Prostate-specific antigen, or PSA, is a protein produced by the prostate gland that may be found in elevated levels in the blood when a person develops certain diseases of the prostate, notably prostate cancer. PSA is specific, because it is present only in prostate tissue. It is not specific for prostate cancer, however, as it may also be elevated in men with benign enlargement of this organ. The PSA test has been called the "male PAP test."
Purpose
The blood test for PSA is used to screen older men to detect prostate cancer at an early stage, and also to monitor its response to treatment. After lung cancer, prostate cancer is the most common form of cancer in men in the United States. Any routine physical exam of a man aged 50 and older should include a digital rectal examination (DRE), in which the doctor's finger probes the surface of the prostate gland to detect any suspicious area of hardness or a tumor mass. If the examination suggests that a tumor may in fact be present or if the examiner is uncertain the logical next step is a PSA test. If the PSA test is positive, a sample of prostate tissue (biopsy) may be taken to confirm that cancer is present. If negative, the test may be repeated immediately to confirm the diagnosis, or repeated the next year. Many physicians today routinely do both a DRE and a PSA test each year on their older male patients, so that, if cancer does develop, it will be found at an early stage will be easier to treat. The combination of a DRE and a PSA test can detect approximately 80% of all prostate cancers.
At present, the PSA test is widely accepted as a way of telling whether a patient with definite cancer is responding to treatment. Because only the prostate produces PSA, its presence in the blood following complete removal of the prostate (radical prostatectomy) indicates that some cancer has been left behind.
Precautions
There is no physical reason not to do a PSA test. Although, the level of PSA usually is elevated in men with prostate cancer, it also may be abnormally high (though usually not as high) in men with non-cancerous enlargement of the prostate (benign prostatic hyperplasia or BPH). If thousands of men have the PSA test routinely each year, many of them will have unnecessary tests (such as biopsy or an ultrasound study) to confirm cancer. If a "false-positive" result is obtained, where the PSA level seems high but really is not, some men may even be treated for prostate cancer when no cancer is present. Both the American Cancer Society and the American Urological Association urge annual PSA testing to detect early cancers, but the National Cancer Institute does not.
Description
The PSA test is a radioimmunoassay. Any antigen causes the body to produce antibodies in an attempt to neutralize or eliminate the antigen, often a substance that harms body tissues. In the laboratory, a sample of the patient's blood is exposed to the antibody against PSA, so that the amount of antigen (PSA) can be measured. The results generally are available the next day.
Preparation
No special measures are needed when doing a PSA test other than taking the usual precautions to prevent infection at the needle puncture site.
Normal results
Each laboratory has its own normal range for PSA. In fact, they may redefine the normal range whenever starting to use a new batch of test chemicals.
Abnormal results
Some experts believe that more than 90% of men with prostate cancer will have an elevated PSA level. Others claim that as many as one-third of cancers will be missed. The amount of PSA in the blood drops when cancer is successfully treated, but rises again if the tumor recurs, especially if it spreads to other parts of the body. A new variation of the PSA test shows how much of the material is bound to other protein in the blood and how much is "free." This procedure may be more accurate and could well indicate whether either prostate cancer or BPH is present.
BOOKS
Fox, Arnold, and Barry Fox. The Healthy Prostate. New York: John Wiley & Sons, 1996.
Rous, Stephen N. The Prostate Book: Sound Advice on Symptoms and Treatment. 2nd ed. New York: W. W. Norton, 1995.
ORGANIZATIONS
Prostate Health Council, American Foundation for Urologic Disease. 1128 N. Charles St., Baltimore, MD 21201.
OTHER
Prostate Health Council Important Information About Prostate-Specific Antigen (PSA). American Foundation for Urologic Disease, 1128 N. Charles St., Baltimore, MD 21201.
David A. Cramer, MD
KEY TERMS
Antibody—A substance formed in the body in reaction to some foreign material invading the body, or sometimes to diseased body tissue such as prostate cancer. An antibody also may be prepared in the laboratory and used to measure the amount of antigen in the blood.
Antigen—Either a foreign substance such as a virus or bacterium, or a protein produced by diseased or injured body tissue.
Biopsy—A procedure using a hollow needle to obtain a small sample of tissue, such as from the prostate. Often done to determine whether cancer is present.
BPH—Benign prostatic hyperplasia, a noncancerous disorder that causes the prostate to enlarge.
