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Prostate Cancer

PSA Testing

If you or a loved one experience any of the symptoms or signs associated with prostate cancer, you must immediately make an appointment with a physician. There's a range of tests to determine whether you have prostate cancer:

This NetWellness feature provides more information on the diagnosis and staging of prostate cancer.

PSA Test

PSA (Prostate Specific Antigen) is a substance that's only produced in the prostate. Under normal conditions, very little PSA will leak into the bloodstream, but the patient can have an elevated degree of leakage if the prostate is cancerous. However, this can also occur if the patient has a less serious condition known as BPH, also called benign (non-cancerous) enlargement or an infection in the prostate.

Questions commonly asked about the PSA Test:

  1. When should I be tested?
  2. What do the PSA values mean?
  3. My PSA is fluctuating. What does that mean?
  4. I have been diagnosed with prostate cancer, but my PSA has remained stable for some time now. What does that mean?
  5. I have been told I was in remission following treatment for prostate cancer, but my PSA is elevated again. What should I do?
  6. Does sexual activity before obtaining a PSA affect the results?
  7. How accurate is the "Free PSA" level in determining whether or not prostate cancer is present?

When should I be tested?

The American Urological Association and the American Cancer Society both recommend that men over the age of 50 have yearly Prostate Specific Antigen (PSA) determinations and digital rectal exam of the prostate. Men with a family history of prostate cancer, or of African American descent should begin yearly examination starting at 40 years old.

What do the PSA values mean?

A normal PSA level is less than 4, depending on your age, and whether you have had any prostate infections or other problems with the prostate gland. While there are varying opinions about the levels at which PSA indicates a problem, as a general rule, the higher the PSA level, the more likely it is to be cancer. It is not uncommon for patients with advanced prostate cancer to have PSA levels in the hundreds and occasionally in the thousands.

My PSA is fluctuating. What does that mean?

If a PSA goes up and then down, the rise may very well be due to an infection that results in inflammation of the prostate (prostatitis). If the PSA remains elevated or rises, further evaluation, including a prostate biopsy, may be indicated.

I have been diagnosed with prostate cancer, but my PSA has remained stable for some time now. What does that mean?

If a PSA remains stable following diagnosis of prostate cancer, it generally means the cancer is not progressing or spreading.

I have been told I was in remission following treatment for prostate cancer, but my PSA is elevated again. What should I do?

If you have been told you are in remission following treatment for prostate cancer, but your PSA rises significantly during a later date, it is best to get a repeat PSA test. If the repeat PSA determination confirms the rise in PSA, then this would indicate that there has been recurrent disease and further follow-up and possible treatment is indicated.

Does sexual activity before obtaining a PSA affect the results?

PSA can be elevated after sexual activity enough to generate an abnormal value. It is suggested that PSA be obtained after a 48 hour period of abstinence from sexual activity.

How accurate is the "Free PSA" level in determining whether or not prostate cancer is present?

Free PSA is elevated in men with benign enlargement of the prostate and is low in those with cancer, however, the test is not perfect and ultimately the need for biopsy is determined by the total PSA, the change in PSA over time, and the findings on physical examination.

More articles about prostate cancer:

For more information:

Go to the Prostate Cancer health topic, where you can:

This article is a NetWellness exclusive.

Last Reviewed: Mar 10, 2006

Martin I Resnick, MD Martin I Resnick, MD
Formerly, Professor of Urology
School of Medicine
Case Western Reserve University