- Elevated PSA (Prostate-Specific Antigen) Level
- Tips for naturally lowering PSA levels
- Elevated PSA levels
- Reduced PSA levels
- Natural ways to reduce PSA levels
- Digital Rectal Exam (DRE)
- Prostate-Specific Antigen (PSA) Test
- Who Should Get a PSA Test?
- What Do the Numbers Mean?
- The Role of PSA in Choosing the Best Treatment
- Tips for Naturally Lowering PSA Levels
- 1. Eat more tomatoes
- 2. Choose healthy protein sources
- 3. Take vitamin D
- 4. Drink green tea
- 5. Exercise
- 6. Reduce stress
- The takeaway
- PSA Screening
- What is the PSA test?
- What is Prostate-Specific Antigen?
- What is the controversy surrounding PSA screening?
- When should I get a PSA test?
- How can I get a PSA test?
- Understanding Your PSA Test
- Additional Testing
- Stress and the prostate
- How Stress Affects Prostate Health
- How Stress Affects and Prostate Health
- How Stress Affects Prostate Cancer
- Stress, Prostatitis, and Enlarged Prostate
- Emotional Therapy for Prostate Health
- What factors can affect your PSA levels?
- I Have High PSA Levels: How Do I Find Out If I Have Prostate Cancer?
- PSA and Prostate Cancer: What Do My Numbers Mean?
- I Have High PSA Levels: What Next?
- MRI/Ultrasound Fusion Guided Biopsy: Working Together For Your Health
- High PSA Levels? Consider Fusion Guided Biopsy at UVA Health
Elevated PSA (Prostate-Specific Antigen) Level
What is a prostate-specific antigen (PSA)?
Prostate-specific antigen (PSA) is a protein produced by the prostate gland. Blood levels of PSA can be elevated in men with prostate cancer.
For this reason, measurement of PSA in the blood has been used as a screening test for prostate cancer. However, the PSA test was first developed only to monitor men who had a history of prostate cancer. Views about PSA screening and appropriate follow-up have been evolving.
What constitutes an elevated prostate-specific antigen (PSA)?
No single normal level has been established. Historically, a level of 4.0 ng/mL or higher was used to justify a biopsy of the prostate (a sample of prostate tissue) to try and determine if a man has prostate cancer. However, this practice has been changing and other factors are being considered in the decision to perform a prostate biopsy.
Also, the thinking with regard to the management of prostate cancer continues to evolve. Considerations include:
- Aggressiveness of the cancer.
- Volume of cancer detected on biopsy.
- How it will affect a man’s longevity (length of life).
Does a prostate-specific antigen (PSA) level higher than 4.0 ng/mL mean that I have prostate cancer? Can prostate cancer be ruled out if my level is less than 4.0 ng/mL?
No, prostate cancer has been detected in men with levels less than 4.0 ng/mL. And many men with PSA levels higher than 4.0 ng/mL do not have prostate cancer. There is no PSA level below which the risk of cancer is zero. Two men with the same PSA level may have very different risks of prostate cancer depending on other risk factors.
Factors other than prostate cancer can cause the PSA level to be higher. These include:
- An enlarged prostate and prostate inflammation (prostatitis).
- Urinary tract infection.
- Having had a urinary catheter placed.
Drugs known as 5-alpha reductase blockers (finasteride or dutasteride), which are used at times to treat an enlarged prostate, will lower PSA levels. These factors are important to consider when interpreting the PSA test result.
Generally, higher PSA levels are associated with higher risks of prostate cancer.
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Tips for naturally lowering PSA levels
This article is not intended to replace professional medical care or advice. If you have any questions or need additional information, please talk with your doctor.
The prostate-specific antigen blood test (PSA) is one of two exams used in the early screening of prostate cancer. Approved by the FDA in 1986, the test was intended to monitor the development of the disease among those who were already diagnosed, according to the National Cancer Institute (NCI).
Eight years later, however, it was mandated that even those who were asymptomatic would be given both the PSA and the digital rectal exam (DRE). Since then, the use of routine population screening has remained up for debate. As more is understood about both potential risks and benefits of early screening, some professionals in the field have begun to caution against annual PSA screening, though many insurers, both private and public, continue to cover them yearly, according to the NCI.
Elevated PSA levels
Cells within the prostate gland are responsible for producing PSA, which is typically found in semen, but may sometimes leave small traces in the blood as well. Among men who do not have prostate cancer, typically numbers from this screening test will indicate PSA levels that are under 4 nanograms per milliliter (ng/mL) of blood, according to the American Cancer Society (ACS). As PSA levels rise, so does the risk for cancer. For those with a PSA level over 10, the chance of developing prostate cancer is more than 50 percent.
Heightened levels of prostate-specific antigen do not always mean that prostate cancer is present. However, heightened levels do not always indicate that cancer is present, and there is also no guarantee that PSA levels below 4 eliminate the risk altogether.
An elevated PSA may also point toward conditionssuch as prostatitis or benign prostatic hyperplasia (BPH), reported the ACS. As men grow older, many are affected by BPH, a non-cancerous enlargement of the prostate which causes PSA levels to rise. Ejaculation, male hormone medications and some urologic procedures can also provoke an elevated reading. Additionally, prostate levels tend to slowly rise with age, even if there is no abnormality within the prostate.
Reduced PSA levels
At the same time, there are also external factors that can cause a lowered PSA level reading than what is actually present, according to the ACS. Those who carry extra weight, frequently take aspirin or use certain cholesterol-lowering drugs may see lowered levels. Drugs used to treat urinary symptoms of BPH, such as finasteride or dutasteride, may also lead toward erroneous numbers.
Natural ways to reduce PSA levels
Though an elevated PSA is not the cause of the cancer, but merely an indicator of the problem, a low PSA level is still a strong sign of good prostate and overall health, pointed out the Prostate Cancer Institute (PCI). And as such, all men should aim to have a low PSA level. While age and genetics are two big constituents affecting PSA levels, lifestyle factors actually play the largest role, reported the source. Thus, by making simple changes to health, lifestyle and diet, there are several ways to naturally bring down PSA levels.
1. Engage in regular physical activity
According to the PCI, engaging in regular aerobic exercise may help to reduce PSA levels in men. Excess estrogen, which can negatively affect prostate health, is often promoted by weight gain. Studies have shown that those who take part in activities such as yoga, running, swimming or meditation can help to lower their levels not only by losing weight, but by simultaneously reducing stress-related inflammation.
A 2011 study from the Harvard School of Public Health in collaboration with the University of California, San Francisco analyzed 2,705 men who were diagnosed with prostate cancer over the course of 18 years. Each participant recorded the average time per week spent biking, walking, running, working outdoors or playing sports. The researchers’ findings concluded that those who were actively engaging in three or more hours of vigorous physical activity each week had a 61 percent lower risk of prostate cancer-specific death in comparison to the men who completed less than one hour each week. Additionally, results showed that both vigorous activity and non-vigorous activity were beneficial to overall survival.
Weekly physical activity can help to reduce prostate cancer-related death.
“Our results suggest that men can reduce their risk of prostate cancer progression after a diagnosis of prostate cancer by adding physical activity to their daily routine,” said Stacey Kenfield, lead study author and researcher at the Harvard School of Public Health. “This is good news for men living with prostate cancer who wonder what lifestyle practices to follow to improve cancer survival.”
2. Add more tomatoes to your diet
Getting the recommended daily serving of both fruits and vegetables is extremely important for your overall health, as well as avoiding disease. In particular, consuming tomatoes can help to lower PSA levels and reduce the risk of prostate cancer, according to an article published in the Journal of the National Cancer Institute. Tomatoes contain lycopene, a micronutrient and antioxidant that is released when these juicy red vegetables are cooked. In the experimental study of 43 men with PSA levels between 4 and 10, study authors found a 10.77 percent decrease in PSA levels among patients with BPH who were submitted to daily ingestion of tomato paste.
Moreover, the PCI reported on another study showing that PSA levels in men with advanced prostate cancer can be lowered by 65 percent simply by adding more tomato products to a diet. However, it is important to avoid canned tomatoes as they often contain toxins such as bisphenol-A.
3. Consume less meat and dairy
Both meat and dairy products can lead to increased production of hormones, which can affect prostate enlargement, according to the Physicians Committee for Responsible Medicine. In fact, those who eat meat on a daily basis have a tripled risk of prostate enlargement, reported the source. Limiting the amount of each and consuming more vegetables can help lead to lowered PSA levels. Additionally, the unhealthy fats in meat can lead to weight gain – another factor in raised PSA levels.
The earlier cancer is detected, the greater the chance that it can be treated successfully. Prostate cancer can be detected early, before symptoms develop, with a digital rectal exam (DRE) and the prostate-specific antigen (PSA) blood test.
Digital Rectal Exam (DRE)
The digital rectal exam enables your doctor to feel anything abnormal in the posterior (rear) area of your prostate, where most prostate cancers develop. Wearing a lubricated glove, the doctor will gently insert a finger into your rectum and check for any lumps or other irregularities that might be signs of prostate cancer.
Prostate-Specific Antigen (PSA) Test
The PSA test was developed at Roswell Park in the 1970s and is now in use worldwide. It’s a way to detect prostate cancer in the early stages, when it can be treated most effectively. Since the test was first introduced, the cure rate for prostate cancer has increased from about 4 percent to 80 percent.
How does it work? PSA is a protein that’s made by the prostate gland. PSA levels in the blood increase when a man has prostate cancer, an infection, or a condition called benign prostatic hypertrophy (BPH) or benign prostatic enlargement (BPE), a condition that is not cancer. To perform the test, a small amount of blood is drawn from your arm and tested to determine the amount of PSA it contains.
Who Should Get a PSA Test?
Not everyone should get a PSA test. Why? Because many men in this country are treated for low-risk prostate cancer that is discovered through the PSA test, even when it is unlikely that the disease will ever cause symptoms or lead to death. And treatment is associated with significant side effects, including impotence (inability to get an erection) and incontinence (inability to hold urine). So a PSA test is recommended only for men who might be at greater risk for dying of prostate cancer — for example, younger men with a family history of prostate cancer or African-American men.
To avoid the risks of over-treatment, Roswell Park follows the guidelines established by the National Comprehensive Cancer Network (NCCN). The NCCN brings together world-renowned experts from 30 of the nation’s top cancer centers to write guidelines that specify the best ways of preventing, detecting and treating cancer. The guidelines are updated continually — at least every year — on the basis of the latest research.
Two members of Roswell Park’s Prostate team — James Mohler, MD, Department of Urology, and Michael Kuettel, MD, PhD, MBA, Department of Radiation Medicine — serve on the NCCN Prostate Cancer Treatment Panel, which Dr. Mohler has headed since 2005.
Screening tests detect cancer’s hidden warning signs long before symptoms appear and when the disease is most treatable. Understand your screening needs and complete the cancer screening and prevention questionnaire to manage your cancer risk.
The NCCN recommends that only men in these categories receive a PSA test for early detection of prostate cancer:
- If you are African-American, or if you have a father or brother who had prostate cancer — especially if they were younger than 60 at the time of diagnosis — or if you have undergone genetic screening that showed you have a genetic mutation (such as BRCA1, BRCA2, ATM, HOXB13, MLH1, MSH2 or MSH6), you and your doctor should have a discussion about whether you should begin early detection of prostate cancer at age 40 and continue to be tested regularly. If you have a family history of prostate cancer, you should talk with your doctor about beginning early-detection testing 10 years before the age of the earliest prostate cancer case in your family (for example, at age 35 if your father or brother received a prostate cancer diagnosis at age 45).
- If you do not fall into any of the groups above, you may consider beginning early detection with a baseline PSA test and digital rectal exam at age 45. The results of those tests will be used to compare with future tests. If your first PSA test shows a level of 1.0 ng/mL or higher, you should undergo follow-up testing every one to two years. If your first PSA test shows a level less than 1.0 ng/mL, you should have follow-up testing every two to four years.
- A PSA test is generally not recommended for men over the age of 75 unless they are very healthy and have a life expectancy of 10 years or more.
You should discuss the pros and cons of having a PSA test with your doctor. If you do receive a PSA test, your doctor will need to put the results in perspective with your age, how long you can be expected to live, your family medical history, your race and the results of any previous PSA tests.
What Do the Numbers Mean?
PSA levels are measured as a number of nanograms (units) in each milliliter of fluid tested. This is written as ng/mL.
- PSA level 2.5 ng/mL or lower: This is a normal PSA level for men under age 60, but in some cases, prostate cancer may still be present.
- PSA level between 2.5 and 4 ng/mL: This is a normal PSA level for most men.
- PSA level between 4 and 10 ng/mL: This indicates that prostate cancer might be present. At this level, there is about a 25% chance that you have prostate cancer.
- PSA level 10 ng/mL or above: There is a 50 percent chance that prostate cancer is present. The higher the PSA rises above 10 ng/mL, the greater the chance that you have prostate cancer.
Your doctor may also monitor your PSA velocity, or doubling time, which means recording your baseline PSA — the level at your very first PSA test — and seeing how fast the PSA level increases over time. Rapid increases in PSA readings can suggest cancer. If your PSA is slightly high, you and your doctor may decide to keep an eye on your levels on a regular basis to look for any change in the PSA velocity.
PSA levels can increase for reasons other than prostate cancer. These include aging, infection, difficulty urinating, the use of certain herbal supplements, or an enlarged prostate (not due to cancer). Some prostate glands naturally produce more PSA than others; for example, African-American men tend to have higher PSA levels than men of other races. Your PSA level also may increase after ejaculating, exercising vigorously, bicycling or drinking alcohol, so doctors advise men not to do any of these things for at least three days prior to a PSA exam.
The Role of PSA in Choosing the Best Treatment
If you have received a diagnosis of prostate cancer, your PSA levels can be used along with the results of other tests and physical exams and your tumor’s Gleason score to help determine which tests are needed for further evaluation and to decide on the best treatment plan. After treatment has begun, your PSA and other tests will be used to determine how well the treatment is working: The more successful the therapy, the lower the PSA.
Tips for Naturally Lowering PSA Levels
If you’ve had your prostate-specific antigen (PSA) tested and your numbers were higher, you and your doctor may have discussed ways to lower it. There are also some things you can do on your own that may help.
PSA is a type of protein that’s made by both normal cells in your prostate gland and by cancer cells. It can be found in your blood and semen. Doctors measure PSA in your blood to check for new or returning prostate cancer. The higher your PSA levels are, the more likely it is that you have active prostate cancer.
Some scientific research has found that it’s possible to lower your PSA numbers and reduce risk of developing or returning cancer by making lifestyle changes, like eating certain foods and being more physically active.
Read on to find out six things you can do at home to have a positive impact on your PSA levels.
1. Eat more tomatoes
Tomatoes have an ingredient called lycopene that’s known to have health benefits. Lycopene is the substance that gives tomatoes their red color. It’s also been found to have antioxidants that might protect against cancer.
A few studies have shown eating lycopene reduces the risk of developing prostate cancer in men with a family history of the disease. More recently, researchers found evidence that eating higher amounts of lycopene can lower PSA levels as well.
You can add more tomatoes into your diet by eating them raw in salads, or by using tomato sauce and adding canned or sundried tomatoes to different recipes. Cooked tomatoes may actually give you more lycopene than raw ones.
2. Choose healthy protein sources
In general, going for lean proteins, like chicken, fish, and soy or other plant-based protein, is better for overall health. These sources of protein help you to maintain a healthy weight and protect against heart disease. They can also benefit your prostate health and lower PSA levels.
Avoid fatty or processed meats and instead choose fish that’s rich in omega-3s and chicken baked or grilled without the skin.
Soy, which is used to make tofu and other meat substitutes, contains isoflavones. Researchers believe these nutrients can protect against certain cancers. In fact, there is some evidence that drinking soy milk can actually help to lower PSA levels and slow the progression of prostate cancer.
3. Take vitamin D
Vitamin D is made by your body when you spend time in sunlight. It’s also found in fish and eggs and is often added to fortified foods, like cereals. You can take vitamin D as a dietary supplement as well.
Not getting enough vitamin D or having a vitamin D deficiency has been connected to higher risk of having prostate cancer, according to a study in Clinical Cancer Research. Other research has found that people with higher levels of vitamin D have lower levels of PSA.
4. Drink green tea
Green tea has been a popular drink in Asia for many generations. It’s become more popular in the United States as people discover its many health benefits.
The tea is full of antioxidants that protect against several cancers, including prostate cancer. Asian countries where men drink large amounts of green tea have some of the lowest prostate cancer rates in the world.
Some studies found the nutrients in green tea were able to protect against prostate cancer and lower PSA levels. Green tea was also studied as a supplement to help slow the rate of growth in men with existing prostate cancer.
If you have a high body mass index, this can complicate your PSA readings. Carrying the extra weight can cause your PSA to read lower, when in fact you could still be in danger. Combining an exercise plan with a healthy diet can help you lose weight.
In addition to helping you maintain a healthy weight, getting regular exercise has also been shown to reduce your risk of prostate cancer. Research has also found that getting three hours of moderate to intense exercise per week is associated with a higher survival rate in men with prostate cancer.
However, it’s important to note that you shouldn’t exercise the day of getting your PSA tested. This could temporarily make your levels go up and give an inaccurate reading.
6. Reduce stress
Stress can affect your body in so many different ways. It’s also possible that periods of high stress can affect prostate health and PSA scores. One study did find a link between abnormal PSA levels and high levels of stress.
Learning some ways to relax and decompress can help reduce your stress levels. Find something that works well for you and make time for it.
Eating healthier and getting more exercise is beneficial to your overall health. These are good changes to start and stick to.
If you choose to take additional dietary supplements, like vitamins or minerals, make sure to tell your doctor. It’s possible that these could interfere with other medications you’re taking. Your doctor should also have all your health information in order to make suggestions about next steps in your treatment.
A popular herbal supplement used by prostate cancer patients has been found to significantly reduce prostate specific antigen (PSA) levels—a protein in the blood that often indicates prostate cancer—in men with advanced disease, according to a University of California, San Francisco study.
The study, one of the first of its kind to subject the herb PC-SPES to rigorous scientific scrutiny, will be published November 1 in the Journal of Clinical Oncology. PC-SPES (“PC” stands for prostate cancer, “SPES” is Latin for hope) consists of extracts from eight different Chinese herbs. It is sold commercially at some health food stores.
“My belief is people approach complementary medicine in two ways. They either accept it without critical thought simply because it’s alternative, or they reject it without critical thought because it’s alternative,” said Eric Small, MD, study lead author and UCSF associate clinical professor of medicine. “Either way, it’s all opinion. We wanted to study PC-SPES and hold it to the same standard as we would any other new drug. This is the first attempt to study this herb in a scientifically methodical way.”
The phase II study evaluated 70 men divided into two groups: those with hormone dependent disease (33 patients) and those with hormone independent disease (37 patients). Hormone dependent disease is defined by its responsiveness to withdrawal of the male hormone testosterone. This can be accomplished by the use of several hormonal medications, including the female hormone, estrogen. Testosterone fuels prostate cancer growth. Lowering testosterone levels can cause tumors to shrink or slow their growth. As a result, PSA levels fall. However, tumors can become resistant to hormonal therapy. Hormone independent disease is defined by cancer progression despite low testosterone levels.
All of the men in the hormone dependent arm of the study had a PSA decline of greater than 80 percent, with a median duration of that decline lasting 57 or more weeks. Only one patient had disease progression while taking the herb. About 97 percent of these patients had steep declines in their testosterone also, causing researchers to theorize PC-SPES may work like standard hormonal therapy, Small said. “We think PC-SPES is estrogen-like,” he said.
In the men with hormone independent disease, 19 men, or about 50 percent, had PSA declines of greater than 50 percent. Median time before PSA increased was 16 weeks. But several men in this group have not had any disease progression in more than a year of taking the herb.
The finding that PC-SPES can lower PSA levels in men with hormone independent disease is significant, Small said, because it represents another line of defense for patients when standard hormonal therapy fails to slow the disease.
“In this group of patients we can use another hormone, but beyond that, short of chemotherapy, there is not much more we can do,”” Small said. “PC-SPES can be used as a second or third line hormone. We don’t know what kind of impact it will have on survival, but it clearly offers a clinical benefit. It provides us with another treatment we can use before chemotherapy.”
In addition, some men in both groups saw shrinkage of their tumors. Side effects included impotency, lowered sex drive and breast tenderness. Overall, PC-SPES was well tolerated. The men were enrolled in the trial for two years and were given a dose of nine capsules daily.
While PC-SPES appears to be mimicking estrogen in men with hormone dependent disease, Small and colleagues believe there may be other active anti-cancer ingredients in the supplement because it lowered PSA levels in men with hormone independent disease whose testosterone was already low.
“We have proven that this has some activity,” Small said. “The next step is to sort out if this is any different from estrogen,” he said.
To that end, Small and colleagues at Dana Farber Cancer Institute in Boston, MA are enrolling 100 men with hormone independent disease for a trial to test which agent, estrogen or PC-SPES, works better to slow the disease. Once one therapy stops producing PSA declines, the patient will be switched to the other agent. Patients will be enrolled for a year.
“The importance of that study is it will help us get to the mechanism of PC-SPES,” Small said.
Prostate cancer is the most common cancer, excluding nonmelanoma skin cancers, in American men, according to the American Cancer Society. The organization estimates that 180,400 new cases of prostate cancer will be diagnosed in the U.S. this year. Prostate cancer is the second leading cause of cancer death in men, exceeded only by lung cancer. About 31,900 men in the United States will die of this disease during 2000, according to the American Cancer Society.
Other authors on the paper include Mark Frohlich, MD, UCSF assistant professor of medicine; Robert Bok, MD, PhD, UCSF assistant clinical professor of medicine; Katsuto Shinohara, MD, UCSF assistant professor of urology; Gary Grossfeld, MD, UCSF assistant professor of urology; Zinovi Rozenblat, UCSF clinical research associate; William Kevin Kelly, DO, Memorial Sloan-Kettering Cancer Center; Michele Corry, NP, UCSF; David Reese, MD, UCSF assistant clinical professor of medicine.
The study was supported by the Association for the Cure of Cancer of the Prostate (CaP CURE).
What is the PSA test?
The most common screening tool for prostate cancer is the prostate-specific antigen (PSA) test. This is a simple blood test that measures the presence of PSA circulating in your bloodstream. This test is usually the first step in any prostate cancer diagnosis. However, the PSA screening by itself cannot tell you if cancer is present.
The PSA test is also used to track the effects of prostate cancer treatment such as surgery, radiation, hormone therapy and chemotherapy. When a man has treatment for prostate cancer, his PSA level will drop significantly. Regular screening with PSA is one of the tools the physician will use to measure if the cancer has returned.
When PSA levels rise to a certain threshold after prostate cancer treatment, this is known as biochemical recurrence. This means that some cancer cells have survived and are producing PSA. If this happens, the doctor will order additional tests and make recommendations for additional treatment.
What is Prostate-Specific Antigen?
PSA is a protein produced by prostate cells, which keeps semen in liquid form so that sperm can swim. A simple blood test can measure how much PSA is present in a man’s bloodstream. When a man has prostate cancer, his PSA level increases, which is why the PSA test is used as a screening tool.
However, the levels of PSA can rise due to a number of reasons, including cancer. When PSA is elevated it is a warning sign that you should follow up on with your doctor.
What is the controversy surrounding PSA screening?
In recent years, there has been some controversy surrounding the PSA test. In 2012, the U.S. Preventive Services Task Force (USPSTF) assigned the PSA test a “D” rating. This meant that the USPSTF concluded the harms that resulted from PSA testing, such as unnecessary biopsies and negative treatment side effects, outweighed the benefits of finding and managing the disease early. This recommendation did not include exceptions for men at increased risk of developing the disease, such as African American men, those with a family history of the disease, and those with BRCA gene mutations. The USPSTF recommendation is important as it guides primary care physicians in preventive care and can impact insurance coverage and reimbursement for screening. Prior to its “D” rating, the PSA test had an “I” rating, meaning the USPSTF concluded there was insufficient evidence to assess the pros and cons of testing.
In May 2018, the USPSTF updated their recommendation on PSA screening. In response to new research demonstrating the benefits of PSA screening (such as the European Randomized Study of Screening for Prostate Cancer), an increase in the number of men choosing active surveillance, and advocacy efforts, the USPSTF released a draft recommendation in April 2017 that assigns the PSA test a “C” rating for men ages 55to 69 (the test still has a “D” rating for men ages 70+). This rating has now been certified official by the task force.
This means that the USPSTF recognizes a small potential benefit of PSA testing and recommends that men make individual decisions about whether or not to get tested after discussing the risks and benefits with their doctors. Like the 2012 recommendation, this update does not include specific language for men at increased risk.
The National Comprehensive Cancer Network® (NCCN®) and ZERO – The End of Prostate Cancer strongly recommend that men should be fully educated about prostate cancer, should know their options for early detection, and should have access to the tests we have available now. Researchers, with support from organizations like ZERO, are working every day to improve prostate cancer screening, but for now, we must use the tools we have. A PSA test score is an important part of making a decision on how best to determine a prostate cancer diagnosis and/or treatment pathway. to learn about ZERO’s advocacy efforts in early detection and access to PSA screening.
This 2016 article by Dr. Stacy Loeb provides a thorough overview of the evidence for and against the PSA test, and how we can interpret this evidence with nuance in order to prevent suffering and death.
When should I get a PSA test?
The guidelines below are adapted from the NCCN Clinical Practice Guidelines In Oncology (NCCN Guidelines®) for Prostate Cancer Early Detection. Please use these guidelines to have a discussion with your physician about your personal risk and make a plan for screening.
- If you are between ages 45 and 75:
- Discuss the risks and benefits of prostate cancer screening with your doctor, have a baseline PSA, and consider a baseline DRE
- If your PSA is below 1 ng/mL and your DRE is normal, repeat testing every 2-4 years
- If your PSA is between 1 and 3 ng/mL and your DRE is normal, repeat testing every 1-2 years
- If your PSA is greater than 3 ng/ML or your DRE is very suspicious, your doctor may suggest additional testing or a biopsy
- If you are over 75:
- Decide together with your doctor if PSA/DRE testing is right for you
- If you continue testing and your psA is less than 3 ng/mL and your DRE is normal, repeat testing every 1-4 years
- If your PSA is greater than 3 ng/ML or your DRE is very suspicious, your doctor may suggest additional testing or a biopsy
How can I get a PSA test?
Talk to your general practitioner or urologist about receiving a PSA test in their office. If you do not have insurance or if your insurance does not cover the PSA screening, consult our national free testing map or look into our free testing partners.
- National Free Testing Map
- Community Testing Partners
Understanding Your PSA Test
In general, a PSA level that is above 4.0 ng/mL is considered suspicious. However, there are many other factors to consider before taking further action. The following are some general PSA level guidelines:
- 0 to 2.5 ng/mL is considered safe
- 2.6 to 4 ng/mL is safe in most men but talk with your doctor about other risk factors
- 4.0 to 10.0 ng/mL is suspicious and might suggest the possibility of prostate cancer. It is associated with a 25% chance of having prostate cancer.
- 10.0 ng/mL and above is dangerous and should be discussed with your doctor immediately. It is associated with a 50% chance of having prostate cancer.
However, PSA levels can easily rise with greater age. You and your physician should consult age-specific normal PSA ranges.
If Your PSA is High
You and your doctor can explore several options if your PSA is high. One option is to have a second PSA screening; recent research has shown that a second screening can improve the accuracy of an abnormal result1. A digital rectal exam (DRE) and a biopsy can also confirm the presence or absence of prostate cancer. However, there are several other reasons why a PSA result might be high:
- Advanced age
- Recent biopsy
- Injury to pelvic region or prostate
- Riding a bicycle
- Sex (within the past 24 hours)
- Supplements that effect testosterone
- Urinary tract infection
If you have an elevated PSA, talk with your doctor about your activities and your health.
If Your PSA is Low
In general, a low PSA is a good result. However, there are several reasons a PSA screening level may be artificially low including taking statins to lower cholesterol, anti-inflammatory drugs and obesity (body fat decreases the amount of PSA circulating in the blood stream). Be sure to discuss these with your doctor.
If Your PSA is Rising Quickly
The rate in yearly increase in the PSA level is known as the PSA velocity. This is one measure of prostate cancer risk, since PSA levels can rise rapidly in men who have prostate cancer. This can be especially useful to find prostate cancer in early stages before the cancer has left the capsule of the prostate.
Research shows that an increase of .75 ng/mL a year is an early indicator of prostate cancer if a man has a total PSA result between 4.0 and 10.0 ng/mL.2 Further, an increase of 2.0 ng/mL over a year period predicts a higher likelihood of death due to aggressive prostate cancer.3
Research is also showing PSA velocity may be able to predict survivability from prostate cancer as men with a PSA increase of .35 ng/ML or less over a year have a 92 percent survival rate compared to PSA increases of more than .35 ng/mL over a year have a 54 percent survival rate.4
The Prostate Health Index was recently approved for the detection of prostate cancer. The PHI is a simple blood test that combines three tests in one. Research has shown that the test is better at detecting prostate cancer than the traditional PSA screening.5 The test also predicts the likelihood of progression during active surveillance.
Because this test is very new, it is possible your physician has not heard of it yet. If you are interested in the test, talk with your doctor and discuss your risk, the test, and how to use the information from the test.
While none of these tests are conclusive on their own, when performed in addition to a PSA test, DRE (Digital Rectal Exam), and a biopsy, they can provide each patient with more information about their specific cancer and can aid in both the diagnosis and decision on treatment. Read more on this and further additional testing.
Stress and the prostate
Published: April, 2008
Men with benign prostatic hyperplasia (BPH) often find the condition stressful. It’s easy to see why. Urinary urgency that triggers a frantic hunt for a bathroom will jangle the most placid gent, and nighttime urination that interrupts sleep can only add to mental distress. If they’re under stress, some young men with normal prostates can also find it hard to urinate; doctors call it paruresis or the “shy bladder syndrome.”
If the symptoms of BPH can cause stress, is the reverse also true? Doctors have learned that stress can contribute to many medical conditions, ranging from palpitations, heart attacks, and hypertension to asthma, heartburn, colitis, and skin rashes. But even though mental stress can affect many of the body’s organs, the prostate has been considered exempt from psychic influences. Two reports may begin to modify that view.
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The prostate-specific antigen (PSA) test to screen for prostate cancer is fraught with controversy, despite being one of the most common clinical tests given to older men. A large 2009 study found no difference in cancer-specific mortality over 10 years between men who were screened for prostate cancer and those who weren’t. And in 2012, based on this and another large study, the US Preventive Services Task Force recommended against PSA-based screening for prostate cancer altogether, citing very little benefit versus the risk of false positives, invasive follow-up procedures, treatments with significant side-effects, and added health care costs.
Other groups like the American Cancer Society and the American Urological Association still recommend that men of a certain age (i.e. younger) and health status (i.e. healthier) have a discussion with their physician about screening. Many physicians—including those here at the University of Chicago—also recommend selective screening, following proper consultation with a physician on the implications and a shared, informed decision. Clearly, a number of considerations go into whether a man should be screened for prostate cancer: life-expectancy, overall health, family cancer history, doctor’s advice and the patient’s general attitude toward preventive health care.
A medical student at the University of Chicago Pritzker School of Medicine and his mentor recently conducted a study to look at how another set of factors, a man’s emotional state, figures into this decision. The results of this work were recently published in the journal Medical Care.
Ashwin Kotwal, a fourth-year student, and William Dale, MD, PhD, a geriatrician and chief of the Section of Geriatrics & Palliative Medicine, analyzed a nationally representative data set to see how men’s perceived stress, depression and anxiety affect PSA screening rates. Kotwal said that in previous research, he and Dale had found that the frequency of screening was often inversely proportional to the likely good it would do. Men who were already in poor health and had low life-expectancy, and who wouldn’t benefit from PSA screening, were still being tested at significantly high rates. Those with longer life expectancies, were not be screened nearly enough.
To understand why those differences exist, Kotwal and Dale used data from the National Social Life Health and Aging Project (NSHAP) from NORC at the University of Chicago, which is a longitudinal, population-based study of the physical, social and emotional health of older Americans. They found that men who reported higher levels of stress from external factors were less likely to get a PSA test. Men who were depressed had lower rates of screening as well, which other studies had shown.
However, when they controlled for stress, the relationship between depression and screening was no longer statistically significant, which is a new discovery. In short, it is stress, rather than depression, that decreases screening rates.
Kotwal and Dale found a third emotional component, anxiety, also affected their likelihood of being screened, but its effect differed based on how often a man saw a doctor. Men who reported high anxiety, but didn’t visit the doctor very often, were much less likely to get screened for prostate cancer. Conversely, men with high anxiety who visited the doctor a lot were much more likely to be screened. Anxiety is a “trigger” for screening, but only it you are already going to the doctor frequently.
Kotwal said this was a unique opportunity to look at all three of these distinct emotions in the same dataset, since NSHAP is unique in this way. Previous studies had looked at the effects of depression on rates of PSA testing, but this was the first to add in the additional factors of anxiety and stress, and their unexpected consequences.
“When you tease these emotions apart, they all have a unique relationship with PSA screening, which is important to recognize,” he said.
This has important implications for clinicians treating men with different emotional profiles. The results are indicative of how a person’s attitude impacts their medical decision-making. Those who visit a doctor often, and are more experienced in a health care setting, are much more likely to receive preventive services like prostate cancer screening, especially if they are anxious. Kotwal acknowledges that the PSA test is an especially interesting case, given the history of changing and conflicting recommendations.
“Right now, for prostate cancer screening the evidence is mixed on whether it ultimately benefits patients. But it’s the best tool we currently have to screen for prostate cancer. You typically have noticeable symptoms when it’s at a late stage,” he said. “So we’re kind of in a tight spot as providers. It’s either we screen men and expose them to the possibility for all these potential harms of prostate cancer diagnosis and treatment, or we don’t screen and more people will present with late stage prostate cancer.”
This situation puts a lot of emphasis on the doctors who counsel men on whether or not to get screened, and this data suggest an understanding of the nuances of how a patient’s emotions can significantly affect their decisions.
“Physicians are pretty good at judging how anxious or stressed a patient is,” Kotwal said. “So just being aware of that can help in making sure that patients are making informed decisions.” Hopefully, such attention to these emotional factors will lead to better choices for men regarding a disease that currently claims about 30,000 lives a year.
How Stress Affects Prostate Health
It’s probably not news to you that stress can have a significant impact on your health and that stress affects prostate health. What may be surprising is the severity of the effect of stress and anxiety on prostate conditions such as prostatitis, prostate cancer, and enlarged prostate (benign prostatic hyperplasia, BPH) and, perhaps more importantly, the benefits of emotional therapy, as a form of stress management, on prostate health.
How Stress Affects and Prostate Health
One way stress can have an impact on prostate health is if a man already has a prostate problem and he is anxious, fearful, worried, and perhaps even angry about having the condition. In such cases, the anxiety can make the prostate disease worse by impairing the ability of the immune system to fight the illness.
However, preventing a disease is always better than having to treat it once it develops, therefore it’s important to address stress and its role in contributing to or causing prostate problems. That is the topic discussed here.
How Stress Affects Prostate Cancer
Reducing the amount of stress in your life while also eating better and exercising regularly can slow the progression of early prostate cancer. According to Dean Ornish, MD, of the University of California at San Francisco, he and his team found evidence that these lifestyle changes can put the brakes on progression of this disease.
The study, which was published in the journal Urology in 2008, involved 93 men with prostate cancer. The men who followed a primarily vegan diet (no animal foods) and who participated in regular moderate exercise and relaxation methods such as yoga for one hour a day had better scores on the PSA test (prostate specific antigen), which was used to follow prostate cancer growth. Specifically, the men who followed this healthy lifestyle program experienced an average 4 percent decline in PSA while those who did not follow the program had an average increase of 6 percent.
In addition, patients who adopted these lifestyle modifications were less likely to need additional treatment. Ornish pointed out that this study was “the first randomized trial showing that the progression of prostate cancer can be stopped or perhaps even reversed by changing diet and lifestyle alone,” while also emphasizing that these changes should be used in addition to standard treatment and not as a substitute.
Another study explored the relationship between stress and prostate cancer at a chromosomal level. Specifically, Ornish and his team looked at how improvements in diet and lifestyle, including stress reduction, could increase the activity of an enzyme called telomerase. This enzyme helps protect telomeres, which are complex proteins that protect the ends of chromosomes and help prevent telomeres from shortening. Why is this important?
Because shortness of telomeres is associated with aging and with premature death in many cancers, including prostate cancer. Therefore, Ornish’s team investigated whether 24 men with low-risk prostate cancer who participated in three months of intensive lifestyle changes would experience any changes in telomerase activity.
Overall, telomerase activity increased, and the increase was significantly associated with declines in low-density lipoprotein (LDL) cholesterol and a decrease in psychological distress.
Stress, Prostatitis, and Enlarged Prostate
Prostatitis is a condition characterized by inflammation of the prostate, which results in pain in the pelvic and genital area and a variety of urinary tract symptoms. A small percentage of men with prostatitis have a form caused by bacteria, while the remainder mostly have a form called chronic nonbacterial prostatitis/chronic pelvic pain syndrome. Stress can impact both bacterial and nonbacterial prostatitis. While stress may worsen the symptoms of bacterial prostatitis, it may actually have a role in causing nonbacterial prostatitis.
In fact, some experts believe that just like people often tighten their neck or shoulder muscles when they are stressed, so, too, do some men unknowingly focus their stress (or at least part of it) on their pelvic floor muscles. Chronic tightening of the pelvic floor muscles may be a cause of prostatitis. Men who take steps to manage chronic stress may help prevent the development of prostatitis as well as reduce symptoms if they already have this prostate condition.
Stress can have several effects on an enlarged prostate. For men who already have BPH, stress can make symptoms such as urinary frequency, painful urination, and urinary urgency worse. Men also should be aware there is a relationship between zinc, stress, and BPH. Stress can lower zinc levels, and a zinc deficiency can cause the prostate to become enlarged.
Emotional Therapy for Prostate Health
Men who have a prostate condition should consult with their healthcare provider to find appropriate treatment for their symptoms. Among the options considered should be emotional therapy, which are techniques men can utilize to help them both acknowledge and address the impact of stress and anxiety on prostate health.
Emotional therapy can take a variety of forms, including psychotherapy, group therapy, meditation, guided visualization, breathing therapy, self-hypnosis—whatever helps an individual reach the goal, which is to release stress and tension and embrace and maintain a sense of calm and balance. Another critical part of emotional therapy is social support. Men who are struggling with a prostate health problem, such as an enlarged prostate, prostatitis, or prostate cancer, also can greatly benefit from emotional support provided by family and friends, as well as from other men who share their particular prostate condition.
If you are facing a prostate health challenge, your best bet for relief and recovery is to include emotional therapy as part of your treatment program. The importance of the mind-body connection needs to be addressed when treating prostate cancer, enlarged prostate, and prostatitis.
This article is from the WebMD News Archive. For more information on this topic visit: PSA Levels
May 27, 2003 — The PSA blood test is commonly used to check for signs of prostate cancer or other prostate problems. When a PSA level comes back high, the next step is often a biopsy. But a new study suggests another course of action: Another PSA test done more than a month later.
That’s because PSA levels can fluctuate up and down — so a man with a high PSA level may not actually have any prostate problems at all. In fact, after studying nearly 1,000 men, researchers found that about half of those whose PSA levels were initially high had a normal result in a subsequent test.
But unfortunately, says the study’s lead researcher, James Eastham, MD, FACS, of Memorial Sloan-Kettering Cancer Center, the initial finding of an elevated PSA is enough to warrant one of three typical responses from doctors.
“The first scenario, and a common one, is that the patient is referred for a biopsy, which may be unnecessary and painful,” Eastham tells WebMD. “The second is that the PSA is immediately repeated, within a week or so. But that will only take into account any possible lab error, since it’s not enough time to get a handle on natural fluctuations. And the third scenario is that the patient is assumed to have inflammation or infection in the prostate, and put on antibiotics or anti-inflammatory drugs.”
Instead, Eastham suggests taking no action until another test is done four to six weeks later — a time period that he says allows for a natural decrease in fluctuating PSA levels.
“The bottom line is that the recommendation for a biopsy should not be based on a single elevated test result, and a second test shouldn’t be given too soon after the first,” he says.
In fact, even after a second test produced elevated PSA levels, biopsy detected prostate cancer in only one of four of study participants, according to Eastham’s findings, published in the May 28 issue of TheJournal of the American Medical Association.
“But the study is unable to determine how many men with an elevated PSA level who later returned to normal still could have had prostate cancer — subsequent ‘normal’ tests may actually have been false negatives,” says Richard M. Hoffman, MD, MPH, of the University of New Mexico School of Medicine.
What factors can affect your PSA levels?
June 19, 2017
Prostate specific antigens, usually shortened to the acronym PSA, occur naturally in the prostate. PSAs are present in every man’s bloodstream. However, abnormally high levels of PSA may be a sign of prostate cancer.
That said, more often than not, if your blood test shows high PSA levels, the cause is something besides prostate cancer. Sometimes, the elevated levels can be caused by very common variables. A minor infection, a simple surgical procedure or even having sex before a PSA test could cause a worryingly high number.
Your age is an important factor. PSA levels over 2.5 ng/mL (that means nanograms of PSA per milliliter of blood) would be cause for concern for men under 50. For men over 60 years of age, however, PSA levels under 4.5 ng/mL are considered normal. The amount of naturally occurring PSA in your blood gets higher as you age. Furthermore, people of certain ethnic groups, may have naturally higher PSA levels.
Way of life
Certain activities are not recommended before taking a PSA test. If you exercise vigorously less than 48 hours before your PSA test, you could experience elevated PSA levels. This is especially common in people who ride bicycles for extended periods of time.
Anal sex or prostate stimulation within a week of a PSA test could lead to a high PSA number. Moreover, although not proven, ejaculation in the 48 hours before a PSA test could lead to a “false positive” test.
An enlarged prostate, a condition known as BPH (benign prostatic hyperplasia), can cause elevated PSA levels. Though this problem is not as serious as prostate cancer, it can cause trouble urinating. BPH does not cause cancer, however. It is quite common, affecting about half of all men by the age of 75.
Mild infections in the prostate are common in older men, but acute infections can cause other symptoms. If you are diagnosed with prostatitis you should wait until the infection is fully treated before taking (or retaking) a PSA test.
Urinary infection, a similar infection in the urinary tract, which is adjacent to the prostate, can cause high PSA levels. After this infection is fully treated, you should wait 4-6 weeks before retaking the PSA test.
Finally, if you have had a prostate biopsy in the past six weeks, your PSA levels may be significantly elevated. It is best to wait for at least six weeks to pass before retesting.
Any operation in the area near your prostate could cause a temporary spike in PSA levels.
It is important to keep these variables in mind when you are planning to get a PSA test. Being properly prepared can limit the chances of getting a high PSA number for some reason other than cancer. This will increase the effectiveness of the test when it comes to the early detection.
HOT NEWS, SCREENING
I Have High PSA Levels: How Do I Find Out If I Have Prostate Cancer?
Prostate cancer is the most common form of cancer in men. The first test most doctors use to screen for prostate cancer is the PSA (prostate specific antigen) test. A high PSA level can indicate the presence of cancer. But other factors besides cancer can cause an elevated PSA level. If your PSA level is rising, learn more about your options for finding out if you have prostate cancer.
PSA and Prostate Cancer: What Do My Numbers Mean?
The prostate is a walnut-sized gland that sits below the bladder in men. It is responsible for creating semen, the milky liquid that carries sperm out of the body when a man ejaculates.
A PSA (prostate specific antigen) test is a blood test used to screen for prostate cancers. PSA is a protein produced in the prostate by both cancerous and noncancerous tissue. Elevated PSA levels can indicate the presence of cancer, but high PSA levels can also be a result of non-cancerous conditions like benign prostatic hyperplasia (BPH), or an infection. PSA levels also rise naturally as you age.
Elevated PSA levels do not necessarily mean that you have prostate cancer. PSA tests aren’t always accurate: many men who have prostate cancer have normal PSA levels. Alternatively, some men have high PSAs but don’t have cancer. Or they have a slow growing form of cancer that would never have had symptoms or caused them any harm.
I Have High PSA Levels: What Next?
If your PSA shows elevated levels, you might be concerned, anxious, or worried. But an elevated PSA alone is not enough to indicate that you have cancer. Doctors must use other tools to learn more about what might be causing your elevated PSA level.
Digital Rectal Exam
A digital rectal exam is usually done at the same time that your doctor orders a PSA test. For a digital rectal exam, your doctor will insert a lubricated, gloved finger into your rectum to feel your prostate. By pressing on your prostate, your doctor may be able to detect any lumps or hard areas that might indicate the presence of cancer.
A prostate MRI is non-invasive imaging alternative that your doctor might recommend if your PSA levels are elevated. Often, it is the next step after a PSA test and a digital rectal exam, and before a more invasive prostate biopsy.
MRI stands for magnetic resonance imaging. An MRI machine uses magnetic and radio waves to produce detailed images of soft tissues and structures in the body, like the prostate. Prostate MRIs last about 30-45 minutes, and they are painless and non-invasive. A prostate MRI is accurate at detecting cancers, and can also detect other conditions like infections or BPH. .
If the results of your MRI are inconclusive, your doctor might next recommend a traditional prostate biopsy. A biopsy is a procedure that uses a needle to collect tissue from an organ or other part of your body. A prostate biopsy is usually performed with ultrasound guidance, so that the doctor can better tell where to guide the needle.
During the biopsy, a sterilized ultrasound probe is inserted into the patient’s rectum. Next, a physician will guide a very fine needle through the walls of the rectum and into the prostate. This needle will capture a tissue sample from the prostate gland. The doctor will repeat the process of guiding the needle into the prostate 6-12 times to get samples from different areas of the prostate.
Though ultrasound helps guide the needles to the prostate, it isn’t precise enough to tell cancerous tissue from normal tissue. Doctors do their best to take samples from all over the prostate, in the hopes that, if a harmful tumor is present, they will sample it. But if none of the samples taken is of an area with a tumor, that tumor might be missed.
MRI/Ultrasound Fusion Guided Biopsy: Working Together For Your Health
At UVA Health, we are proud to offer a new prostate cancer detection option: MRI/ultrasound fusion guided biopsy. Through a unique partnership between the UVA Radiology and Urology departments, we are able to use MRI imaging to help guide a biopsy in real time. This makes the biopsy much more accurate. It also reduces the risk of false negative or false positive results, and decreases the odds that you may have to repeat a biopsy.
How Fusion Guided Biopsy Works
First, a patient will have a prostate MRI. The MRI will image the prostate and any abnormalities in much greater detail than the ultrasound used for traditional biopsies. This allows the radiologist to better distinguish between abnormal and regular tissue.
Next, the patient will have an ultrasound-guided biopsy. A special machine attaches to the ultrasound probe and overlays the MRI image onto the ultrasound image. So when the doctor moves the ultrasound probe, the detailed MRI image moves with it in real time.
The doctor then biopsies the prostate with fine needles, using the MRI image to guide the needles directly to the areas with tumors or abnormal tissue. Because the MRI images are so detailed, doctors can more precisely target exactly where they need to biopsy. This means that far fewer clinically significant tumors are missed. This strategy also helps reduce the number of biopsies a patient might need by giving the doctor better information the first time.
High PSA Levels? Consider Fusion Guided Biopsy at UVA Health
The UVA Radiology and Urology departments are proud to offer fusion guided biopsies for patients who need to be screened for prostate cancer. If you have elevated PSA levels, speak to your doctor about having a fusion guided biopsy at UVA Health.