The PSA test is a simple blood test which is commonly performed to screen for the presence of an enlarged prostate and of prostate cancer. In spite of the fact that the test cannot by itself be used for diagnosis it is an excellent indicator and, along with other tests, PSA test can point to the need for additional investigation.
The PSA test is generally recommended for men in high risk groups (like those with a family history of the condition) once they reach the age of about 40 to 45 and for men in general after they reach 50.
An isolated PSA test will give a snapshot of of the level of prostate specific antigen in the blood and may indicate a problem straight away if you record particularly high psa numbers. In the majority of cases however, and when a prostate problem is in its early development, a single PSA test result will turn out to be inconclusive and a further test will usually be recommended in a few weeks time. In fact, if possible PSA testing ought to be done regularly 2 or 3 times every year so PSA levels may be plotted over a reasonable period of time.
Providing you record a normal PSA score all is well, but as soon as your PSA scores start to increase they need to be watched closely. The speed with which PSA scores rise is usually referred to as the ‘PSA velocity’ and if the increase is gradual and the velocity slow then it is again often enough simply to monitor the situation as numerous things can influence levels of PSA and apparently increasing levels will often be seen to return to normal over time.
However, when PSA readings start to rise rapidly and the velocity is fast then further investigation is certainly needed.
PSA testing and monitoring has been followed for a long time but, although the test has always been considered to be a good indicator of the need for additional investigation, it was not until fairly recently that we have been in a position to link specific PSA velocity figures to prostate cancer in a fashion which can foretell the aggressiveness of a cancer.
In a recent study data from 950 men who had been diagnosed with prostate cancer and undergone either radiation treatment or surgery at four hospitals between 1988 and 2004 was carefully scutinized.
In all cases each patient had been diagnosed with aggressive prostate cancer on the basis of an isolated very high PSA score, a noticeable rise in PSA velocity during the year prior to diagnosis, an advanced stage tumor, a biopsy indicating signs of an aggressive cancer at cellular level or a combination of two or more of these markers.
The study also looked at the outcomes for all of the patients and discovered that a rapidly increasing PSA level which rose by 2 or more points in a year was the clearest indication or an aggressive cancer.
Until this point we have been able to associate increasing PSA levels with an indication of the possible presence of prostate cancer but it has been necessary to guess to some extent about whether or not such a cancer might be aggressive and need correspondingly aggressive intervention.
However, now we can say with a fair degree of certainty that where a PSA level increases by more than 2 points in a year then prostate cancer is likely to be aggressive and requires swift and vigorous treatment.