PSA
PSA (Prostate-Specific Antigen) is a protein produced by the prostate gland and commonly measured in the blood as an indicator of prostate health. Elevated PSA levels may suggest prostate cancer but can also be caused by non-cancerous conditions such as benign prostatic hyperplasia or prostatitis.
Description
Testing PSA levels can be beneficial for:
- Men Aged 50 and Older: Routine PSA screening is often considered for men in this age group, as the risk of prostate cancer increases with age.
- Men with a Family History of Prostate Cancer: Those with a father or brother who had prostate cancer are at a higher risk, and earlier or more frequent testing might be recommended.
- African American Men: They are at a higher risk for prostate cancer and might benefit from earlier or more frequent screening.
- Men with Symptoms of Prostate Problems: Symptoms like difficulty urinating, blood in urine, or pelvic discomfort might warrant a PSA test to help diagnose the underlying issue.
- Men Diagnosed with Prostate Cancer: To monitor the effectiveness of treatment and check for recurrence of cancer.
Elevated PSA levels themselves do not cause any symptoms. Instead, they may indicate an underlying condition affecting the prostate. However, it’s important to note that a high PSA level does not always signify a serious condition like prostate cancer. Conditions that can lead to elevated PSA levels include:
- Benign Prostatic Hyperplasia (BPH): This is an enlargement of the prostate gland and is common in older men. Symptoms can include frequent urination, trouble starting urination, weak urine stream, inability to urinate, or needing to urinate at night.
- Prostatitis: This is the inflammation of the prostate gland, often caused by infection. Symptoms can include painful or difficult urination, urgent and frequent urination, pelvic pain, and discomfort in the lower abdomen.
- Prostate Cancer: While prostate cancer may not cause early symptoms, advanced cases can lead to symptoms such as difficulty urinating, weak or interrupted urine flow, blood in the urine, and pain in the hips, back, or chest.
Total PSA and free PSA are two different measurements used in the evaluation of prostate health, particularly in the context of screening for prostate cancer.
- Total PSA: This refers to the total amount of prostate-specific antigen (PSA) in the blood. It includes both PSA that is bound to proteins (complexed PSA) and PSA that is not bound (free PSA). Total PSA testing is the standard test used in the initial screening for prostate cancer.
- Free PSA: Free PSA refers specifically to the fraction of total PSA in the blood that is not bound to proteins. In men with prostate cancer, a smaller percentage of the total PSA is typically “free.” Therefore, a low level of free PSA (compared to the total PSA) can be an indicator of a higher risk of prostate cancer.
Several factors can affect PSA levels. Understanding these factors is important for interpreting PSA test results accurately:
- Age: PSA levels naturally increase with age, so older men typically have higher PSA levels.
- Prostate Size: Men with larger prostates, typically associated with aging and often due to benign prostatic hyperplasia (BPH), may have higher PSA levels, as more prostate tissue produces more PSA.
- Prostate Infections/Inflammation: Conditions like prostatitis (inflammation of the prostate) can cause elevated PSA levels.
- Urinary Tract Infection: A UTI can inflame the prostate, leading to temporarily increased PSA levels.
- Recent Ejaculation: Sexual activity resulting in ejaculation can temporarily increase PSA levels. It’s often recommended to abstain from ejaculation for a day or two before a PSA test.
- Medical Procedures: Procedures involving the prostate, such as a digital rectal exam (DRE), prostate biopsy, or catheter insertion, can elevate PSA levels temporarily.
- Certain Medications: Some medications, especially those used to treat BPH, like 5-alpha reductase inhibitors, can lower PSA levels.
- Prostate Cancer: This is the most serious cause of elevated PSA levels, but it’s important to remember that not all increases in PSA are due to cancer.
- Exercise: Strenuous exercise, particularly activities that put pressure on the prostate like bike riding, can increase PSA levels.
- Diet and Lifestyle: Some studies suggest that diet and lifestyle factors may influence PSA levels, though the evidence is not conclusive.
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