What is a Prostate-Specific Antigen (PSA)?

A Prostate-Specific Antigen (PSA) is a substance produced almost exclusively in the prostate and plays a role in fertility. The vast majority is released into the ejaculate, but tiny amounts are released into the bloodstream and can be detected by a simple blood test. 

Abnormally high levels of PSA can be an indication of disease of the prostate. Common reasons for a high PSA level in the bloodstream may include prostate cancer, large prostates, and age-related inflammation of the prostate or infection of the prostate. The first concern is to exclude prostate cancer.

What is a PSA Blood Test?

PSA blood tests are common diagnostic tools used to assess various aspects of prostate health, including the possibility of an enlarged prostate. 

A blood test for an enlarged prostate typically measures the levels of PSA in the bloodstream. PSA is a protein produced by the prostate gland. The test involves taking a small blood sample from a vein in the arm and sending it to a laboratory for analysis.

What is the Purpose of a PSA Test?

The primary purpose of a blood test for an enlarged prostate is to screen for prostate cancer and monitor the health of the prostate gland. Elevated levels of PSA can indicate various prostate conditions, including benign prostatic hyperplasia (BPH), which is commonly associated with an enlarged prostate, as well as prostate cancer.

Who is Suitable for a PSA Test?

• Men over the age of 50 are at increased risk of developing prostate conditions, including BPH and prostate cancer. Therefore, regular PSA screening may be recommended for this age group, typically starting at age 50. However, individual risk factors, such as family history and ethnicity, may influence the timing and frequency of screening, possibly starting in your 40s.
• Men with symptoms of an enlarged prostate include frequent urination, difficulty starting or maintaining a urine stream, weak urine flow, urgency to urinate, and incomplete emptying of the bladder. Men experiencing these symptoms may benefit from a blood test and PSA screening to assess prostate health and rule out other potential causes of urinary symptoms.
• Men with one or more risk factors of BPH may be candidates for earlier or more frequent PSA screening to monitor prostate health and detect any abnormalities early.
• Men who have been diagnosed with prostate cancer and are undergoing treatment may require regular PSA testing to monitor the effectiveness of treatment and detect any signs of cancer recurrence.
• The decision to undergo blood and PSA testing for an enlarged prostate should be based on individualised risk assessment and shared decision-making between the patient and their doctor. Factors such as overall health status, life expectancy, personal preferences, and potential benefits and risks of testing should be considered when determining the appropriateness of screening.

Benefits of PSA Blood Tests

• Early Detection of Prostate Cancer: PSA testing can help detect prostate cancer at an early stage when it's more treatable. Early detection may lead to better treatment outcomes and increased chances of survival.
• Monitoring Prostate Health: PSA Blood tests monitor PSA levels over time, which can help assess prostate health and identify any abnormalities or changes that may require further evaluation.
• Assessment of Treatment Efficacy: For individuals undergoing treatment for prostate conditions, such as BPH or prostate cancer, PSA testing can be used to monitor the effectiveness of treatment and detect any signs of disease progression or recurrence.
• Risk Stratification: PSA testing can help stratify individuals into risk categories based on their PSA levels, family history, and other factors. This information can guide doctors in determining each patient's appropriate management and follow-up strategies.
• Peace of Mind: For individuals with concerns about their prostate health, blood and PSA tests can provide reassurance if the results are within normal limits. Conversely, if abnormalities are detected, timely intervention and management can be initiated to address the underlying issue.

Types of PSA Tests

• Total PSA Test: The total PSA test measures the total amount of PSA in the bloodstream. It is the most common type of PSA test and is used to screen for prostate conditions such as BPH and prostate cancer.
• Free PSA Test: The free PSA test measures the percentage of PSA in the bloodstream that is not bound to other proteins. This test can help differentiate between benign prostate conditions, such as BPH, and prostate cancer. A higher percentage of free PSA relative to total PSA may indicate a lower risk of prostate cancer.
• PSA Density: PSA density calculates the concentration of PSA in the bloodstream relative to the size of the prostate gland. This measurement may help account for variations in prostate size among individuals and provide additional information for assessing prostate health.

Alternative Options to PSA Tests

• Digital Rectal Examination (DRE)
• Imaging Studies
• Uroflowmetry
• Biopsy
• Watchful Waiting or Active Surveillance

Preparation Before a Blood and PSA Test

• Consultation with doctor: Before undergoing a blood and PSA test, it's essential to consult with your doctor. They can provide information about the purpose of the test, its potential benefits and risks, and what to expect during and after the test.
• Medication Review: Inform your doctor about any medications, supplements, or herbal remedies you are taking. Some medications, such as finasteride and dutasteride, can affect PSA levels and may need to be temporarily discontinued before the test.
• Hydration: Drink plenty of water the days before the test to ensure adequate hydration. This can help make drawing blood and obtaining accurate test results easier.
• Relaxation Techniques: If you're feeling anxious or nervous about the test, practice relaxation techniques such as deep breathing or meditation to help calm your nerves and reduce stress.

Blood & PSA Test Procedure

• Preparation: You will be asked to sit or lie down comfortably. A healthcare professional will clean the area around a vein in your arm with an antiseptic.
• Blood Draw: A needle will be inserted into a vein in your arm, usually in the inner elbow or the back of your hand. A small blood sample will be drawn into a tube attached to the needle.
• Post-Blood Draw: After the blood is drawn, pressure will be applied to the puncture site to stop bleeding. A bandage or adhesive strip may be placed over the puncture site to cover it and keep it clean.
• Laboratory Analysis: The blood sample will be analysed in a laboratory to measure the levels of PSA in the bloodstream.

What to Expect After Blood & PSA Tests?

• Resume Normal Activities: In most cases, you can resume normal activities immediately after the test. There are typically no diet or physical activity restrictions following a blood and PSA test.
• Avoid Heavy Lifting: To minimise the risk of bruising or bleeding at the puncture site, avoid heavy lifting or strenuous exercise involving the arm from which blood was drawn for a few hours after the test.
• Monitor for Complications: While complications from blood and PSA tests are rare, it's essential to monitor the puncture site for any signs of infection, such as redness, swelling, warmth, or drainage. If you experience persistent pain, swelling, or bleeding at the puncture site, contact your doctor for further evaluation.
• Follow-up Appointment: Depending on the blood and PSA test results, your doctor may schedule a follow-up appointment to discuss the findings and any necessary further evaluation or treatment.
• Results: Your doctor will communicate your blood and PSA test results. If the results indicate any abnormalities or concerns, your doctor will discuss the next steps and any additional testing or treatment options.

Blood & PSA Tests Risks

• False Positives: PSA testing can sometimes yield false-positive results, indicating elevated PSA levels when no prostate cancer or other significant prostate condition is present. This can lead to unnecessary anxiety, further testing, and potentially unnecessary treatments. False-positive results may also result in overdiagnosis and overtreatment of prostate cancer, which can have adverse effects on quality of life without providing clear clinical benefits.
• False Negatives: Conversely, PSA testing can also produce false-negative results, indicating normal PSA levels even when prostate cancer is present. False-negative results may delay diagnosis and treatment, potentially allowing the disease to progress to a more advanced stage with a poorer prognosis.
• Risk of Overdiagnosis and Overtreatment: PSA testing has been associated with overdiagnosis and overtreatment of prostate cancer, particularly in cases of low-risk or indolent tumours that may not require immediate intervention. Overtreatment of low-risk prostate cancer can lead to unnecessary side effects and complications from treatments such as surgery or radiation therapy, with little to no benefit in terms of improving overall survival or quality of life.
• Anxiety and Psychological Impact: Abnormal results from blood and PSA tests can cause anxiety and psychological distress for individuals, particularly if there is uncertainty about the significance of the findings or the need for further evaluation or treatment. The psychological impact of undergoing testing and receiving potentially concerning results should be considered when discussing the risks and benefits of blood and PSA tests with patients.

What if Blood & PSA Tests are Delayed?

Blood and PSA tests play a crucial role in prognosis and risk assessment. Early detection through these tests can lead to timely intervention and improved outcomes for prostate cancer and other prostate conditions. However, there are also risks associated with testing, including false-positive and false-negative results, as well as the potential for overdiagnosis and overtreatment. 

Delaying testing may result in missed early diagnosis and monitoring opportunities, impacting treatment outcomes and prognosis. Therefore, the decision to undergo testing should be based on carefully considering the individual's risk profile, preferences, and overall health status.