Prostate Specific Antigen (PSA)

PSA (Prostate Specific Antigen) is a small protein molecule which is released from the prostate gland into the bloodstream. As you get older, your prostate slowly enlarges and your PSA gradually increases. The larger your prostate, the higher the PSA.

Prostate cancer also becomes commoner with increasing age. By the age of 90 years, almost all men will have areas of tumour in the prostate that can be seen only under the microscope. This does not mean that they have active prostate cancer. Many elderly men live a normal lifespan without requiring treatment for these “incidental” tumours.

Only detailed urological investigation can determine whether a prostate cancer is “incidental” (requiring no treatment) or “significant” (requiring active treatment).

PSA is not a specific test for prostate cancer; raised levels may also be caused by inflammation, benign enlargement, retention of urine or previous surgery. If there is a high suspicion of prostate cancer on the basis of the blood tests, you will normally be advised to have biopsy samples taken from your prostate gland called ad prostate biopsies (TRUS biopsy). Even negative biopsies do not always rule out prostate cancer; further biopsies may be needed if your PSA remains raised or increases with time.

Tests that may be required

Clinical examination is done first that will include examination of the prostate through a finger in the back passage. TRUS biopsy of the prostate

Samples are taken from the prostate through the back passage guided by an ultrasound probe in your back passage. For more information – click here.

MRI (Magnetic Resonance Imaging) scan of your prostate

This uses strong magnetic fields to produce a detailed image of the prostate. Experienced radiologists can examine these images and see whether there are any suspicious areas within the prostate that may be prostate cancer; any abnormal areas can then be targeted by a prostate biopsy. Recent evidence suggests that mp-MRI (multiparametric) may be especially useful in identifying high-risk (significant) prostate cancers. It is important to note, however, that some prostate cancers (including low-risk cancers) are not visible on MRI scan. Sometimes we may arrange for you to have a mp-MRI before arranging a prostate biopsy.

mp-MRI may also be arranged as a staging investigation after a prostate cancer diagnosis (see below)

Negative prostate biopsy

If your prostate biopsies are negative for prostate cancer, you will normally be advised about treatment of any prostate symptoms you may have and your urologist will arrange for you to have regular (6-monthly) blood tests to check your PSA.

If the PSA level remains raised or increases with time, you may be advised to have repeat biopsies or to have biopsies performed under a general anaesthetic (saturation biopsies). The latter allows more extensive sampling and is more likely to detect prostate cancer if it is present.

Positive prostate biopsy

If your prostate biopsies are positive for prostate cancer, then your urologist will then discuss the following:

Staging investigations

To find out the extent of your prostate cancer, your urologist may arrange a CT scan, an MRI scan or a bone scan). Together with the Gleason grade found on the biopsies, these will determine what treatment is needed. Not all patients, however, require staging investigations before treatment.

Treatment options

Once the results of all the tests are available, your urologist will discuss what treatment options are available and what is best for you. This will consider your age, general health, PSA level, Gleason grade and stage of the tumour.

Your urologist will help you decide whether treatment by surgery, hormones, chemotherapy or radiotherapy is best for you. If your tumour is at low risk of progression, it may be more appropriate for your cancer to be monitored closely and treated only if there are signs of progression (active surveillance).


All about PSA Test by Dr. Vasantharaja Ramasamy

All about PSA Test by Dr. Vasantharaja Ramasamy

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