PSA (Prostate-Specific Antigen) Levels

Creator: Dr. Y Gayathri
Published: 2022-07-08T16:03:37

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Prostate-specific antigen (PSA) is a protein produced by the prostate gland. Their levels in the blood help in the detection of the presence of cancer.

Written by

Dr. Y Gayathri

Medically reviewed by

Dr. J. N. Naidu

July 8, 2022

January 4, 2024

What Does PSA Mean?

The prostate-specific antigen is a protein produced by the prostate gland in men and breast tissue in women. PSA is mostly present in semen, and little amount can be found in the blood. Prostate-specific antigen prevents seminal coagulation, thereby facilitating impregnation. Though the sperm count and quality change with increasing age, prostate-specific antigen also increases with age which is considered an evolutionary adaptation in men. The prostate-specific antigen can be found both in healthy and cancerous conditions. Though the PSA levels help in detecting cancer, they do not help much in distinguishing benign and malignant cancers. Both benign and malignant prostate cancers cause elevated levels of a prostate-specific antigen. Breast cancer also elevates the PSA levels in the body. Serum PSA levels help in the early detection of cancer, thereby giving a chance to the individual for a cure.

What Is a PSA Test?

A blood test is conducted to observe and find out any abnormal values that help detect a disease or cancer, which helps in appropriate treatment planning for the patient. Blood is drawn from the arm of the patient and sent to the laboratory for analysis. Elevated PSA levels alone are not enough to justify the presence of cancer. Lower PSA levels alone do not confirm the absence of cancer. There have been reports of a few patients with low PSA who develop prostate cancer. Elevated PSA levels in the blood indicate various conditions other than prostate cancer. Once the doctor receives the report of the PSA test with results elevated, further tests are required that confirm cancer. PSA level in blood is measured in nanograms per milliliter (ng/ml).

What Are the Examples of PSA?

Examples of PSA (Prostate-Specific Antigen) in clinical contexts encompass various assessments and measurements pivotal in understanding prostate health. The PSA test is a fundamental example, involving blood analysis to gauge PSA levels, where elevated readings might indicate potential issues like inflammation, benign prostatic hyperplasia, or prostate cancer.

PSA density, which factors in both PSA levels and prostate size, aids in more accurate assessments, particularly for men with larger prostates. PSA velocity measures the rate of change in PSA levels over time, offering insights into potential risks. Additionally, PSA doubling time, assessing how quickly PSA levels double, provides information about the aggressiveness of prostate cancer.

PSA screening, though debated, involves routine testing, particularly for high-risk groups like older men or those with a family history of prostate cancer. PSA monitoring post-diagnosis helps track treatment effectiveness or potential cancer recurrence. These examples showcase the diverse applications of PSA in diagnosing, assessing risk, and monitoring prostate health, guiding healthcare decisions and treatment strategies.

What Is a Normal PSA By Age?

If the PSA level is below 4 nanogram/milliliter, it is indicative of the absence of prostate cancer. But it has been observed that few cases with lower PSA have been reported with prostate cancer. Based on other clinical conditions and medical and family history, the doctor may decide to perform other tests despite lower PSA. If the PSA level is between 4 to 10nanogram/milliliter, it is considered that the individual has a risk of developing prostate cancer. If the PSA level is 10nanogram/milliliter, it is 50 percent indicative of prostate cancer.

Various Other Factors That Increase PSA Levels Are:

Enlarged Prostate: Larger than usual prostate size may cause an elevation in PSA.

Prostatitis: A bacterial infection that causes a painful prostate condition in which PSA levels are elevated.

Benign Prostatic Hyperplasia: This is a condition in which the prostate gland enlarges, making urination and ejaculation difficult.

Urinary Tract Infection (UTI): Infection to the urethra or bladder, along with some medical procedures that irritate the urethra, also increases prostate-specific antigen levels.

Medical Procedures: Certain urologic procedures like cystoscopy and digital rectal examination show elevated PSA levels temporarily.

Medicines: Hormones like testosterone increase PSA levels.

Riding Bicycles: There are only a few studies to support this. There has been an observation of a transient increase of 9.5 percent of PSA levels in the blood, especially in males above 50 years of age, when tested immediately after bicycling.

There Are a Few Medicines That Lower PSA:

5-Alpha Reductase Inhibitors: This group of drugs is used to treat prostate cancer. A few examples are Finasteride and Propecia.

Herbal Mixtures: Few herbal mixtures that claim to support male wellness by lowering PSA levels are lycopene, phytoestrogen combinations, and saw palmetto.

Medicines Like Anti-Cholesterol Drugs: Anti-cholesterol drugs that lower PSA levels are Crestor, Lescol, and Lipitor.

What Is a Dangerous PSA Level?

The earlier the cancer is detected, the greater the chance for successful treatment. Understanding the levels of prostate-specific antigen is important to reach a diagnosis.
PSA levels less than or equal to 2.5 nanogram/milliliter in men under 60 years are considered normal, though few men can still have prostate cancer.
Levels between 2.5 and 4 nanogram/milliliter are considered healthy for almost all men.
Levels between 4 and 10 nanogram/milliliter indicate a 25 percent chance of having prostate cancer.
Levels that breach 10 nanogram/milliliter raise a red flag for an individual, which indicates high chances of having prostate cancer.

How High Can PSA Go Before Death?

PSA (Prostate-Specific Antigen) levels alone do not determine mortality. Elevated PSA levels can indicate issues like prostate cancer, but the level at which it becomes life-threatening can vary significantly among individuals. Very high PSA levels may suggest aggressive or advanced prostate cancer, but they do not directly correlate with imminent death. The prognosis depends on various factors like cancer stage, overall health, age, and response to treatment.

Why Is PSA Important?

After confirming the presence of prostate cancer, PSA levels, along with physical examination, biopsy, and Gleason’s score, help to determine the need for further tests and planning on the best treatment for the patient. During the treatment, PSA levels are constantly monitored. A successful therapy shows a reduction in PSA levels.

How to Test For PSA Levels?

Serum PSA exists in three different isoforms, which differentiate the causes behind the elevation of PSA levels. They are:

Intact Free BSA - It helps improve the sensitivity of prostate cancer detection.
Pro-PSA - It helps to detect aggressive prostate cancer even with the tests that show a mild increase in PSA levels.
Benign Prostatic Hyperplasia Associated PSA (BPSA) - A slight elevation of BPSA indicates the presence of benign prostatic hyperplasia.
Velocity Clinical Research - It is a company that conducts studies to better understand prostate health, specifically focusing on PSA (Prostate-Specific Antigen) levels. They work with pharmaceutical and biotech companies to test new medications or treatments related to prostate conditions like prostate cancer.

What Does It Mean to Have A High PSA?

Elevated PSA indicates the presence of prostate cancer. Further, the levels of PSA and forms of PSA help in planning the treatment. Before starting the treatment, few further examinations are done, which will be more helpful for a successful treatment.
Digital rectal examination (DRE).
Free PSA test.
Test for PSA velocity and density.
Biopsy.
PSA-based markers like prostate health index (PHI) and 4k score.
Other markers test like prostate cancer antigen 3 (PCA3 antigen).
Magnetic resonance imaging test (MRI).

How to Lower PSA Levels?

Lowering PSA (Prostate-Specific Antigen) levels is not a straightforward process, but certain lifestyle adjustments may help manage them. A balanced diet, rich in fruits, vegetables, and whole grains, while limiting red meat and high-fat dairy, might support prostate health. Regular exercise and weight management could also positively impact PSA levels. Additionally, reducing alcohol and caffeine intake, managing stress, and discussing medications or supplements with a healthcare provider might contribute to maintaining healthy PSA levels.

Conclusion:

Prostate-specific antigen tests are important to detect the presence of prostate cancer. Though it solely does not confirm the diagnosis of cancer, continuous monitoring of PSA levels helps the doctor understand cancer better and plan further treatment. There is no need to panic once the tests show an increase in PSA levels. Earlier detection, the best is the treatment and the better the prognosis.

Frequently Asked Questions

1. What Level of PSA Is Alarming?

PSA levels below 4 ng/mL are often regarded as normal, while values above 4 ng/ml are abnormal. Prostate cancer risk is elevated when PSA levels are between 4 and 10 ng/mL. The risk of prostate cancer is significantly increased when the PSA level is above 10 ng/mL.

2. What Is a Normal PSA by Age?

- For males in the age range of 40 to 50 years, the median PSA is between 0.6 and 0.7 ng/mL. A PSA level of more than 2.5 ng/mL is regarded as abnormal.
- For males who are 60 years and more in age, the normal PSA ranges between 1.0 and 1.5 ng/mL. A PSA level of more than 4.0 ng/mL is regarded as abnormal.

3. Does a High PSA Always Mean Cancer?

Prostate-specific antigen, or PSA, is a protein that is measured by PSA tests. PSA levels rise in the presence of prostate cancer; however, this cannot guarantee that a person has the disease. When anything benign, like ejaculating 24 hours prior to the test, or a condition that requires treatment, such as a urinary tract infection, causes an elevated PSA reading, it is not necessarily a malignancy.

4. How Can I Lower My PSA Quickly?

- People who are obese or overweight are more likely to develop cancer, not just prostate cancer. Obesity can affect the prostate and cause changes in sex hormones, prostate inflammation, and insulin levels, among other things. These problems may encourage the spread of prostate cancer.
- Hence maintaining a lean physique and remaining fit is essential.
- Exercise that is aerobic both activates the resting metabolic rate and helps burn calories; thus, regular exercising is necessary.
- The association between a high-fat diet and prostate cancer should not be shocking. A high-fat diet may increase testosterone levels, which may increase the risk of prostate cancer. Hence mindful and healthy eating should be incorporated into the lifestyle. Consuming tomatoes and vitamin E-enriched food may reduce your risk of developing prostate cancer.

5. What Is the Average PSA for a 70-Year-Old?

Typically, a PSA value of less than 4.0 is considered to be normal. However, an age-adjusted scale has been devised because benign growth of the prostate gland tends to occur as men age, and a PSA level between 4.5 to 5.5 ng/mL is considered normal for men between the age of 70 and 80.

6. At What PSA Level Should a Biopsy Be Done?

Historically, a PSA level above 4 ng/mL has been accepted as a suitable threshold to propose a biopsy. There have been requests to modify the referral criteria for biopsy due to the risk of high-grade disease seen in men with lower PSA levels. The percent-free PSA can be helpful in determining whether one has benign prostatic hyperplasia or prostate cancer if the PSA readings are on the borderline (4 to 10 ng/mL).

7. What Level of PSA Indicates Prostate Cancer?

Generally, blood PSA levels correlate with an increased risk of prostate cancer. Most doctors advise repeat testing combined with additional noninvasive procedures, including an MRI scan if a relatively high PSA level (about 4.0 ng/mL or more) is found, rather than immediately ordering a biopsy.

8. What Should PSA Levels Be After Hormone Therapy?

The PSA level can indicate whether or not a different treatment should be tried when more advanced prostate cancer patients are receiving therapies like hormone therapy, immunotherapy, or chemotherapy. According to recent research, PSA levels should be lower than 1 ng/mL and even lower than 0.5 ng/mL for the best outcomes.

9. What Does a Urologist Do if Your PSA Is Elevated?

A urologist will always want to run additional PSA tests in addition to other diagnostic procedures after the initial test reveals elevated PSA levels. A PSA test determines the quantity of PSA in a person's blood. PSA is a protein produced by cells of the prostate gland.

10. How Fast Does PSA Drop After Hormone Therapy?

According to research, after hormone therapy, the median time to obtain the lowest PSA levels was around 8 months.

11. What Is the Importance of PSA Levels in Men?

The PSA test is a blood examination used primarily for prostate cancer screening. The prostate-specific antigen (PSA) level in the blood is determined by the test. The prostate is a tiny gland that resides underneath the bladder in males. Both malignant and noncancerous cells in the prostate produce the protein known as PSA.

12. Does Orchiectomy Help With Prostate Cancer?

The process of removing the testicles surgically is known as an orchiectomy.
The main advantages of orchiectomy are the reduction in testosterone production and the inhibition of tumor growth, which are anticipated to reduce disease symptoms, avoid complications, and increase survival in patients with advanced prostate cancer. It can be applied prior to radiation therapy or in conjunction with radiation therapy in individuals at high risk for cancer recurrence to reduce cancer and enhance the effectiveness of the treatment.

13. Does the PSA Level Rise After Prostate Removal?

PSA reduces to practically undetectable levels (less than 0.1) following surgical removal of the prostate (prostatectomy). Due to the test's sensitivity and the possibility that other proteins may be mistaken for "PSA protein" at very low levels, this is effectively zero, although it is impossible to get 0 completely. In contrast, the PSA level rarely goes to zero following radiation therapy. This is due to the fact that radiation therapy does not always totally destroy normal, healthy prostate tissue. Instead, each person experiences a unique low point which serves as the standard by which to evaluate an increase in PSA.

Sources

Dr. J. N. Naidu

General Practitioner

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