PSA Test – Prostate Examination

What is PSA and how is the PSA test conducted?

PSA stands for Prostate-Specific Antigen, which is a protein produced by the prostate gland cells. Its primary function is to produce the fluid component of semen, aiding in the mobility and function of sperm.

PSA levels can be measured during a simple blood test.

The PSA test is often used as a diagnostic tool for the early detection of prostate cancer. It involves a simple blood test to measure the level of PSA in the blood. It is usually recommended for men over the age of 50, or earlier for those with a family history of prostate cancer. High PSA levels may indicate the presence of prostate cancer, but further testing is required to confirm the diagnosis.

Deiktis PSA

Interpreting PSA Values

PSA levels are typically reported in nanograms per milliliter (ng/mL) of blood. PSA levels are affected by various factors such as age, race, and the size of the prostate.

High PSA levels may indicate the presence of prostate cancer, but it is noted that high PSA levels can also be caused by non-cancerous conditions, such as benign prostatic hyperplasia (BPH) or prostatitis.

Factors Affecting PSA Levels

Several factors can influence PSA values. These include age (PSA levels tend to increase with age), the size of the prostate (a larger prostate produces higher PSA levels), inflammation or infection of the prostate, recent ejaculation or sexual activity, and certain medications.

Disadvantages of the PSA Test

Although the PSA test is an important tool for the early diagnosis of prostate cancer, it must be emphasized that it has significant drawbacks.

High PSA levels can be caused by non-cancerous conditions, resulting in false positive results. Similarly, some men with prostate cancer may have normal PSA levels, resulting in false negative results. For this reason, the PSA test should be used in conjunction with other diagnostic tools such as a digital rectal exam and various imaging tests.


Based on the results of the PSA, an individualized monitoring plan is developed that includes regular PSA tests, digital rectal examination, imaging tests (such as multiparametric magnetic resonance imaging), or prostate biopsy. Regular monitoring allows for the early detection of any changes in PSA levels and contributes to the assessment of disease progression.

The Role of PSA in Making Therapeutic Decisions:

PSA levels, along with other factors such as biopsy results, imaging findings, and the overall health of the patient, play a significant role in making therapeutic decisions for the treatment of prostate cancer.

In conclusion, PSA plays a vital role in the detection, monitoring, and decision-making for the treatment of prostate cancer. Understanding the role of PSA, its limitations, and the factors affecting its levels helps patients actively participate in managing their prostate health.

What is the purpose of the PSA test?

The PSA test is used to measure PSA levels in the blood and is primarily used as a tool for the early diagnosis of prostate cancer.

How is PSA measured?

PSA levels are measured through a blood test, which can be taken at any microbiological laboratory.

What are the normal values for PSA?

Generally, PSA values below 4 ng/mL are considered normal. However, the interpretation of PSA levels may vary depending on age and various individual risk factors.

Can a high PSA value indicate prostate cancer?

A high PSA value may indicate the possibility of prostate cancer, but it is not a definitive diagnostic tool. Further evaluation, such as magnetic resonance imaging and prostate biopsy, is usually required to confirm the diagnosis.

Can a low PSA value rule out prostate cancer?

A low PSA value may indicate a reduced risk of prostate cancer but does not completely rule out the possibility. Other factors, such as age and individual risk factors, should also be considered.

Can the PSA test detect other prostate diseases besides cancer?

Yes, the PSA test can detect other prostate conditions, such as prostatitis (inflammation of the prostate) and benign prostatic hyperplasia (BPH), a non-cancerous enlargement of the prostate.

How often should the PSA test be conducted?

The frequency of the PSA test depends on many factors, including age and other individual risk factors. According to the European Urological Association, the frequency of the examination is personalized and can range from annually to every 8 years.

At what age should men start undergoing the PSA test?

The age to start PSA testing depends on some risk factors for the appearance of prostate cancer, such as heredity, the presence of genetic mutations, etc. Generally, it is customary to advocate starting PSA testing from 40 years for men who carry the BRCA2 gene and at 45 years for men with a hereditary risk for prostate cancer.

Is the PSA test accurate for diagnosing prostate cancer?

The PSA test is not an absolutely accurate test for diagnosing prostate cancer. However, it is a tool that can indicate the need for further evaluation with other tests, such as magnetic resonance imaging of the prostate and possibly a prostate biopsy.

What are the defects of the PSA test?

The PSA test has some flaws, including false positives, which means that someone can have high PSA values without cancer, and false negatives, which means that someone can have normal PSA values and have cancer. A significant defect is also that PSA can lead to overdiagnosis and overtreatment of prostate cancer, i.e., diagnosing and treating a cancer that is not clinically significant and not life-threatening.

Can PSA levels fluctuate over time?

Yes, PSA levels can naturally fluctuate due to various factors, such as age, prostate size, prostate inflammation, recent ejaculation, and certain drugs or examinations.

Can certain drugs or examinations affect PSA values?

Yes, certain drugs (such as finasteride or dutasteride) and examinations (such as prostate biopsy or any procedure through the urethra) can affect PSA levels. It is important to inform your doctor about any medications you are taking or any recent examinations to properly evaluate PSA values.

Should I be concerned if my PSA levels are increasing?

A progressive increase in PSA values over time may indicate the need for further evaluation but does not necessarily mean cancer. It is important to discuss your PSA results with your doctor to determine the appropriate procedure to follow.

What is the recommended examination that should be done in case of an increase in PSA?

If PSA levels are high, further evaluation is usually recommended, which may include repeat PSA tests, digital rectal examination of the prostate, imaging tests with multiparametric magnetic resonance imaging of the prostate, or possibly a prostate biopsy.

Can the PSA test distinguish aggressive from non-aggressive prostate cancer?

The PSA test alone cannot distinguish between aggressive and non-aggressive prostate cancer. Additional tests, such as biopsy or imaging tests such as multiparametric magnetic resonance imaging of the prostate, are usually required to determine the aggressiveness of the cancer.

Is a prostate biopsy necessary if PSA levels are high?

High PSA values may indicate the need for a biopsy for further evaluation. However, the decision to conduct a biopsy is based on other factors, as your doctor will inform you.

Are there other blood tests besides PSA that can be used to diagnose prostate cancer?

Other tests, such as the prostate health index (phi) or the 4Kscore, can provide additional information. These tests can also help evaluate the likelihood of finding aggressive prostate cancer after a negative biopsy.

Can the PSA test be used to monitor the treatment of prostate cancer, i.e., surgery or radiation?

Yes, the PSA test is used to monitor the effectiveness of prostate cancer treatment. A reduction in PSA levels after treatment can indicate a positive response, while increased or continuously increasing PSA values may indicate the need for further treatment.

Can PSA levels predict the risk of recurrence and relapse of prostate cancer?

Yes, PSA levels after treatment can indicate the risk of recurrence of prostate cancer.

Where is the PSA test conducted?

The PSA test is a common blood test that can be performed in any laboratory or hospital.

Is any preparation needed before the PSA test?

No special preparation is needed for the PSA test, except to avoid ejaculation for the previous 3 days and to avoid the examination if a digital examination or diagnostic or interventional procedure through the urethra has preceded.

What is free PSA?

Free PSA is the percentage of PSA circulating in the blood without being bound to any protein. The ratio of free or unbound PSA is lower in the serum of men with prostate cancer (and conversely, the amount of complexed PSA is higher) compared to those with a normal prostate or benign prostatic hyperplasia. This finding has been utilized in the use of the ratio of free to total PSA and complexed PSA (cPSA) as a means of distinguishing between prostate cancer and prostate hyperplasia.

Why does PSA increase in prostate cancer?

PSA increases in cases of prostate cancer not because there is greater production from the cancer cells of the prostate but because in cases of cancer there is greater release into the blood due to disruption of the normal architecture of the organ.

Why does PSA increase in prostate cancer?

No, under no circumstances should antibiotic treatment be administered to an asymptomatic patient with the aim of reducing PSA.