Prostate Cancer and the Role of the PSA Test

There is no specific normal or abnormal level of PSA in the blood. In the past, most doctors considered PSA levels of 4.0 ng/mL and lower as normal. Therefore, if a man had a PSA level above 4.0 ng/mL, doctors would often recommend a prostate biopsy to determine whether prostate cancer was present.  

However, more recent studies have shown that some men with PSA levels below 4.0 ng/mL have prostate cancer and that many men with higher levels do not have prostate cancer. In addition, various factors can cause a man’s PSA level to fluctuate. For example, a man’s PSA level often rises if he has prostatitis or a urinary tract infection. Prostate biopsies and prostate surgery also increase PSA level. Conversely, some drugs—including finasteride and dutasteride, which are used to treat BPH—lower a man’s PSA level. PSA level may also vary somewhat across testing laboratories.  Pinnacle BioLabs PSA micro® has a cutoff level of 4.0 ng/mL exactly.  Reports of PSA micro are qualitative, indicating "normal" (for below 4.0 ng/mL) or "elevated" (for above 4.0 ng/mL) because a definite consensus regarding exact levels have not been reached in the medical community.  The graphic below explains why:

prostate specific antigen test explained

Another complicating factor is that studies to establish the normal range of PSA levels have been conducted primarily in populations of white men. Although expert opinions vary, there is no clear consensus regarding the optimal PSA threshold for recommending a prostate biopsy for men of any racial or ethnic group.

In general, however, the higher a man’s PSA level, the more likely it is that he has prostate cancer. Moreover, continuous rise in a man’s PSA level over time may also be a sign of prostate cancer.

Recently, the PSA test has garnered a lot of attention as the US Joint Preventative Task Force has revisited and revised it's recommendations on the test.  Pinnacle BioLab's official stance on the Prostate Specific Antigen test is that it is a potentially life-saving test that is minimally invasive and poses little to no risk to the patient/consumer.  

The PSA test, or Prostate Specific Antigen Test is a much maligned, yet valuable tool to screen for prostate cancer.  In 2012, the US Joint Preventative Task Force - gave the PSA test a "D" rating, or "not recommended" for average risk males.  Earlier this year, the task force began the process of updating their guidelines on PSA screening.  This is due, in part, to the overwhelming evidence in support of the PSA test.  

Specifically, the European Randomized Study of Screening for Prostate Cancer (ERSPC) found PSA testing cuts the chances of developing advanced prostate cancer by about 30 percent and the risk of dying from the disease by about 20 percent.

While not unanimous, most physicians agree that the updated guidelines will decrease mortality and morbidity for prostate cancer.  "I'm very pleased. I view this as a victory for PSA screening for prostate cancer," says Dr. Catalona, a professor of urology at the Northwestern University Feinberg School of Medicine.

"PSA screening saves lives," he says. "And having the U.S. Preventive Services Task Force discourage PSA screening has sort of created a whole generation of family practitioners and internists who feel that PSA screening is a bad thing to do for patients.

If this were to continue, we would lose all these gains in reducing the prostate cancer death rate." He says he wishes the group had gone further and recommended that doctors actively encourage PSA screening beginning at age 40 and continuing past age 70.