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PSA indicates prostate health

Prostate-specific antigen, or PSA, is a protein produced in the prostate gland. The prostate is a gland that men have around the urethra, between the penis and the bladder. PSA sampling can diagnose various prostate conditions.

Brief about PSA

  • The risk of prostate enlargement increases with age.
  • Benign prostatic enlargement is a normal age-related phenomenon, but it can cause urinary symptoms.
  • Overweight and a high-fat diet increase the risk of developing prostate cancer.
  • Elevated PSA indicates prostate disease, but most men with an elevated PSA value do not have prostate cancer.

What is PSA?

Prostate-specific antigen, or PSA, is a protein produced in the prostate gland. It is not produced by any other organs or glands; all PSA in the blood comes from the prostate.

Analysis of PSA in the blood is the most significant method for detecting prostate cancer, as well as for monitoring disease progression and treatment efficacy for this condition. PSA has been used for the diagnosis and screening of prostate cancer for approximately 30 years and is a well-established clinical blood test.

Two different forms

PSA levels in the blood are elevated in 80% of all patients with prostate cancer. PSA levels are also elevated in a large proportion of patients with benign prostatic enlargement and prostate infections.

PSA exists primarily in two different forms in the blood, bound or free. By analyzing both types and comparing their ratio, clinicians can better diagnose the cause of the elevation.

What does a PSA test show?

PSA levels in the blood increase with several prostate-related conditions. The most common prostate diseases are benign prostatic enlargement and prostate cancer, which is the most common form of cancer in men. Elevated PSA levels can also be associated with other conditions, such as prostatitis, which is a bacterial infection in the prostate gland.

Threshold values for PSA

The national care program for prostate cancer specifies age-specific threshold values for PSA. Values above these levels mean that patients should be referred to a urologist.

Age      Threshold values for PSA

Under 70 years       3,0 µg/L

70 to 80 years        5,0 µg/L

Over 80 years         7,0 µg/L

The value is expressed in µg/L. It stands for micrograms per liter.

What can an elevated PSA level mean?

PSA levels in the blood increase in practically all prostate-related conditions.

The risk of prostate cancer increases the higher the PSA level, up to values around 50 µg/L. Before that, the cancer risk is as follows:

PSA
(µg/L)
Percentage with cancer at prostate biopsies
0-15 %
1-210 %
2-315 %
3-425 %
4-1030 %
10-2060 %
20-3075 %
30-5090 %
> 5099 %

To further differentiate between the various possible causes of the elevated PSA value, one can use an additional blood test, PSA ratio. This compares the ratio between free and bound PSA in the blood.

What can a low PSA value mean?

If the PSA value is below the threshold for your age, the risk of having serious prostate cancer is low.

However, a low PSA value does not completely rule out the risk of cancer, as cancer cells sometimes do not produce unusually high amounts of PSA protein in the blood.

PSA testing

Socialstyrelsen has assessed that the benefits of general PSA testing do not outweigh the disadvantages from a population perspective. However, as an individual, you may weigh the potential benefits and drawbacks differently.

For example, it may be relevant to undergo a PSA test if you have a family history of prostate cancer. Conversely, if you are very young and have no direct reason to worry about prostate cancer, a PSA test may be less relevant.

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