PSA Tests

What is PSA?

Prostate-specific antigen (PSA) is a small protein that is secreted from the prostate into the blood and can be measured in the blood in nanograms per millilitre (ng/ml).

It’s normal for men to have a small amount of PSA in their blood. However, raised amounts of PSA may indicate a prostate problem including prostate cancer.

When it comes to levels of PSA in the blood it’s worth noting a few things:

• The amount of PSA per millilitre rises slightly as you get older, and your prostate gets bigger.
• A raised PSA may suggest a problem with your prostate, but it does not automatically mean you have prostate cancer.
• PSA is used as a marker of prostate cancer, but PSA is ‘prostate specific’ not ‘cancer specific’.

What is a normal PSA level for my age?

The normal range of PSA is debated. While some guidelines include a range of less than 3ng/ml being ‘normal’, if you do not suffer from urinary symptoms. Others use an age-specific range to determine ‘normal.

The age specific ranges recommended by NICE are:

Men in their 40s: A PSA score greater than 2.5 ng/ml is considered abnormal.

Men in their 50s: A PSA score greater than 3.5 ng/ml is considered abnormal.

Men in their 60s: A PSA score greater than 4.0 ng/ml is considered abnormal.

Men in their 70s: A PSA score greater than 6.5 ng/ml is considered abnormal.

Other factors that are taken into consideration are the size of your prostate (PSA density) and how fast PSA has been rising (PSA velocity).

When should you start screening your PSA levels

For any man it’s a good idea to start screening your PSA level from the age of 50, as it’s from this age and onwards men are at most risk of developing prostate cancer.

We recommend men with a higher risk of getting prostate cancer (e.g. a family history of prostate or breast cancer, are of black ethnic origin, or are overweight/obese) start screening at the earlier age of 45.

If your PSA is higher than the ‘normal’ level for your age. Or if your doctor sees a significant rise since your last test, they may recommend further tests.

It’s worth noting that your PSA level isn’t the only factor in deciding next steps. A doctor will also take into consideration a range of other factors that can cause an elevated PSA.

Causes of raised PSA

There are a number of reasons PSA can be raised:

1. Enlarged prostate

The prostate is very enlarged, usually through a benign process such as Benign Prostatic Hyperplasia (BPH).

If your prostate is enlarged it is more likely to secrete higher amounts of PSA. If your MRI scan shows an enlarged prostate without suspicion of prostate cancer we will calculate the PSA density (amount or PSA released per millilitre) which might give a reason for the PSA to be raised and provide reassurance.

2. Inflamed prostate

PSA is elevated through activity in the prostate usually due to inflammation.

This inflammation could be because of a current or previous infection (e.g. prostatitis) or recent instrumentation of the urinary tract (e.g. a catheter). This is an entirely benign process and is the most common cause of artificially elevated PSAs. Trauma or exercise while cycling could also transiently raise PSA, although this should go back down with time.

3. Prostate cancer

The main reason to investigate raised PSA is to rule out prostate cancer.

Prostate cancer comes in many forms, from slow growing cancers that will not make a difference to a patient’s length or quality of life, to aggressive tumours that can spread.

If you are diagnosed with prostate cancer you will be given a Gleason score, which is made up of the two most common patterns of prostate cancer seen in your prostate. This combined with your PSA and stage (how far the prostate cancer has spread locally) will be used to determine how aggressive your prostate cancer is and how we should treat it.

More recently NICE has recommended using the Cambridge prognostication group to help decide.

Cambridge Prognostication Group	Risk Factors
1	Gleason score 6 and PSA less than 10 microgram/L and stages T1–T2
2	Gleason score 3 + 4 = 7 or PSA 10–20 microgram/L and stages T1–T2
3	Gleason score 3 + 4 = 7 and PSA 10–20 microgram/L and stages T1–T2 or Gleason 4 + 3 = 7 and Stages T1–T2
4	One of: Gleason score 8, PSA more than 20 microgram/L, Stage T3
5	Two or more of: Gleason score 8, PSA more than 20 microgram/L, Stage T3 or Gleason score 9–10 or Stage T4

Here at The Urology Partnership we can offer a full range of treatments, from active surveillance for low risk disease to robotic assisted radical prostatectomy for intermediate or high risk localised prostate cancer.

Our specialists Luke Stroman and Adam Jones both regularly perform a high volume of robotic radical prostatectomy ensuring a high quality of surgery.

If you notice a change in your normal urinating patterns and are concerned it is advisable to seek medical advice. Urinary problems are often caused by something other than cancer, for which there are treatments that will help.

Diagnosing raised PSA

1. PSA blood test

The PSA test is a blood test that measures the amount of PSA in your blood. An elevated PSA level may suggest you have a problem with your prostate.

The test involves taking a sample of your blood. A laboratory then tests this sample to establish the amount of PSA you have in your blood. The result is then given as the number of nanograms per millilitre of blood (ng/ml).

While a PSA test can help to indicate a prostate problem. It alone can’t tell you whether you have prostate cancer. Further investigative tests and diagnosis may be recommended.

2. Digital Rectal Examination (DRE)

As well as a PSA test, we might also perform a digital rectal examination. This allows a consultant urologist to feel for any changes to your prostate gland. This is done by inserting a gloved, lubricated finger into your rectum. While a little undignified, it is painless and provides a consultant urologist with valuable information.

A DRE on its own is not enough to detect cancer, so further tests such as an MRI scan and biopsy may also be performed.

3. MRI Scanning

If you are found to have a raised PSA or a suspicious digital rectal examination you will be recommended to undertake an MRI of your prostate. Prostate MRI has been shown to be accurate in being able to predict whether there is prostate cancer in your prostate. If there is suspicion of prostate cancer then we will arrange a targeted biopsy of your prostate, targeting abnormal areas on MRI.

4. Transperineal prostate biopsy

At The Urology Partnership we believe that targeted transperineal prostate biopsy based on MRI findings allows us to perform optimal biopsy while minimising the risk of infection.

Transperineal prostate biopsy can be performed under local anaesthetic.

Benefits of local anaesthetic prostate biopsy include:

• It avoids the risks associated with general anaesthetic.
• It might reduce the chance of difficulty passing urine (urine retention) following the procedure.
• The procedure can be done in an outpatient clinic therefore avoiding a
  hospital visit.
• There are quicker recovery times as no general anaesthetic.
• It’s less expensive with no hospital/anaesthetist fees.

Following prostate biopsy we’ll arrange for you to have a face-to-face appointment with one of our prostate cancer specialists, to discuss results and make a personalised plan going forward.

Fast access to PSA tests and results

If you’re at all concerned about your prostate health we offer fast access to tests and diagnostics to identify the cause of raised PSA, before recommending the best course of treatment for your individual case.

Please contact The Urology Partnership on 0118 920 7040 or make an appointment with one of our specialists.