Prostate-Specific Antigen (PSA)

PSA (Prostate-Specific Antigen) Test

What To Think About

• When combined with a digital rectal exam, the prostate-specific antigen (PSA) test increases the chance of detecting prostate cancer. For more information, see the medical test Digital Rectal Examination (DRE).
• A PSA level within the normal ranges does not mean that prostate cancer is not present. Some men with prostate cancer have normal PSA levels.
• Experts disagree about the frequency of PSA testing to screen for prostate cancer.
  • The American Cancer Society (ACS) recommends an annual PSA test and DRE for men age 50 and older. ACS also recommends annual screening, beginning at age 45, for men who are at high risk for prostate cancer, such as black men and men who have a family history of prostate cancer.
  • Other expert groups, such as the National Cancer Institute and the U.S. Preventive Services Task Force, believe there is not enough evidence to recommend routine screening with the PSA test for all men. Experts that do not recommend annual screening say the high rate of false-negative and false-positive results and the costs and risks of further tests do not support annual screening tests.
• Experts disagree about the type of testing that is appropriate if the PSA level is high. The decision may depend on:
  • Results of your digital rectal exam.
  • Results of any PSA tests you have had in the past. If your PSA level gets higher in a short amount of time, follow-up testing may be recommended.
  • Your age and health.
  • The costs and risks of more tests and treatments.
• Other prostate tests are being evaluated to determine how well they tell the difference between prostate cancer and benign prostatic hypertrophy.
  • The prostate-specific antigen density (PSAD) test compares the PSA value to the size of the prostate gland. The size of the prostate is measured using transrectal ultrasound (TRUS).
  • The PSA velocity test is a measure of how rapidly PSA levels increase over time. PSA levels increase more rapidly in men with prostate cancer and more slowly in men with prostate enlargement (benign prostatic hypertrophy).
• Complexed prostate-specific antigen (cPSA) when used in combination with a digital rectal exam can detect prostate cancer. The cPSA test currently is not widely available.

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Author:	Ralph Poore	Last Updated: May 15, 2007
Medical Review:	Martin Gabica, MD - Family Medicine Christopher G. Wood, MD, FACS - Urology/Oncology
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