When Should I Get a PSA Test for Prostate Cancer?

By: Laurence H. Belkoff, DO, FACOS

Prostate cancer is the second-leading cause of cancer deaths in men, after lung cancer. A simple blood test can help reduce that, butwhen you get that test can play a significant role.

The test, called a PSA screening, measures the amount of prostate-specific antigen (PSA) in your blood. PSA is a protein a man’s prostate makes that serves as a marker of prostate abnormalities, including cancer. The amount of PSA in your blood is considered your PSA reading, or score.

When you should get your PSA test matters, however, because several non-cancerous factors can influence a reading from one man to the next, and from one year to the next. For instance, as you age, your prostate just tends to make more PSA. Further, certain circumstances can temporarily elevate your PSA level.

Learn more about the symptoms and treatments for prostate cancer.

In support of September being Prostate Cancer Awareness Month, we want to share information about how the PSA test for prostate cancer works, what determines a “normal” reading, and when you should get tested.

You can get involved, as well. Join us on our annual ZERO Prostate Cancer Run/Walk event at Fairmount Park on Saturday, Sept. 19. This fundraising event supports crucial research, raises awareness, and celebrates prostate cancer survivors and their caregivers, while remembering those we lost. The day includes a 5K run/walk, a 1-mile run, and a children’s dash.

At the event, you can help spread following information.

How PSA Is Measured, and What Doctors Look For

Your PSA levels are scant – they’re measured in mere nanograms (one billionth of a gram) per each milliliter of blood. But those nanograms can tell a lot depending on your age:

If you’re in your 40s and 50s – The median PSA score for this age group of men ranges from 0.6 to 0.7 nanograms of PSA per milliliter of blood. A score above 2.5 ng/ml is deemed higher than normal.

If you’re 50 to 60 – A PSA score of 2.5 to 3.5 ng/ml is considered normal; anything higher than 3.5 ng/ml is not.

If you are in your 60s – Once men enter their 60s, a PSA score greater than 4.5 ng/ml is flagged as abnormal.

A High PSA Score Can Represent Several Urinary Issues

As the numbers reveal, a man’s PSA level tends to rise as he ages, due to a range of factors, so doctors look for sharp spikes or persistent increases in PSA readings as warning signs. One rule of thumb considers a PSA gain of more than 0.75 in a year a red flag.

However, other conditions can cause an elevated PSA level, including an enlarged prostate, prostatitis, and/or a urinary tract infection. Even vigorous exercise and ejaculation can increase PSA for a day or two.

Indeed, an estimated 75% of men with an elevated PSA show no proof of cancer. Read our blog about factors that affect a “normal” PSA reading.

Your Guidelines for When to Get a PSA Prostate Test

We recommend that most men undergoing regular PSA tests after age 50 and until they are 69, when the value of the screening is believed to be the greatest. After this point, and depending on your overall health and genetics, your physician might advise you have a PSA test every two or three years.

However, you might benefit from more frequent testing, or getting a PSA screening before you reach 55 or after you turn 70, depending on risk factors. Here are the guidelines:

You should ask about a PSA screening from ages 50 to 70 if:

• You are at risk of developing prostate cancer due to family history, overall health, or other issues (see below).
• The benefits of treating the cancer outweigh the potential side effects.

From ages 40 to 50 years, ask about a PSA screening if:

• At least one of your close relatives has had the disease – a father or brother with prostate cancer can more than double the risk.
• At least two extended family members have had prostate cancer.
• You are African American. A more aggressive form of prostate cancer tends to develop among this racial group, and it tends to develop earlier.

After you reach 70, talk about a PSA screening if:

• You are healthy and expect to live for more than 10 years. (Otherwise the cancer might not reach a life-threatening stage in your lifetime.)
• The benefits of cancer treatment would outweigh its adverse side effects.

Other conditions that can raise your risk of prostate cancer include obesity, smoking, and exposure to toxins. Talk to your doctor about these risks.

What to Expect If Your Prostate Score is Considered Abnormal

Should your PSA score sharply elevates year-over-year or is flagged for potential cancer, your doctor might do the following:

1. Perform a digital exam using a gloved finger to feel for physical changes in your prostate gland, such as lumps.
2. Take a second PSA test. If the reading remains high, your doctor might monitor your score over time to see if your PSA level changes.
3. Order a prostate biopsy – removing a small prostate tissue sample and examine it for cancer cells.

If follow-up tests indicate prostate cancer, your doctor will perform further analyses to identify whether the cancer is slow growing or aggressive, as well as the cancer’s stage. Slow-growth prostate cancer is less likely to spread to other organs, so you might be prescribed active surveillance (watchful waiting) instead of treatment.

Aggressive cancers will grow rapidly and therefore require fast attention before potentially spreading to nearby lymph nodes, rectum, bones, and other body parts.

Across cancer stages, treatment approaches can include radiation therapy, partial or complete prostate removal, hormone therapy, and immunotherapy. Your path to recovery will depend on your overall health, lifestyle, and your cancer.

You Can Get Ahead of Prostate Cancer

All prostate cancer survival stories begin with a test. The more aware you are of your risks and results, the better your chances of undergoing a successful, low-risk treatment.

Whichever pathway you choose, it will likely be guided by the timing and results of your PSA test. Until then, we hope to see you at the ZERO Philadelphia Prostate Cancer Run/Walk on Sept. 19.

MidLantic Urology is accepting new patients. Learn more about how we diagnose prostate cancer. If you would like to talk to a physician about a PSA screening, find a MidLantic Urology location near you.