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PSA

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Also known as: Total PSA; Free PSA; Complexed PSA
Formal name: Prostate Specific Antigen

The Test Sample

What is being tested?

Diagram of the prostatePSA is a protein produced primarily by cells in the prostate, a small gland that encircles the urethra in males and produces a fluid that makes up part of semen. Most of the PSA that the prostate produces is released into this fluid, but small amounts of it are also released into the bloodstream. PSA exists in two forms in the blood: free (not bound) and complexed (cPSA, bound to a protein). The most frequently used PSA test is the total PSA, which measures the sum of the free PSA and the cPSA in the blood. When a doctor orders a "PSA test," he is referring to a total PSA.

This test is used as a tumor marker to screen for and to monitor prostate cancer. It is a good tool but not a perfect one, and currently there is no consensus among experts on the usefulness of this test for screening asymptomatic men. Elevated levels of PSA are associated with prostate cancer, but they may also be seen with prostatitis and benign prostatic hyperplasia (BPH). Mild to moderately increased concentrations of PSA may be seen in those of African American heritage, and levels tend to increase in all men as they age.

PSA is not diagnostic of cancer. The gold standard for identifying prostate cancer is the prostate biopsy, collecting small samples of prostate tissue and identifying abnormal cells under the microscope. The total PSA test and digital rectal exam (DRE) are used together to help determine the need for a prostate biopsy. The goal of screening is to minimize unnecessary biopsies and to detect clinically significant prostate cancer while it is still confined to the prostate. The term clinically significant is important because while prostate cancer becomes relatively common in men as they age, many of the tumors are very slow-growing and this type of cancer is an uncommon cause of death. Doctors must try to both detect prostate cancer and to differentiate between slow-growing cases and prostate cancers that may grow aggressively and spread to other parts of the body (metastasize). Over-diagnosing and over-treatment are issues with which doctors are currently grappling. In some cases, the treatment can be worse than the cancer, with the potential for causing significant side effects, incontinence, and erectile dysfunction. The PSA test and DRE can detect most cases of prostate cancer, but they cannot, in general, predict the course of a person's disease.

Free PSA and cPSA tests can be ordered individually. The tests that measure them were developed to better differentiate between cancer-related and non-cancer-related PSA increases. Both of the tests operate on the principle that men with prostate cancer frequently have altered ratios of the two forms of PSA - decreased amounts of free PSA and increased amounts of cPSA.

How is the sample collected for testing?

A blood sample is taken by needle from a vein in the arm.

NOTE: If undergoing medical tests makes you or someone you care for anxious, embarrassed, or even difficult to manage, you might consider reading one or more of the following articles: Coping with Test Pain, Discomfort, and Anxiety, Tips on Blood Testing, Tips to Help Children through Their Medical Tests, and Tips to Help the Elderly through Their Medical Tests.

Another article, Follow That Sample, provides a glimpse at the collection and processing of a blood sample and throat culture.

Is any test preparation needed to ensure the quality of the sample?

Ejaculation should be avoided for 24 hours before sample collection as it has been associated with elevated PSA levels. The sample should also be collected prior to the physician performing a digital rectal exam (DRE) and prior to (or several weeks after) a prostate biopsy.