Men’s 5 Most Burning Questions About PSA Answered

A prostate specific antigen test can indicate prostate cancer—but not necessarily

The decision for a man to take the test is left up to men and their doctors. Christopher Furlong/Getty Images

Since prostate cancer is the second most common cancer in men after skin cancer, men should know certain facts about prostate specific antigen (PSA) test. PSA is a protein produced by the prostate gland and is found in the blood. For a PSA test, a blood sample is taken to monitor the level of PSA being produced by the prostate.

The more a man understands PSA testing, the more informed his decisions are. Here are five important questions every man needs to know the answer to.

#1. Is the PSA test a prostate cancer test?

Yes and no. The PSA test is a simple test used to monitor PSA levels over a period of years. When its done regularly, urologists are much better able to detect elevations. One aspect looked at is PSA velocity, the rate at which a man’s PSA levels change over a time. PSA mapping is the best way to determine if elevations are a cause for concern.

#2. What does a man’s PSA level say about his prostate health?

A PSA level of 4.0 ng/ml or less is considered normal. Changes of more than 2.0 ng/ml per year or abnormal levels can indicate prostate cancer, infection (prostatitis), or benign prostatic hyperplasia (BPH) (an enlargement of the prostate.) Any number below 10 is acceptable. Levels increase with age due to the growing size of the prostate. A male between the ages of 70 and 79 can typically register 6.5 ng/ml of PSA in the blood while a male of 20 to 29 will typically register the normal level of 4.p0 ng/ml. A 10 ng/ml of PSA in the blood can be a sign of prostate cancer, but this is not always the case.

#3. How necessary is it for a man to have a PSA test?

Ever since the United States Preventative Task Force (USPSTF) recommended against routine PSA-based screening in 2012, there have been disagreements among experts. Some argue that the PSA test is not reliable because it can give false positive and false negative results. Medical organizations such as the American Cancer Society and the American Urologic Association still recommend some form of prostate cancer screening. The decision is generally left up to men and their doctors.

#4. What are other risk factors of prostate cancer besides a high level of PSA?

If a man has a PSA test done and it comes back high, he should not panic. There are other risk factors that indicate the possibility of a problem. Based on certain risk factors, a man’s doctor will decide if a man needs additional testing. These risk factors include race (black men are more prone to prostate cancer than white or Hispanic men), age (risk of prostate cancer increases with age), and family history (men with a family history have increased risk).

If a man’s risk of prostate cancer is low—he has no risk factors and a digital rectal exam reveals no abnormal-feeling areas in the prostate—then a doctor may decide to forego a biopsy and do another PSA test in a few months.

#5. What age should a man begin PSA testing?

Not all doctors agree on what age a man should start having PSA tests, but several studies have shown that men below the age of 50 should be screened for prostate cancer because treatment and surgical outcomes are more favorable at a younger age. Men as young as 40 can get prostate cancer, and if they do it is often more aggressive. Additionally, waiting to screen men until the age of 50 can result in missing an early diagnosis. If there is a failure to diagnose early, the cancer can advance and metastasize, complicating treatment and the outcome. Therefore, men should start getting PSA tests done at age 40.

Dr. Samadi is a board-certified urologic oncologist trained in open and traditional and laparoscopic surgery and is an expert in robotic prostate surgery. He is chairman of urology, chief of robotic surgery at Lenox Hill Hospital. He is a medical correspondent for the Fox News Channel’s Medical A-Team. Follow Dr. Samadi on Twitter, Instagram, Pintrest, SamadiMD.com and Facebook