Currently it’s the baseline test used for evaluating the likelihood of prostate cancer. But the PSA test often raises more questions than answers.
“PSA is a blood test. It stands for Prostate Specific Antigen and it’s a component of prostate fluid that we find in the blood and that we use as a screening tool for men, to see whether or not they might have prostate cancer,” says Dr. Jasper Rizzo, a urologist on the medical staff of Lee Memorial Health System.
There’s no positive or negative result. The test is not nearly as black and white as patients would like.
“The protein actually has nothing really to do directly with cancer. It’s a protein that’s part of normal seminal fluid and helps the seminal fluid break down once it’s at the cervix and in the vagina. Men that have prostate cancer may have up to ten times more of this protein or antigen than the normal man,” says Dr. Rizzo.
At this point, zero to four is considered to be in the normal range.
“What’s also helpful is not just the absolute PSA number, but what it does over time, where the trend is,” says Dr. Rizzo.
Another point of discussion is what age group should get the PSA test and what it really means.
“The recommendations up to this point are that screening starts for men at the age of 50 in this country, with a rectal exam and a PSA. There has always been a subgroup that starts at 40, those men that are considered higher risk,” says Dr. Rizzo.
In the past, older men may have skipped their PSAs thinking that most prostate cancers are slow moving, so it wouldn’t matter. With longer life expectancies that logic isn’t holding up.
“You’ll hear people say ‘I don’t need to check this because I’m going to die of something else before I die of prostate cancer.’ It’s still out there, you know over a certain age you don’t need to be screened, I don’t think any of us buy that,” says Dr. Rizzo.
Other things such as an enlarged prostate can result in higher scores without involving cancer. The true value of the PSA test may identify the patient who merits more attention.