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Free PSA ( Prostate Specific Antigen )

Free PSA ( Prostate Specific Antigen )

Overview

Prostate specific antigen (PSA) is a protein produced primarily by cells in the prostate, a small gland in males that encircles the urethra and produces a fluid that makes up part of semen. Most of the PSA that the prostate produces is released into this fluid, but small amounts of it are also released into the blood. PSA exists in two main forms in the blood: complexed (cPSA, bound to other proteins) and free (fPSA, not bound). The most frequently used PSA test is the total PSA, which measures the sum of cPSA and fPSA in the blood.

The PSA test may be used as a tumor marker to screen for and to monitor prostate cancer. The goal of screening is to detect prostate cancer while it is still confined to the prostate. However, most experts agree that screening should be done on asymptomatic men only after thorough discussions with their healthcare practitioners on the benefits and risks and after informed decisions are made to undergo screening. Elevated blood levels of PSA are associated with prostate cancer, but they may also be seen with inflammation of the prostate (prostatitis) and benign prostatic hyperplasia (BPH). PSA levels tend to increase in all men as they age, and men of African American heritage may have levels that are higher than other men, even at earlier ages.

PSA is not diagnostic of cancer. The gold standard for identifying prostate cancer is the prostate biopsy, collecting small samples of prostate tissue and identifying abnormal cells under the microscope. An elevated PSA may be followed by a biopsy, which has risk of complications such as pain, fever, blood in the urine, or urinary tract infection. (Read the article on Anatomic Pathology for more information on biopsies.) The total PSA test and digital rectal exam (DRE) are used together to help determine the need for a prostate biopsy.

Once the presence of prostate cancer is confirmed by biopsy, another decision must be made with regard to treatment. Prostate cancer is relatively common in men as they age and many, if not most, of the tumors are very slow-growing. While prostate cancer is the number two cause of cancer death in men, the slow-growing type is an uncommon cause of death and may never cause symptoms. A pathologist may be able to help differentiate between slow-growing cases and cancers that are likely to grow aggressively and spread to other parts of the body (metastasize).

Over-diagnosis and over-treatment of prostate cancer are issues with which health practitioners are currently grappling. In some cases, the treatment can be worse than the cancer, with the potential for causing significant side effects such as incontinence and erectile dysfunction. The PSA test and DRE cannot, in general, predict the course of a person?s disease. The free PSA test is sometimes used to help determine if a biopsy should be done when the total PSA is only slightly elevated

Preparation(Before)

Avoid ejaculation for 24 hours before sample collection as it has been associated with elevated PSA levels; avoid rigorous physical activity like bike riding; certain medications and herbal supplements can also affect PSA levels so be sure to tell your healthcare practitioner about any of these you are currently taking; the sample should be collected prior to your healthcare practitioner performing a digital rectal exam (DRE) and prior to (or several weeks after) a prostate biopsy as both of these can elevate PSA levels

Report delivery time

Samples should be collected prior to the digital rectal exam and a prostate biopsy. Report delivery. 96 hours.

Normal range

There's no such thing as a normal PSA for any man at any given age, but most men with prostate cancer have a higher than normal level. In general: Safe: 0 to 2.5 ng/mL. Safe for most: 2.6 to 4 ng/mL

Result explanation

PSA test results can be interpreted a number of different ways and there may be differences in cutoff values between different laboratories.

Many experts consider a PSA level less than 4.0 ng/ml (nanograms per milliliter of blood) to mean that it is unlikely that you have prostate cancer. However, some feel that this level should be lowered to 2.5 ng/ml in order to detect more cases of prostate cancer. Yet, others argue that this would lead to more over-diagnosing and over-treating cancers that are not clinically significant. There is agreement that a total PSA level greater than 10.0 ng/ml indicates an increased risk for prostate cancer (more than a 50% chance, according to the American Cancer Society, (ACS)). Total PSA levels between 4.0 ng/ml and 10.0 ng/ml may indicate prostate cancer (about a 25% chance, according to the ACS), benign prostate hyperplasia (BPH), or inflammation of the prostate. These conditions are more common in the elderly, as is a general increase in PSA levels. Total PSA between 4.0 ng/ml and 10.0 ng/ml is often referred to as the "gray zone." It is in this range that the free PSA may be useful (see next bullet). Free PSA?prostate tumors typically produce mostly complexed PSA (cPSA), not free PSA (fPSA). Benign prostate cells tend to produce more free PSA, which will not complex with proteins. Thus, when men in the gray zone have decreased levels of free PSA, it means that they have increased cPSA and a higher probability of prostate cancer. Conversely, when they have elevated levels of free PSA and low cPSA, the risk is diminished. The ratio of free to total PSA can help the individual and his healthcare practitioner decide whether or not a prostate biopsy should be performed. Additional evaluations of the PSA test results are sometimes used in an effort to increase the usefulness of the total PSA as a screening tool. They include:

Age-specific PSA ranges?since PSA levels naturally increase as a man ages, it has been proposed that normal ranges be tailored to a man's age. PSA velocity?the change in PSA concentrations over time; if the PSA continues to rise significantly over time (at least 3 samples at least 18 months apart), then it is more likely that prostate cancer is present. If it climbs rapidly, then the affected person may have a more aggressive form of cancer. PSA doubling time?another version of the PSA velocity test; it measures how rapidly the PSA concentration doubles. PSA density?a comparison of the PSA concentration and the volume of the prostate (as measured by ultrasound); if the PSA level is greater than what one would expect given the size of the prostate, the chance that a cancer is present may be higher. During treatment for prostate cancer, the PSA level should begin to fall. At the end of treatment, it should be at very low or undetectable levels in the blood. If concentrations do not fall to very low levels, then the treatment has not been fully effective. Following treatment, the PSA test is performed at regular intervals to monitor the person for cancer recurrence. Since even tiny increases can be significant, those affected may want to have their monitoring PSA tests done by the same laboratory each time so that testing variation is kept to a minimum.

Benefits

On average, free PSA testing can reduce the need for 20 percent of unnecessary biopsies. It also can help determine if there's a greater likelihood you have prostate cancer. If your results suggest that you may have prostate cancer, you'll still need a biopsy to confirm the prostate cancer diagnosis.

Common uses

The PSA test and digital rectal exam (DRE) may be used to screen both asymptomatic and symptomatic men for prostate cancer. PSA exists in two forms in the blood: free (fPSA, not bound) and complexed (cPSA, bound to other proteins). Lab tests can measure fPSA or total PSA (cPSA plus fPSA).

Most organizations, including the U.S. Preventive Services Task Force, the American Cancer Society, and the American Urological Association, recommend that men discuss the advantages and disadvantages of PSA-based screening for prostate cancer with their healthcare practitioner before making an informed decision about whether to be screened or not.

The total PSA test can be elevated temporarily for a variety of reasons. If an initial PSA is elevated, another PSA test may be done a few weeks after the first to determine if the PSA is still elevated. If the repeat test is elevated, a healthcare practitioner may recommend that a series of PSA tests be done over time to determine whether the level goes down, stays elevated at about the same level, or continues to increase. In cases where the cancer appears to be slow-growing, the healthcare practitioner and patient may decide to monitor its progress rather than pursue immediate treatment (called "watchful waiting" or "active surveillance").

If the DRE is normal but the PSA is moderately elevated, a free PSA test may be used to look at the ratio of free to total PSA. This can help to distinguish between prostate cancer and other non-cancer causes of elevated PSA.

If prostate cancer is diagnosed, the total PSA test may be used as a monitoring tool to help determine the effectiveness of treatment. It may also be ordered at regular intervals after treatment to detect recurrence of the cancer. The PSA test and digital rectal exam (DRE) may be used to screen both asymptomatic and symptomatic men for prostate cancer. PSA exists in two forms in the blood: free (fPSA, not bound) and complexed (cPSA, bound to other proteins). Lab tests can measure fPSA or total PSA (cPSA plus fPSA).

Most organizations, including the U.S. Preventive Services Task Force, the American Cancer Society, and the American Urological Association, recommend that men discuss the advantages and disadvantages of PSA-based screening for prostate cancer with their healthcare practitioner before making an informed decision about whether to be screened or not.

The total PSA test can be elevated temporarily for a variety of reasons. If an initial PSA is elevated, another PSA test may be done a few weeks after the first to determine if the PSA is still elevated. If the repeat test is elevated, a healthcare practitioner may recommend that a series of PSA tests be done over time to determine whether the level goes down, stays elevated at about the same level, or continues to increase. In cases where the cancer appears to be slow-growing, the healthcare practitioner and patient may decide to monitor its progress rather than pursue immediate treatment (called ?watchful waiting? or ?active surveillance?).

If the DRE is normal but the PSA is moderately elevated, a free PSA test may be used to look at the ratio of free to total PSA. This can help to distinguish between prostate cancer and other non-cancer causes of elevated PSA.

If prostate cancer is diagnosed, the total PSA test may be used as a monitoring tool to help determine the effectiveness of treatment. It may also be ordered at regular intervals after treatment to detect recurrence of the cancer

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