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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

  • Elevated PSA indicates prostate disease, but most men with an elevated value do not have prostate cancer.
  • 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.

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 prostate-specific antigen 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. Prostate-specific antigen tests have been used for the diagnosis and screening of prostate cancer for approximately 30 years and are a well-established clinical blood test.

Two different forms

PSA levels in the blood are elevated in 80% of all patients with prostate cancer. The 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?

It is primarily used to:

Since the levels can be affected by various factors, doctors typically consider other tests and factors, such as digital rectal exams (DRE) and biopsies, before making a diagnosis.

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

However, a low 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 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 test may be less relevant.

FAQ

A PSA test is conducted through a blood sample that measures the level of prostate-specific antigen in the blood.

It is generally recommended for men to have a PSA test once a year starting from the age of 50. If there is a higher risk of prostate cancer, such as a family history, testing may begin earlier or be done more frequently based on a doctor’s recommendation.

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