PSA (Prostate Specific Antigen) is a blood test released from prostate tissue in men and measures the response of prostate diseases to diagnosis and treatment. It can increase at various levels in conditions such as prostate cancer, benign prostate enlargement and inflammatory diseases of the prostate (prostatitis),and this test tries to distinguish these diseases from each other.
Prostate cancer is the second most common type of cancer in men worldwide. Despite this, the cancer-related mortality rate in low-stage prostate cancers is very low. The PSA test is also easy to measure, inexpensive, and has a high sensitivity for prostate cancer, making it effective for screening in prostate cancer.
PSA is an antigen released from prostate tissue. In cases where the cell life-death balance in the prostate tissue is disturbed (apoptosis),PSA rises. These are generally prostate cancer and benign prostate enlargement.
The PSA test is checked with a tube blood test taken from the arm. It is not affected by hunger or satiety, and this blood test can be given at any time of the day.
Not all PSA elevations mean prostate cancer. As mentioned above, there is a slight increase in Total PSA level in other prostate diseases such as benign prostatic enlargement and prostate inflammation.
Rectal examination is very important to distinguish them. It is also instructive to interpret the PSA according to the prostate volume by measuring the prostate volume with ultrasonography (PSA Density). Again, urine analysis and urine culture are among the tests to be done in the patient with inflammatory symptoms. Therefore, the cancer approach to every PSA elevation is not correct.
In general, a PSA value higher than 4 ng/ml has been accepted as a limit for years. However, this is not the right approach for every patient.
For example, the upper limit of Total PSA for young patients aged 45-55 has been accepted as 2.5 in most scientific publications. For men who are relatively older (70-80 years old and above),the upper limit can be set higher than 4.
For example, if the Total PSA value is measured as 6 ng/ml in an 87-year-old male patient, it would not be the right approach to immediately perform a biopsy with the suspicion of prostate cancer, and only follow-up of these patients would be a more accurate approach. In addition, the detected PSA elevation should be evaluated with rectal examination and other tests (urine, ultrasonography, multiparametric MRI) to differentiate between prostate enlargement or inflammatory diseases.
It should be kept in mind that cancer can be detected even at a low rate in PSA values within the normal range. However, to rank the relatively safe PSA ranges for men with no other findings, roughly according to age;
PSA values by age
It should be known that these data are only a number and do not make sense on their own without the patient's history, prostate volume or examination.
As we mentioned before, not all PSA elevations mean prostate cancer. Of course, the higher the PSA value, the higher the probability of detecting cancer pathology. However, after examination, imaging methods (MR, Ultrasonography) and other tests (urine, etc.) are performed in the patient with high PSA, prostate biopsy is decided.
Therefore, our patients should be aware that benign diseases can also occur. Even if a malign possibility is detected, it should not be forgotten that we have powerful weapons for prostate cancer.
The higher the PSA, the higher the detection rate of prostate cancer. This rate is very high (85-90%),especially in PSA values above 20 ng/ml. In the studies performed, almost 100% metastatic disease was detected in patients with a total PSA value above 100.
Of course, as I mentioned in the other sub-headings of our article, these pathologies should be ruled out, since PSA will increase in cases of severe increase in benign prostate enlargement, prostate infections and complete obstruction due to prostatic enlargement.
After evaluation according to age and person, prostate biopsy is essential in patients with high PSA values. Multiparametric prostate MRI performed beforehand increases the chance of success of biopsy. Especially with MR Fusion Biopsy, the percentage of correct diagnosis increases.
Interventional procedures applied to the prostate (biopsy, resection) cause temporary increases in PSA level. This is not important.
The PSA test should be measured at the age of 45 in male individuals with a first-degree relative with prostate cancer, and at the age of 50 in individuals without any complaints or risk factors.
There are drugs that reduce the PSA value and prostate volume. These drugs should be used long-term. However, it should be known that the decrease due to these drugs will be a virtual decrease and will not reduce the individual's cancer probability. These are drugs that should be used under the supervision of a doctor.
Studies conducted for a period stated that antioxidants such as lycopene (in tomatoes),selenium, vitamin E and D, green tea may have a positive effect on the protection of prostate cancer. Again, pumpkin seeds and saw palm plant are known to reduce prostate volume.
However, all these are publications with a low level of evidence, and it has been stated that antioxidants do not have a protective effect, especially in the recently published articles. It should be known that there is no benefit in lowering PSA. I recommend that the individual with high PSA take this seriously and follow the doctor's recommendations and not to waste time with the methods that lower PSA and not allow the disease to progress.
PSA rises after sexual activity. This higher measurement is generally 1.5 times the normal range and takes 24 hours.