PSA- Prostate Specific Antigen

The prostate produces a protein called PSA which prevents the semen from becoming to thick and may also help with fertilisation. Small amounts leak into the bloodstream & elevated levels are common in men with benign prostatic hypertrophy (BPH), prostatitis or urinary tract infection. Levels may also rise after digital rectal examination (DRE), ejaculation, bicycle riding and physical exercise. The use of PSA as a screening test for prostate cancer detection provides valuable information for the general practitioner in everyday clinical practice. 

Early detection of prostate cancer - Men having PSA testing need to be counselled about the information it provides & its limitations such as- if a PSA result is within the ‘normal’ range this may not exclude prostate cancer. The combination of PSA and DRE is advised in early detection tests. If either of these tests are abnormal and there are no other factors indicating a possible reason for PSA rise then referral to a urologist is recommended. 

Detection of prostate cancer - Prostate biopsy Monitoring treatment outcomes for prostate cancer Surgical removal of the prostate (radical prostatectomy) should stop PSA production; PSA levels fall then remain at zero. Persistence of PSA levels or rising PSA after radical surgery indicates a failure to remove the gland completely, cancer recurrence or metastases. Similarly, a positive response to radiation or hormone treatment should drop PSA levels while any subsequent increase in PSA would suggest disease recurrence or spread. Watchful waiting Not all prostate cancer requires treatment and some men with nonaggressive cancers may be managed by ‘watchful waiting’, including serial PSA testing every 6–12 months. A gradual increase in PSA may suggest disease progression and urological intervention may be considered. Diagnosing and monitoring prostatitis Prostatitis can be diagnosed by a sudden rise in PSA levels combined with typical symptoms and signs (deep seated pelvic discomfort; tender, boggy prostate). A return to normal PSA levels 6 weeks after appropriate antibiotic treatment signifies a positive response to treatment. Contraindications There are no absolute contraindications to PSA testing. Clinician discretion is required in regards to if and when to test, and the appropriate interval between testing. Most research suggests that PSA testing is not indicated beyond 75 years unless monitoring known cance

Currently universal screening is not recommended but,