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Public release date: 10 August 2008
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What men should know about PSA test
PSA is a protein made by cells in prostate gland and virtually no other organ. It is manufactured in large quantities
whether prostate cells are normal or cancerous.
Like all human glands are organized, there is a secreting or absorbing layer of cells with a basement membrane that
keep a tight separation between the inside and the outside of prostate. As the same time, little PSA leaks from the
prostate into the blood. That is how the prostate makes a lot of PSA but only a tiny amount normally is found in the
blood. This is what urologists are measuring with the PSA test.
As PSA is manufactured by the prostate gland cells (the epithelium), the cells will continue to made PSA if they are
in locations outside the prostate. When prostate gland cells are outside of normal prostate location, PSA levels in
the blood go up. This abnormal situation happens when the barrier between the epithelium and the bloodstream is damaged.
The three most typical sources for damage are:
- cancer,
- bacterial infection,
- prostate infarction or destruction of part of the prostate by damage to its blood supply.
As a little PSA leaks from the prostate into the blood, most men have levels under 4 nanograms per milliliter (ng/mL)
of blood. This is considered the normal condition. Minor elevation of the PSA levels is sometimes due to cancer.
If the prostate is enlarged then the leakage and PSA levels in the blood appear exaggerated. This is probably why the
PSA can be slightly abnormal in men with enlarged prostates who do not have cancer. Trauma to the prostate, as by
physicians performing prostate massage, sex, even bicycle riding might also cause minor transient elevations of PSA.
Because of these non-cancer causes of PSA rises, it is not surprising that if you have an abnormally high test result,
it may not be due to prostate cancer. The chance for a man to have prostate cancer is only about one in three.
Normal for age range of PSA (used only as a guide)
| Age (years) |
Serum PSA (ng/ml) |
| 40 - 49 |
2.0 |
| 50 - 59 |
3.0 |
| 60 - 69 |
4.0 |
| 70 - 79 |
5.5 |
Despite of fact the above levels are used only as a guide, most authorities agree that if you have a PSA greater than 4
ng/ml, you should have further investigations especially if prostate cancer has a history in your family. Some suggest
that if your PSA is greater than the 'normal for age' range and if it is rising rapidly, it must be investigated.
If, in addition to the PSA test, you have a rectal examination, and it also is abnormal, your chances of having prostate
cancer are higher, (one in two).
Conclusion
When someone takes any test, he likes to get a definite answer: "yes, you have the cancer" or "no, you don't".
Unfortunately the PSA test is not that good. But PSA levels are useful, because they indicate the risk of cancer
in those who haven't been diagnosed with it, and may therefore indicate the need for further investigations. On the
other hand, it is clear that PSA levels can mean different things in different circumstances.
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