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PSA blood test

The Prostate Specific Antigen (PSA) test enables the medical practitioner to detect prostate cancer at an early stage. prostate Specific Antigen (PSA) is a protein produced in small amounts in the cells of the prostate gland. A PSA blood test helps to determine whether stage of prostate cancer is advanced enough to perform a biopsy of the prostate gland or not. When the prostate gland enlarges, PSA level in the blood tends to rise. This is indicative of cancer or benign non-cancerous conditions. PSA is called biological marker or tumor. As men age, both benign prostate conditions and prostate cancer become more frequent. The most common benign prostate conditions are prostatitis which is inflammation of the prostate, and benign prostatic hyperplasia - BPH which refers to the enlargement of the prostate.


BPH - Benign Prostatic Hyperplasia is not usually dangerous by itself. Any strain on the bladder owing to urine retention can lead to complications like bladder/kidney damage, kidney stones, Urinary tract infection (UTI) or incontinence. The etiology of BPH is still not clear while most agree that the metabolism of testosterone can partially exacerbate BPH. A part of the secreted testosterone ends up as DHT - Dihydrotestosterone which may accentuate other conditions other than BPH - like male pattern baldness.

When the PSA test is combined with rectal examination, 90% of prostate cancers can be detected. In the U.S., the American Cancer Society recommends PSA blood test at least once a year to avoid the risk of prostate cancer.

The PSA test has been called the 'male PAP test'. The normal range for a PSA blood test is between 0 - 4 ng/ml (nanograms per milliliter). A PSA level of 4 - 10 ng/ml is considered slightly elevated. Levels between 10 -20 ng/ml are considered moderately elevated. Anything about 20 ng/ml is considered highly elevated. Although the higher the PSA level, the higher the risk of cancer, one abnormal PSA test result does not necessarily mean it is cancer that is present, as various other factors may cause PSA levels to fluctuate.


The PSA test is a radioimmunoassay. In a diagnostic laboratory, the patient's blood sample is exposed to the antibody against PSA. That moment the amount of antigen (PSA) can be measured. It should be borne in mind that a man who is undergoing hormone therapy for prostate cancer may have a low PSA test reading during or immediately after the treatment. The low level may not be a true measurement of PSA in the patient's body. It is essential that such patients brief the doctor who may probably advise him to wait a few months after hormone treatment before having a PSA test done.

PSA test does not help a man with fast-growing tumors or aggressive cancer. It helps only in detection of small tumor and slow growing tumors which are unlikely to threaten a man's life. PSA test also cannot detect cancers spreading to the other parts of the body beforehand. There is a fear of false positives test results in PSA testing. Sometimes PSA level could be elevated but that does not necessarily mean cancer is present. A fear of false negative test result can also occur in PSA testing. That is the PSA test result will show negative even if prostate cancer is actually present in the patient. PSA blood test is often followed by other diagnostic tests such as ultrasound, x rays and cystoscopy to determine the presence of cancer or any other problem in the prostate.

Prostate Biopsy

Some doctors opine that Prostate Cancer begins with a condition called 'prostatic intraepithelial neoplasia' (PIN). Almost 50% of men have PIN by the time they reach the age of 50 years. There occur changes in the microscopic appearance of the prostate gland cells in this condition. These changes can be either normal or abnormal. If a person had an abnormal high-grade PIN, then there is 30 to 50 % of cancer. Men diagnosed with such high-grade PIN are asked to undergo repeated prostate Biopsies. Other reasons for prostate biopsy are:


  • An elevated PSA level in a blood test.
  • Significant change in the standard PSA level over time.
  • Standard PSA level but a low free/total PSA ratio as indicated by the PSA II test.
  • Suspicious feeling prostate on digital rectal examination.

Normally for a prostate biopsy, the tissue is taken using a fine needle from ten or more places in the prostate. Nowadays, specialists recommend the biopsies of the prostate to be carried out only under ultrasound guidance. Several samples from the prostate are taken using a method called 'sextant biopsy'. Biopsies are taken using 'Trans-Rectal Ultrasound' (TRUS) to guide the precise placement of the biopsy needle. The patient is administered an enema prior to carrying out the biopsy. There is no need for anesthesia but an antibiotic is given in order to prevent possible infection. The biopsy specimens ('cores') are sent to a pathologist for evaluation.


Enlarged Prostate

Prostate gland enlargement is common in men as they grow older. For men above 50, the most common prostate problem is prostate enlargement. 50% of men by age 60 suffer from this problem and over 90% of men suffer from this problem when they are 80 plus. Enlarged prostate is also known as prostatic hypertrophy, benign prostatic Hyperplasia or prostate gland enlargement.

Enlarged prostate is a benign enlargement and is non- cancerous. This condition often induces urinary problems. If left untreated, the problem can block the flow of urine out of the bladder and cause urinary infection, kidney and bladder problems. The prostate gland is located beneath the bladder; this tube passes through the center of the prostate and transports urine from and out of the penis. Therefore when the prostate is enlarged, it obstructs the flow of urine. With time, the bladder muscles thicken severely and become over sensitive thus forcing the person to urinate frequently as the bladder can't hold even small amount of urine.

Symptoms of prostate gland enlargement

  • Increased frequency of urination at night.
  • Unable to empty the bladder completely
  • Urinary tract infection
  • Reduced kidney function
  • Frequent or urgent need to urinate
  • Weak urine stream
  • Strain to urinate
  • Bladder stone
  • Difficult to start, stop and restart urination.

Diagnosis includes:

Physical examination and understanding the patient's medical history.
Rectal examination to identify if the prostate is enlarged.
Urine tests.
Urine flow test.
PSA (Prostate Specific Antigen) test in blood.
Trans rectal ultrasound to measure prostate.
Neurological examination to identify reasons other than prostate enlargement for urinary incontinence etc.
Post void residual volume test, to identify if the patient can empty the bladder completely.
Prostate biopsy.
CT urogram to identify blocks in urinary bladder.
Cystoscopy to check bladder and urethra.

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Bibliography / Reference

Collection of Pages - Last revised Date: September 14, 2019