A PSA, or prostate specific antigen, test is a simple blood test that measures the amount of prostate specific antigen present in the blood. PSA is a protein that men have in their blood which is released by the prostate gland. In healthy males, the amount of PSA men have in their blood is low – generally less than 4.0 ng/mL. However, when men age, their prostate can experience physiological or pathological changes which cause the PSA to rise.

What Causes the PSA to rise?

• Age - even without any prostate problems, your PSA levels can go up gradually as you age
• After ejaculation or sex
• After insult or injury to the prostate (i.e. riding a bike, having a catheter in, after a prostate biopsy)
• Medications (i.e. Proscar, Avodart, Propecia – these may falsely lower your PSA than what it actually is)
• Urinary tract infection - can irritate and inflame prostate cells and cause PSA to go up
• Prostatitis (inflammation of the prostate gland)
• Benign prostatic hyperplasia (BPH) – aka enlarged prostate
• Prostate cancer

With less serious conditions, the PSA level goes back to normal within a few hours or in the case of an infection, with antibiotics. However, with more serious conditions like BPH or prostate cancer, your urologist will do further testing to determine which of these may be causing the elevated PSA. Further testing includes a digital rectal exam (DRE) and a prostate biopsy.

The PSA test is mainly used to screen for prostate cancer. If a person is diagnosed with prostate cancer, the PSA is an important value throughout your treatment:

• To guide your treatment plan – The PSA is used along with the DRE and tumor stage to determine how advanced or aggressive the prostate cancer is. The results will determine the best option for treatment.
• Prognosis after treatment – After having a radical robotic prostatectomy and/or radiation, the PSA level is monitored to determine how successful the treatment was. After surgery, the PSA level typically goes down to zero. However, a rising PSA after treatment typically indicates prostate cancer cells are present and the cancer has come back. In this case, further treatment would be needed.

Should you have a PSA test?

Knowing the risk factors for prostate cancer can help you understand why it’s important to have your PSA tested and when to start screening.

• Age – After 50, the risk for prostate cancer greatly increases. However, men as young as 40 can get prostate cancer, and it is often more aggressive. Men should begin screening for prostate cancer at age 40.
• Race – African-American men have the highest risk for prostate cancer; they are more likely to have aggressive cancer, be diagnosed at an advanced stage, and die from the disease.
• Family history – Men who have had a brother or father with prostate cancer are twice as likely to be diagnosed with prostate cancer.
• Diet – A diet high in fat or being obese may increase your risk for prostate cancer.

With early detection, lives can be saved. Not only are there are more treatment options available, but a better outcome, less side effects, and less chance of a recurrence. So if you any of these risk factors, or multiple risk factors, be smart - get your PSA checked.