Andrew Siegel MD 6/20/2020
Many men know their exact cholesterol level and some even their HDL level. It is well-advised to have this knowledge, since cholesterol levels can profoundly affect cardiovascular health.
With rare exception, few men know their exact PSA level and some don’t know what PSA stands for, what the lab test is, or how it is used. Knowledge of one’s PSA level is arguably as important as knowing one’s cholesterol level. Today’s entry aims to convince you of the importance of “knowing your number” and the means of easily recalling that number.
- <a href=”https://www.freepik.com/free-photos-vectors/medical”>Medical vector created by freepik – http://www.freepik.com</a>
PSA—Prostate Specific Antigen is a protein made by the prostate gland that is measurable in the blood. It helps to screen for prostate cancer in men who do not have prostate cancer and to monitor prostate cancer in those who have the disease. The most informative use of PSA is to obtain the lab test annually and compare it on a year-to-year basis. PSA levels typically increase gradually and incrementally year-to-year, reflecting the typical benign growth of the prostate gland that occurs as we age. If the PSA accelerates at a rate greater than anticipated, it is a RED FLAG situation that demands further investigation since prostate cancer is the leading cause of such an acceleration.
PSA elevation or acceleration is a “RED FLAG” warranting further evaluation
(Thank you Wikipedia Commons for image above, Ssolbergj assumed author)
Q. What does the PSA protein actually do?
A. PSA liquifies semen after ejaculation to help the transit of sperm cells to the egg.
PUTTING PSA IN CONTEXT
Many labs use a PSA of 4.0 as a cutoff for abnormal, so it is possible that one can be falsely lulled into the impression that their PSA is normal if one’s current PSA is not compared to previous levels. For example, if the PSA is 1.0 and one year later it is 3.0, it is still considered “normal” (because it is < 4.0) even though it has tripled, making it highly suspicious for a possible underlying problem and mandating further investigation.
My PSA levels (starting age 40). Notice that PSA fluctuates a bit year to year. In the late 1990s, I started Finasteride, which essentially halved expected PSA.
10 Indisputable Facts Regarding Prostate Cancer and PSA:
- Prostate cancer is the #1 cancer in men (200,000 new cases and 33,000 deaths annually in the USA).
- Early prostate cancer causes NO symptoms at all.
- PSA = Prostate Specific Antigen blood test that screens for and monitors prostate cancer.
- The goal of prostate cancer screening is to diagnose and treat prostate cancer in its earliest and most curable stages.
- In general, the larger the prostate, the higher the PSA level measurable in the blood, since the prostate can be considered a “factory” that manufactures PSA.
- Because PSA values can fluctuate from lab to lab, it is always a good idea to try to use the same lab each year.
- Because ejaculation, riding a bicycle, motorcycle, horse, etc., can trigger more PSA release, it is always a good idea to avoid sexual activity and saddle sports for a day or so prior to PSA testing.
- Prostate cancer cells do not make more PSA than healthy prostate cells; prostate cancer increases PSA because of disrupted cellular structure of prostate cancer that permits more PSA to leak into the circulation.
- Other causes of PSA elevation are benign prostate enlargement and prostatitis.
- In men who have prostate cancer, a short PSA doubling time (< 3 years) is usually indicative of an aggressive, rapidly growing and progressive cancer, whereas a long PSA doubling time is indicative of an indolent, slower growing cancer.
PSA DENSITY
PSA density (PSA divided by prostate volume) corrects the PSA for the size of the prostate. The prostate volume can be determined by imaging studies including ultrasound or MRI. PSA elevations are less worrisome under the circumstance of an enlarged prostate. A PSA density > 0.15 is concerning for prostate cancer.
Bottom Line: Know your PSA…it can be lifesaving! Dr. Demian Frasnedo and his Argentinian colleagues have developed a new, user-friendly free app called PSAPP (for iPhone and Android). It calculates PSA density and PSA doubling time (the time it takes for the PSA to double–useful in men with prostate cancer). It allows one to record their PSA, calculate their PSA density and doubling time and record and share the results.
Wishing you the best of health,
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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery. He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community. He is a urologist at New Jersey Urology, the largest urology practice in the United States. His latest book is Prostate Cancer 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families.
Video trailer for Prostate Cancer 20/20
Preview of Prostate Cancer 20/20
Andrew Siegel MD Amazon author page
Prostate Cancer 20/20 on Apple iBooks
PROSTATE CANCER 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families is now on sale at Audible, iTunes and Amazon as an audiobook read by the author (just over 6 hours).
Dr. Siegel’s other books:
PROMISCUOUS EATING— Understanding and Ending Our Self-Destructive Relationship with Food
MALE PELVIC FITNESS: Optimizing Sexual and Urinary Health
THE KEGEL FIX: Recharging Female Pelvic, Sexual, and Urinary Health
Our Greatest Wealth Is Health 