Page 2 - Prostate Specific Antigen (PSA)

Prostate specific antigen (PSA)
result in a potentially higher risk of prostate cancer.
This test is most valuable in patients with a slightly
elevated PSA, between 4 and 10.
As well, PSA density can be used to make the test
more accurate. It is determined by dividing the PSA
by the volume of the prostate. Larger prostate glands
can result in higher PSA levels without necessarily
signifying the presence of cancer. These values may
help the physician decide with greater certainty if
further investigations are required to rule out cancer.
Issues surrounding PSA screening
for prostate cancer
PSA screening for prostate cancer is controversial.
Even with elevated PSA counts, this does not
necessarily mean that you have prostate cancer
although you may have an increased risk. Even with
low PSA levels, there is a chance prostate cancer may
be present.
If your PSA level is considered elevated, your physician
may recommend a prostate ultrasound and prostate
biopsy. Prostate biopsy can occasionally have serious
side effects including bleeding and infection.
If prostate cancer is found on the biopsy, this may
lead to further treatments including radiation or
surgery. Not all prostate cancers are the same and
some grow slowly while others grow quickly and
may spread. Treatment of rapidly growing cancers
is important. However, the benefit of treatment to
slowly growing prostate cancers may be minimal and
these treatments do have side effects that affect your
quality of life.
Many doctors feel that PSA screening is only beneficial
for men with a life expectancy greater than 10 years.
As well, men with higher risk (family history, ethnicity)
of prostate cancer may benefit from earlier PSA tests.
Other factors need to be taken into consideration
This publication is produced by
The information in the publication is not intended to convey medical advice or to substitute for direct consultation with a qualified medical
practitioner. The Canadian Urological Association disclaims all liability and legal responsibility howsoever caused, including negligence, for the
information contained in or referenced by this brochure.
© 2014. Canadian Urological Association. All rights reserved.
including digital rectal exam to determine your risk of
prostate cancer and the possible benefits of getting
a PSA test. It is important to discuss the pros and cons
with your physician about PSA testing.
PSA for the assessment of prostate
cancer treatment
Perhaps the most beneficial use of the PSA blood test
is to follow patients after the diagnosis or treatment of
prostate cancer.
PSA is useful in monitoring patients who have chosen
active surveillance for their prostate cancer. Active
surveillance involves close observation of patients
with an option for treatment at a later date. If the
cancer appears to grow or if the patient wishes, then
radiation or surgery could be considered. Active
surveillance involves routine use of PSA at regular
intervals along with a physical examination.
If you have surgery or radiation for prostate cancer,
your PSA value will be followed at regular intervals. If
the value remains very low after surgery or radiation,
this would likely signify no evidence of recurrent
cancer. However, if the PSA value does not decrease
to appropriate levels after treatment or if it does not
remain low, this may indicate recurrent cancer. The
treating physician may then investigate this further.
If your prostate cancer is being treated with hormone
therapy, frequent PSA measurements are also useful.
The PSA blood test results, along with your physical
examination and symptoms, can determine your
response to the treatment. Your physician may use
this information to tailor your cancer therapy.
In summary, prostate-specific antigen is a useful
test for men diagnosed with prostate cancer. There
are controversies in using PSA to screen for prostate
cancer, but may be used with other information
to determine your risk. You can discuss with your
physician if this blood test is appropriate for you.
cua.org 52E-PSAE-01-10