Prostate-Specific Antigen (PSA) Testing

What is a PSA test?

A Prostate-Specific Antigen (PSA) test is a simple and quick way to screen for prostate cancer. PSA is a protein made in the prostate gland and found in semen. Small amounts of this protein make their way into the blood and can tell doctors if there are problems with the prostate through a PSA blood test.

PSA is often elevated in men with prostate cancer, making a PSA screening test the best tool for early detection. However, the PSA can be elevated due to other benign conditions and does not necessarily mean that there is prostate cancer present. Therefore, screening for prostate cancer typically includes a blood test combined with a digital rectal examination (DRE) of the prostate.

There are conflicting opinions on who should be screened for prostate cancer using the PSA test. Ultimately it should be a shared decision made by you and your doctor, who will help you weigh the pros and cons based on your risk factors.

About PSA screening

This type of screening can detect prostate cancer early, which can help you get timely treatment before it becomes advanced and much harder to treat. The test typically takes around 20 minutes and can be completed in your primary care doctor's office or at a local lab. There isn't much you need to do to prepare, although you may want to avoid biking or sexual activity 24 hours beforehand. Most major health insurances cover one prostate cancer screening every year. If you have urologic-related symptoms, your insurance may cover you for additional tests, as needed.

The test is straightforward, but the results aren't always. Screening can detect high prostate-specific antigen levels, but an elevated level doesn't mean you will develop prostate cancer. An inflamed or enlarged prostate can also result in elevated PSA. That's why it's important to have your test results analyzed by an experienced urologist. If your PSA level is high, a doctor trained in urology will discuss your results and recommend next steps.

Early detection is key

Prostate cancer grows slowly over time, many men don't know they have it because they don't have any symptoms. Catching the disease early with a prostate cancer screening will increase your chances of catching it early when it is easier to treat.

Survival rates are high when caught in the early stages, as 95 percent of men who get early treatment are alive at the five-year mark. If you wait to get a prostate cancer test, you increase your risk of allowing prostate cancer to progress. When the disease becomes advanced, the five-year survival rate drops to about 30 percent.

Men with average risk should talk to their doctor about getting their PSA levels checked starting at age 45.

There are certain things that can increase your prostate cancer risk, including:

Having a family history of the disease
Being African American
Knowing you have a genetic mutation associated with prostate cancer (e.g., the BRCA genes)
Are over 50 years old
Smoke
Are obese

If you have an average risk of prostate cancer, we recommend you start having conversations with your doctor about getting screened beginning at the age of 45 and continuing through 70. If your risk is low, your doctor may suggest less frequent screenings.

However, if you have a high risk of developing prostate cancer, your doctor may recommend earlier or more frequent PSA tests. For example, if your brother was diagnosed with prostate cancer, you may benefit from annual screening starting at 45.

Frequently asked questions

What is a normal PSA?

Most doctors agree that a normal PSA is between 0 and 4.0 ng/ml for the most common PSA tests. However, if your doctor uses a different PSA test, the results may be interpreted differently.

PSA is usually high in men with prostate cancer. However, some men may have high numbers in their blood and do not have prostate cancer. That is why it is important to be seen by a urologic oncologist with experience in treating this form of cancer.
Why does PSA rise?

If the prostate cells begin to break down or make more of the protein, they will escape into the blood. This causes the numbers to become elevated, signaling that there may be a problem with prostate function.
What do the results mean?

Any test result higher than 4.0 ng/ml usually signals a problem with the amount of PSA in the blood. There is a reason why the level in your blood is higher. However, it does not always mean that you have cancer.

If your PSA is elevated, one of our specially-trained urologists will determine what your next steps should be. This test is only one tool for diagnosing prostate cancer. A digital rectal exam and other imaging techniques, including a prostate biopsy, will be used to diagnose prostate cancer.

If a biopsy confirms prostate cancer, you can trust that we have the technology and experience necessary for delivering the best possible care. We treat more patients for prostate cancer than most health systems in the region, and you'll benefit from the latest discoveries in prostate cancer care that lead to excellent outcomes.
How often should I be tested?

We recommend repeating the test annually at your annual physical. However, if you have elevated levels, your doctor may recommend testing more often.

Looking for expert cancer care?

With multiple locations throughout the region, patients have access to many of the nation’s renowned cancer specialists offering high quality care, second opinions and a chance for better outcomes close to where they live and work. Georgetown Lombardi Comprehensive Cancer Center, one of the nation’s comprehensive cancer centers designated by the National Cancer Institute (NCI), serves as the research engine allowing patients access to clinical trials that often lead to breakthroughs in cancer care.