In general, if you have symptoms that may indicate a prostate problem, then your healthcare provider will likely recommend testing. Otherwise, testing and the timing of testing are up to the individual and their healthcare provider to determine.
4. What are some other tests that may be done when the PSA level is only slightly elevated to help decide whether a prostate cancer is present?
Although PSA can help detect cancer, there are sometimes false-positive results, especially when the PSA is only slightly elevated. Biopsies used in follow-up to positive PSA results can cause discomfort, anxiety, and sometimes complications. As these tests becomes more widely available, they may aid some men and their healthcare providers in decisions about their future care:
[-2] proPSA—this test looks for a precursor of PSA, which may be produced by prostate cancer cells at a higher rate than benign prostate cells. The percentage of [-2] proPSA relative to the total PSA level has been used, like the % free PSA, to help decide whether a biopsy is indicated.
PCA3—PCA3 is a protein produced only in the prostate gland. The test measures the urine level of PCA3 messenger RNA (m-RNA), a signal from genes that tells the prostate to produce the PCA3 protein. Increased amounts of the m-RNA (over-expressed) are produced by 95% of prostate cancer cells, so an elevated level may help to indicate that a prostate cancer is present.
TMPRSS2-ERG gene fusion—this test is also a urine-based assay. It detects mRNA that is the result of a gene rearrangement. The gene rearrangement is over-expressed in more than 50% of prostate cancers, so an elevated level may help to indicate that a prostate cancer is present.
These tests do not provide a definitive answer as to whether a man has a prostate cancer or not. A positive biopsy remains the gold standard in diagnosing prostate cancer. Rather, they are intended to help predict whether a biopsy would be useful in helping to establish a diagnosis.
5. What are some tests that may be done to help decide whether a prostate cancer is likely to be fast-growing and spread (metastasize) and therefore should be removed rather than watched?
Gleason scoring—this refers to a part of the pathologist's report after reviewing the biopsy of the prostate that describes the degree to which certain features of prostate cancer known to be associated with a poor prognosis are present in the patient's cancer.
Prostate gene expression profile—this is a test in which the prostate cancer in the biopsy is analyzed using genetic techniques to determine the degree of activation of certain genes known to be associated with poor prognosis.
TMPRSS2-ERG gene fusion—this urine test, sometimes used to help determine if a biopsy is needed, has also been shown to help predict how the cancer will behave.
Although Gleason scoring is performed on all new prostate cancers discovered by biopsy, the other tests are still undergoing study. It is fair to say that there is no easy way to determine whether a prostate cancer will spread and grow quickly or will be a slow-growing cancer unlikely to cause the person's death. This makes the decision to undergo PSA testing and, if PSA is elevated, prostate biopsy, an important one.
This article was last reviewed on September 25, 2015. | This article was last modified on September 25, 2015.
The review date indicates when the article was last reviewed from beginning to end to ensure that it reflects the most current science. A review may not require any modifications to the article, so the two dates may not always agree.
The modified date indicates that one or more changes were made to the article. Such changes may or may not result from a full review of the article, so the two dates may not always agree.