Blog

WHAT EXACTLY IS A PSA AND WHAT IS THIS BLOOD TEST I’M GETTING | Jan 24, 2013

PSA = Prostate Specific Antigen. This is a protein that is made in the prostate that normally circulates in minute amounts in the blood stream. Women don’t have a prostate and, therefore, they will not have any measurable amount of this protein that is specific for the prostate, hence, the term “Prostate SPECIFIC Antigen”. Young people have small prostates and low levels of this protein circulating. Old people have bigger prostates and higher levels of PSA. We don’t really know why but the prostate is one of the few glands/organs that grows as we get older. Your height shrinks, your kidneys shrink, etc. etc.

The PSA test is just a measurement of this protein in your circulation.

It slowly goes up as you age. The normal range is 0-4. Some experts say you should age normalize the results and use a bigger range as you get older. So, up to 4.0 is okay if you are younger than 60 but over that age maybe a top score of 6 is still normal. The actual number is less important than how it changes over time and it’s easy to measure. When the level is elevated or jumps a lot from the last test, there is a reason. There is always a reason but only sometimes is it cancer. Sometimes the level is elevated and it’s just the prostate getting bigger over time. Sometimes it’s an infection and more of this protein leaks out due to the inflammation/infection. But, sometimes, elevation of the PSA is associated with cancer.

There is no perfect test. I have had patients with PSAs under 4 who had cancer and patients with PSAs over 30 who did not have cancer. Cancer can only be determined by a biopsy. Prostate cancer is treated differently depending on the stage, your age, the aggressiveness of the cancer itself. But if you don’t find it when it’s still small, it greatly limits your choices and the PSA offers the only hope of finding the cancer before it has spread from the gland.

So an elevated PSA doesn’t necessarily mean you have cancer BUT a big jump in the PSA (over 1.5 increase) and every number over the current cutoff of 4 should get checked out. This means either having the test repeated within 6 months or talking about a trial of antibiotics or possible prostate biopsy. What do I do with my results. Your results will be sent to me by the method you selected at the time of the blood draw. This will be done by Dr. Barry directly for each and every sample. It will be Dr. Barry who sends you the email, mails the result or calls you…your preference. You should be notified whether the results are normal or abnormal. You should be notified within 10 days or you should call 559-9936 and let me know. You should share your results with your doctor. Tell him you had a free screening done and the results are xyz. It should be a number hopefully less than 4. If it’s over 4, it doesn’t mean you have cancer, but it does mean you should get it checked out.

There is some controversy over the PSA test. Although I don’t know a doctor seeing men who doesn’t order the test, there is one specific government panel that suggests that people shouldn’t be tested. This makes no sense to me. Little the government does lately makes any sense to me including but not limited to the health care field. Just drop dead already will you. Dropping dead is cheap, chemotherapy is not. The PSA is just like the mammogram…not every abnormal mammo is cancer…not every high PSA is cancer. But, the PSA has still revolutionized prostate cancer because before this test was available prostate cancer was usually diagnosed after it had widely spread to the bones. You could do things to slow the cancer down but this was usually a death sentence and prostate cancer was a top 5 cancer for men. Now with the PSA the cancer is found when it’s still inside the prostate and you have options…watchful waiting if you’re 85 but robot surgery or radiation therapy etc. if you are younger. The technical meaning of younger being having a 10 year life expectancy.

I set up this screening because I am an optimist. I’m not looking for new business. Like Scrooge learned… “Mankind is my business.”