Healthy and cancerous prostate cells generate the prostate-specific antigen (PSA). The PSA test may determine the blood PSA level. This evaluation requires the submission of a blood sample for laboratory examination. Nuclear gamma (ng/mL) is the standard reporting unit for PSA levels in blood.

Since 1986, the FDA has permitted the PSA test to follow prostate cancer development in males with elevated PSA levels. In 1994, the FDA approved the PSA test for use in men over 50 to enhance digital rectal examinations (DREs) for prostate cancer detection. Until 2008, medical authorities and business associations recommended PSA testing at 50 for prostate cancer screening. Doctors may request PSA tests and a DRE to diagnose prostate pain. Prostatitis and BPH are two of numerous benign (non-cancerous) prostate conditions that may raise PSA. These illnesses may cause prostate cancer, although neither is proven to cause it.

PSA Test for Prostate Cancer Screening

In 2008, when the advantages and downsides of PSA prostate cancer screening became clearer, numerous medical associations advised against frequent population screening. Everyone believes patients should discuss the merits and cons of PSA screening with their doctors before undergoing it. Some associations recommend PSA testing for prostate cancer-prone men at 40 or 45. African-American men, men with BRCA2 (and BRCA1) germline mutations, and men with a family history of prostate cancer are at higher risk.

USPSTF changed the prostate cancer screening recommendation statement for males 55 to 69 from "D" (not recommended) to "C" (selectively giving PSA-based screening based on professional judgment and patient preferences) in 2018. (The USPSTF still advises against PSA screening for males over 70.) Even individuals at risk due to race, ethnicity, or family history should follow the amended recommendation:

• Each person between 55 and 69 should determine how frequently to have PSA screenings for prostate cancer. Patients should assess the pros and downsides of screening against their values and preferences before deciding with their doctor.
• PSA testing for prostate cancer is not recommended for men over 70.
• Anyone qualified for Medicare and 50 or older may have their PSA tested once a year at no cost to them. There are a lot of private health plans that will pay for PSA tests.

Normal PSA Test Range

There is no hard and fast rule on a normal or abnormal blood PSA level. Levels of 4.0 ng per milliliter or less were once considered typical for PSA. Although many men with PSA levels between four and ten ng/mL are not diagnosed with prostate cancer, some have the disease with levels below 4.0 ng per milliliter.

Additionally, the normal PSA test range might alter for many causes. Higher PSA levels are linked to larger prostates, inflammation, and advanced age. In addition to recent prostate biopsies, vigorous physical exercise like cycling two days before testing may elevate PSA values. Benign prostatic hyperplasia drugs like Propecia and dutasteride lower PSA. PSA levels raise men's prostate cancer risk on average.

After Elevated PSA Level

If a patient without prostate cancer symptoms wants a PSA test, a doctor may recommend a second one to confirm the initial result. The doctor may recommend frequent digital rectal exams (DREs) and PSA testing if PSA levels remain high.

The doctor may recommend further testing if the PSA level rises or a suspicious bulge is seen during a DRE. This includes MRIs and high-resolution micro-ultrasounds. A prostate biopsy may be recommended by the doctor. Inserting and withdrawing hollow needles into the prostate collects tissue samples. The perineum and rectum walls are the most frequent biopsy needle entrance sites. Pathologists analyze the tissue under a microscope. Ultrasonography helps clinicians view the prostate during both kinds of biopsies, but it cannot analyze prostate cancer.

Doctors used to provide medicines to individuals with high PSA levels who had no other symptoms to rule out an infection. In symptom-free males, antibiotics may reduce PSA. The American Urological Association claims this procedure lacks research.

Medical Improvements in PSA Testing

Researchers are trying to improve the PSA test so doctors can distinguish benign from malignant diseases and slow-growing, lethal cancers. Other prostate cancer indicators are being studied. There is no evidence that these diagnostics decrease prostate cancer mortality. Methods that are currently under investigation include

• The proportion of free PSA is the total amount of PSA divided by the "free" PSA in the blood. According to some research, lower free PSA levels may indicate more aggressive malignancy.
• A measure of blood PSA concentration divided by prostate gland volume. This test may be more accurate than the PSA test for prostate cancer, according to the study.
• PSA velocity is a man's PSA level's annual change in ng/mL. This is the time it takes a man's PSA to double. Men with biochemical recurrences following radiation or surgery are suitable candidates for these therapies.
• Several inert forms of PSA are collectively known as pro-PSA. Some evidence shows that pro-PSA is more strongly associated with prostate cancer than BPH. The Prostate Health Index is a mathematical method that combines PSA, free PSA, and [-2]proPSA into one blood test. A guy whose PSA level is between four and ten ng per milliliter may use this algorithm's "phi score" to determine whether he needs a biopsy.
• PSA is present in the blood in various structural forms or isoforms. To identify high-risk males for prostate cancer who should be biopsied the IsoPSA test may be preferable to regular PSA testing. This test examines the complete range of PSA isoforms instead of just the normal PSA test range.
• Consider an abnormal screening result. In such instances, the 4Kscore test uses total PSA, free PSA, intact PSA, and human kallikrein 2 to predict aggressive prostate cancer. Age, biopsy history, and DRE status are also considered.
• Urine biomarkers. Urine biomarkers include the TMPRSS2-ERG gene fusion and PCA3 messenger RNA. They are more specific for prostate cancer than PSA testing. However, they do not identify clinically relevant disorders well. Using these two markers combined may reduce unnecessary biopsies.