PSA pop quiz testing your knowledge

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 normal as well as malignant cells of the prostate gland and is found in the blood.  The PSA test measures the level of PSA in a man’s blood.  For this test, a blood sample is sent to a laboratory for analysis.  The results are usually reported as nanograms of PSA per milliliter (ng/ml) of 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.  To see how much men know about PSA and its impact on their health, here is a quiz to test their knowledge:

1.  The PSA test is a prostate cancer test.  True or false?

Answer – True and false

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.  A PSA level above the normal of 4 nanograms per milliliter means that you have prostate cancer.   True or False?

Answer – False  

Most men with PSA levels greater than 4 do not have prostate cancer especially if their doctor does not feel any prostate irregularities on a rectal exam.  If a man does have an elevated PSA, there can be several other reasons for this – benign prostatic hyperplasia (BPH) which is an enlarged prostate gland, sexual intercourse or ejaculation in the 48 hours prior to the blood test draw, a prostate or bladder infection, a long bike ride, or placement of a urinary catheter.

3.  Younger men generally have higher PSA levels than older men.  True or False?

Answer – False 

Older men have higher PSA levels than younger men.  PSA levels will increase very gradually by about 0.5 nanograms per milliliter every 10 years, in the absence of prostate cancer, an infection or other irritation of the gland.  However, if a man has a sudden increase in his PSA level from one year to the next, it may indicate a problem.

4.  The PSA level reliably predicts who can be cured with prostate surgery (prostatectomy). True or False?

Answer – False

Although the higher the PSA level, the greater the chance that the prostate cancer has spread outside the gland, the PSA level cannot predict which individuals should be treated and what will be the optimal treatment.  Prostate cancer treatment is based on the symptoms, the analysis of the prostate biopsy, and staging to determine the extent of the cancer.

5.  Treatment of prostate cancer with radiation carries little risk of side effects.  True or False?

Answer – False

Radiation treatment either by external beam or with implanted radioactive seeds (called brachytherapy), is used most often when the cancer remains confined within the gland.  Incontinence and erectile dysfunction can occur after radiation therapy.  Prostate radiation can also sometimes cause irritation of the bladder or rectum which could result in frequent urination or diarrhea and bleeding.

6.  A man who has a PSA that is increasing year after year may be a better marker for prostate cancer than a number over 4 that is not rising.  True or False?

Answer – True

This is called the PSA velocity and is a measure of how rapidly PSA levels are rising over time.  Men with BPH show very minimal increases in PSA levels from one year to the next.  A PSA level that increases quickly from one test to the next suggests either irritation of the prostate or prostate cancer.

7.  If a man’s brother has prostate cancer, his risk of developing it is three times greater than the average?  True or False?

Answer – True

Family history of prostate cancer, especially prostate cancer in a first-degree relative, increases your personal risk of developing this disease.  Out of all a man’s relatives, a brother with prostate cancer increases his risk the most.  Any man with a brother with prostate cancer should discuss when to start screening for prostate cancer with his doctor.

5. Men should wait until age 50 to begin PSA testing.  True or False?

Answer – False

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.