Since prostate cancer is the second most common cancer in men after skin cancer, men would be wise to know certain facts about prostate specific antigen or the PSA test. PSA is a protein produced by the prostate gland and is found in the blood.  The blood sample taken is used to monitor the level of PSA being produced by the prostate. 

The more a man understands facts on PSA, the more informed decisions he can make regarding his prostate health.  Here are 5 important facts every man needs to know about PSA:

1. Is the PSA a prostate cancer test?

The answer to this is yes and no.  The PSA test is a simple test used to monitor the PSA levels over a period of years.  When this is done regularly, urologists are much better able to detect spikes or elevations in a man’s PSA level.  One aspect looked at is PSA velocity.  PSA velocity is the rate at which a man’s PSA levels change over a period of time.  PSA mapping is the best way to determine if elevations are a cause for concern such as prostate cancer. 

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, while changes of more than 2.0 ng/ml per year or abnormal levels can be an indicator of the potential presence of prostate cancer, infection (prostatitis), or benign prostatic hyperplasia (BPH) which is an enlargement of the prostate.  However, any number below a 10 is acceptable.  It is important to note that 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 likely be a sign of prostate cancer however 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 on recommending men to have a PSA test.  Some argue that the PSA is not reliable because it can give a false positive (indicating that cancer is there when it is not) and a false negative (indicating that cancer is not there when it is) results.  The decision is generally left up to men and their doctors.  Medical organizations such as the American Cancer Society and the American Urologic Association still recommend some form of prostate cancer screening.  Men are encouraged to discuss with their doctor both the merits and drawbacks to screening.

4. There are other factors besides a high PSA that are important

If a man has a PSA test done and it comes back high, he should not panic.  There are other risk factors that a man may have indicating if there might be a possibility of a problem.  Based on certain risk factors, a man’s doctor can 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 (prostate cancer increases with age), and family medical history (men with a family history are at an increased risk of prostate cancer). 

If a man’s prostate cancer is low – no risk factor and a digital rectal exam reveals no abnormal-feeling areas in the prostate – then a doctor may decide to forego a biopsy and instead do another PSA test a few months or so down the road. 

5. Experts don’t always agree on what age PSA testing should begin but age 40 is generally recommended

Unfortunately, not all doctors agree on what age a man should start having PSA tests. But several studies have shown that younger men below the age of 50 should be screened for prostate cancer as their treatment and surgical outcomes are favorable at a younger age.  It is known that men as young as 40 can get prostate cancer and if they do it is often more aggressive. It has also been shown that waiting to screen men until the age of 50 or older can result in missing an early diagnosis.  When there is a delay in diagnosing prostate cancer, this only leads to an advanced stage of the disease when it finally is discovered where it may have already metastasized complicating treatment and the outcome.