Prostate-specific antigen, or PSA, is a protein produced by normal, as well as malignant, cells of the prostate gland. The PSA test measures the level of PSA in a man’s blood. For this test, a blood sample is sent to a laboratory for analysis. The results are usually reported as nanograms of PSA per milliliter (ng/mL) of blood. The blood level of PSA is often elevated in men with prostate cancer, and the PSA test was originally approved by the FDA in 1986 to monitor the progression of prostate cancer in men who had already been diagnosed with the disease. In 1994, the FDA approved the use of the PSA test in conjunction with a digital rectal exam (DRE) to test asymptomatic men for prostate cancer. Men who report prostate symptoms often undergo PSA testing (along with a DRE) to help doctors determine the nature of the problem.
In addition to prostate cancer, a number of benign (not cancerous) conditions can cause a man’s PSA level to rise. The most frequent benign prostate conditions that cause an elevation in PSA level are prostatitis (inflammation of the prostate) and benign prostatic hyperplasia (BPH) (enlargement of the prostate). There is no evidence that prostatitis or BPH leads to prostate cancer, but it is possible for a man to have one or both of these conditions and to develop prostate cancer as well.
What Is Normal PSA?
There is no specific normal or abnormal level of PSA in the blood, and levels may vary over time in the same man. In the past, most doctors considered PSA levels of 4.0 ng/mL and lower as normal. Therefore, if a man had a PSA level above 4.0 ng/mL, doctors would often recommend a prostate biopsy to determine whether prostate cancer was present.
However, more recent studies have shown that some men with PSA levels below 4.0 ng/mL have prostate cancer and that many men with higher levels do not have prostate cancer (1). In addition, various factors can cause a man’s PSA level to fluctuate. For example, a man’s PSA level often rises if he has prostatitis or a urinary tract infection. Prostate biopsies and prostate surgery also increase PSA level. Conversely, some drugs—including finasteride and dutasteride, which are used to treat BPH—lower a man’s PSA level. PSA level may also vary somewhat across testing laboratories.
Another complicating factor is that studies to establish the normal range of PSA levels have been conducted primarily in populations of white men. Although expert opinions vary, there is no clear consensus regarding the optimal PSA threshold for recommending a prostate biopsy for men of any racial or ethnic group.
In general, however, the higher a man’s PSA level, the more likely it is that he has prostate cancer. Moreover, a continuous rise in a man’s PSA level over time may also be a sign of prostate cancer.
How Is PSA Managed?
Once your PSA test has provided a clear baseline, Dr. Bankhead will discuss your treatment options to help you choose a treatment path that fits your diagnosis and your life. We’ll help you choose the most advanced therapies with the least impact on your body.
Prostate cancer treatment options may include:
• Open prostatectomy
• Robotic surgery
• Modulated radiation (IMRT)
• Brachytherapy
• Cryotherapy
• Molecular-targeted therapy
• Vaccine therapy
• Gene therapy
• Hormone therapy
Prostate Cancer Treatments
If you are diagnosed with prostate cancer, your doctor will discuss the best options to treat it. This depends on several factors, including:
1. Your age and general health
2. Stage and grade of cancer
3. Whether the cancer has spread
4. Side effects of treatment
Your treatment for prostate cancer will be customized to your particular needs. One or more of the following therapies may be recommended to treat the cancer or help relieve symptoms.
The most frequent surgical procedure to treat prostate cancer is radical prostatectomy, which is removal of:
1. The entire prostate gland.
2. Both seminal vesicles, which play a part in making semen.
3. A short segment of the urine tube that passes through the prostate
The urinary system is reconstructed by suturing (sewing) the bladder opening to the urethra. In some patients, one or more lymph node groups in the pelvic area may be removed to find out if the prostate cancer has spread. This is called lymphadenectomy or lymph node dissection. In more advanced prostate cancer, one or both of the neurovascular bundles, which play a part in erectile function, may be partially or completely removed.
Prostate Cancer Surgery Techniques. The two main surgical techniques for removal of the prostate are:
Open: A large incision is made in the lower abdomen, and the prostate is removed.
Robot-assisted (laparoscopic) minimally invasive: Multiple small incisions are made in the abdomen, and then an endoscope connected to robotic arms is inserted. A miniature video camera and surgical tools are attached to the end of the endoscope. The surgeon, seated at a console, can view the surgery site on a video screen and control the robotic arms.
Next Steps…
Your PSA exam and management should be done by a urologist who understands the complicated balance between surgery and alternative therapies. Call Dr. Bankhead to get an evaluation.