Understanding Your Prostate-Specific Antigen Score

prostate-screening-resizedA close friend turned 40 and was debating with his wife that he didn’t need to get screened for prostate cancer – he was too young. She reminded him that because his father had the disease, he was at a much higher risk and needed to start screening earlier. The typical age to start screening is 50.

My friend, like so many men, is uncomfortable even thinking about a prostate exam, much less scheduling one. But, we know that when prostate cancer is detected early, the five-year survival rate is 95 percent. Once it spreads beyond the prostate, the five-year survival rate drops to 33.5 percent.

Older men are more at risk. According to the National Cancer Institute, nearly 63 percent of prostate cancer cases occurring in men age 65 and older and African American men are at a higher risk.

Understanding the results of this critical screening test is important, but it can be confusing. So let’s start at the beginning.

What is a prostate screening?

According to urologist Jaspreet Singh, MD, prostate screenings should consist of a PSA test AND a digital rectal exam (DRE). “Because there are so many factors that can impact a PSA score, you need to do a DRE so that you can try to feel for any masses in the prostate,” Dr. Singh explains.

What is PSA?

Prostate-specific antigen (PSA) is a protein produced by cells of the prostate gland. The prostate screening measures the level of PSA in the blood. The doctor takes a blood sample, and the amount of PSA is measured in a laboratory. If cancer or even benign (non-cancerous) tumors are present in the prostate, the PSA levels rise. But there are other factors that can cause your PSA levels to rise, which is why that test alone is not enough.

What are normal levels for PSA?

“This is where it starts to get a little fuzzy,” Dr. Singh comments. “A normal range is 2.5 to 4. However, if an 80-year-old patient had a 4, I would probably not be too concerned if there were no other indicators, since PSA levels naturally increase as a man ages.

If a 45-year-old patient came back with a 4, I might be more concerned, since he is relatively young and his levels are already on the higher side.”

“This is exactly why we urge men to get screened every year,” he continues. “If that same 45-year-old patient had no other indicators, we would take another level at this next screening to see if there is a continuing trend upward. That is a better indication that something is going on. We need to look at levels over time.”

What are the factors that can influence a PSA score?

According to Dr. Singh, “Having sex within 72 hours of the exam, taking a long bike ride, a urinary tract infection and prostatitis (an inflammation of the prostate gland). These are just some of the reasons your doctor may get a false-positive.”

If the level comes back very high, and there was a mitigating factor, Dr. Singh recommends screening again in a month. Then if the level was out of the normal range, he would move to the next step.

What is the best advice you would give to men about early diagnosis?

“This is where having an open conversation with your family doctor is so important,” he stresses. It’s also important to ask these questions:

  • Do you know your risk factors?
  • Are you looking at your levels in conjunction with your age?
  • Are you experiencing any other symptoms, i.e. frequent urination, the need to urinate multiple times during the night, pain in the lower back or pelvic region?

Because the prostate is located just below the bladder, it’s easy to ignore important symptoms as something to do with the urinary tract. You are your own best advocate and you know your body.

Dr. Singh urges “any patient to really understand your PSA levels, know your risk factors and pay attention to what your body is telling you.”

And of course, exercise and eating healthy are important, too.

Still have questions? Post your question at Ask The Experts This forum is an opportunity to ask questions and have them answered by our leading experts in the diagnosis and treatment of prostate cancer.

To schedule an appointment with a Jefferson urologist, call 1-800-JEFF-NOW or use our online Find A Doctor tool.

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