before the test. These activities can temporarily elevate PSA levels, potentially leading to inaccurate results.
  • Timing: It is advisable to avoid ejaculation for 48 hours before the test, as it can temporarily raise PSA levels. This precaution helps to ensure that the PSA measurement reflects a more accurate baseline level.
  • Medical Procedures: Inform your doctor if you have recently undergone any medical procedures involving the prostate, such as a prostate biopsy, digital rectal exam (DRE), or catheterisation. These procedures can also temporarily increase PSA levels, so timing the test appropriately is essential for accurate results.
  • Hydration: Stay well-hydrated before the test. Drinking plenty of water can make the blood draw easier and more comfortable.

How is the PSA Test Performed?

The PSA test is a straightforward procedure involving the following steps:

Blood Sample Collection

A medical specialist will draw a small sample of blood from a vein in the arm. This is typically done using a needle and syringe, and the procedure only takes a few minutes.

Laboratory Analysis

The blood sample is then sent to a laboratory for analysis. The lab processes the sample to measure the amount of prostate-specific antigen (PSA) present.

Measurement and Reporting

The PSA level in the blood is measured and reported in nanograms of PSA per millilitre (ng/mL) of blood. The results are then communicated to the patient and their doctor, who will interpret the findings and determine any necessary next steps based on the PSA level.

Interpreting PSA Test Results

PSA test results are interpreted based on several factors:

PSA Levels

Normal PSA levels are generally considered to be below 4.0 ng/mL. Higher levels may indicate the presence of prostate cancer. However, elevated PSA levels can also be caused by other conditions, such as benign prostatic hyperplasia (BPH) or prostatitis.

Age-Specific Ranges

PSA levels can vary with age. Higher levels might be normal in older men. Age-specific reference ranges are often used to interpret PSA results more accurately.

Rate of Increase

A rapid increase in PSA levels over time can be a more significant indicator of prostate cancer than a single elevated PSA level. Regular monitoring of PSA levels helps track these changes and allows for more informed decision-making.

Follow-Up and Next Steps After the PSA Test

Based on the PSA test results, the following steps might be taken:

Normal Results

If PSA levels are within the normal range, regular monitoring is typically recommended. Your doctor will advise on the appropriate interval for future PSA tests based on your age, risk factors, and overall health.

Elevated PSA Levels

If PSA levels are elevated, additional diagnostic tests may be recommended to determine the cause. These may include:

  • Digital Rectal Exam (DRE): A physical examination of the prostate to check for abnormalities.
  • Prostate Biopsy: A procedure in which small samples of prostate tissue are removed and examined for cancer cells.

Consistent Monitoring

For men with elevated PSA levels but no immediate signs of prostate cancer, consistent monitoring is crucial. Regular PSA tests and follow-up appointments with your doctor can help track any changes over time and determine if further action is needed.

Discussing Treatment Options

If prostate cancer is diagnosed, your doctor will discuss treatment options based on the stage and grade of the cancer, as well as your overall health and preferences. Treatment options may include surgery, radiation therapy, hormone therapy, or other targeted treatments.

Potential Risks and Limitations of the PSA Test

It is also important to be aware of the potential risks and limitations associated with the PSA test:

Elevated PSA levels do not always indicate prostate cancer. Other conditions like benign prostatic hyperplasia (BPH) or prostatitis can also cause high PSA levels. False positives can lead to unnecessary anxiety and invasive procedures.

In some cases, prostate cancer may be present even if PSA levels are low. This can provide false reassurance and delay diagnosis and treatment.

The PSA test can lead to the detection of prostate cancers that may not cause harm during a man’s lifetime. This can result in unnecessary treatments and associated side effects.

Dr Png Keng Siang

Dr Png Keng Siang

Senior Consultant Urologist & Robotic Surgeon

Dr Png is a United States fellowship-trained urologist who received his urology specialist board certification from Singapore. He is the first and only urologist in Singapore to be inducted into the Fellow, American College of Surgeons (FACS) after completing a minimally invasive surgery fellowship in the USA at the Indiana University School of Medicine, where he sub-specialised in robotic and laparoscopic surgery for urological cancers.

  • Joint Committee of Specialist Training Site Accreditor, Urology Residency Program
  • President of the Robotic Surgery Society of Singapore
Prior To Private Practice:
  • Director of the Robotic Urological Surgery Fellowship Program, Tan Tock Seng Hospital
  • Director of the National Healthcare Group Urology Residency Program & Adjunct Assistant Professor, NUS Yong Loo Lin School of Medicine
  • Member of the American Urological Association, Endourological Society (USA)
  • Executive Committee of the Singapore Urological Association, 2013 to 2020
Read Full Bio

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    Prostate-Specific Antigen (PSA) Test

    Frequently Asked
    Questions

    How often should I have a PSA test?

    The frequency of PSA testing depends on the person’s risk factors, age, and previous PSA levels. Generally, men aged 50 and older should discuss the need for regular screening with their doctor. Men with higher risk factors may need more frequent testing.

    Can PSA levels be too low?

    There is no concern about PSA levels being too low. Low levels generally indicate a lower risk of prostate cancer. However, PSA levels are just one aspect of overall prostate health and should be considered alongside other factors.

    What happens if my PSA levels are high?

    If your PSA levels are high, your doctor will likely recommend additional tests to determine the cause. This may include a digital rectal exam (DRE), prostate biopsy, or imaging tests. Elevated PSA levels do not always indicate prostate cancer, but further investigation is necessary.

    Are there ways to lower my PSA levels naturally?

    Some lifestyle changes and medications may help lower PSA levels. Maintaining a healthy diet, regular exercise, and avoiding activities that put pressure on the prostate can be beneficial. However, it is important to consult your doctor before making any changes, as elevated PSA levels can indicate underlying conditions that need medical attention.