Prostate Specific Antigen (cont.)
Kevin C. Zorn, MD, FRCSC, FACS
Dr. Kevin Zorn is a dual-board-certified (US and Canada), minimally-invasive uro-oncology, fellowship trained urologist at the University of Chicago. His main focus of clinical and scientific interest is in the surgical treatment of renal and prostate cancer. He is also an expert in performing surgery with the DaVinci Surgical Robotic System to manage localized prostate cancer and small renal masses. Dr. Zorn studied medicine and urology at McGill University in MontrĂ©al.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
- Prostate specific antigen (PSA) facts
- What is prostate specific antigen?
- How is PSA measured?
- What causes PSA elevation in the blood?
- What are normal results for the PSA test?
- What are age-specific reference ranges for serum PSA?
- How is PSA used for early detection prostate cancer?
- What is the free PSA test?
- What is free/total PSA ratio?
- What is PSA velocity and PSA doubling time?
- How is PSA testing used for pretreatment staging of prostate cancer?
- How is PSA testing used in the management of prostate cancer posttreatment?
- What are the limitations of the PSA test?
- What is digital rectal examination (DRE)?
- What is the PSA screening controversy?
- How should the PSA test be used for the early detection of prostate cancer?
- What is PCA3?
How is PSA testing used for pretreatment staging of prostate cancer?
Once prostate cancer is diagnosed by the presence of cancer cells on prostate biopsy, PSA is used for cancer staging. Staging is used to decide what is the best management and appropriate treatment for the cancer. Serum PSA levels correlate with the risk of prostate cancer extension outside of the prostate including seminal vesicle invasion and lymph node involvement. The proportion of men with cancer confined to the prostate is about 80% when the PSA level at diagnosis is less than 4.0 ng/mL; about 70% when the PSA level is between 4.0 and 10.0 ng/mL; and about 50% when the PSA level is greater than 10.0 ng/mL. This is why patients with serum PSA levels of less than 10.0 ng/mL are most likely to respond well to local therapy such as prostatectomy (surgical removal of the prostate) or external beam radiation (radiation therapy). Over the past few decades, several predictive tools (otherwise called nomograms) have included the PSA in their parameters to predict posttreatment outcomes. These nomograms include the Partin and Kattan nomograms. For instance, the Kattan nomogram is an online predictive tool that is available to the public.
How is PSA testing used in the management of prostate cancer posttreatment?
A periodic PSA determination is used to detect disease recurrence after treatment. Serum PSA should decrease and remain at undetectable levels after local treatment such as radical prostatectomy. Following initial therapy, a PSA increase indicates recurrence of prostate cancer. For example, if the prostate gland is surgically removed, and all of the cancer is contained within the gland, then the PSA should drop to zero. Similarly, serum PSA should fall to a low level following radiation therapy, high intensity focused ultrasound, and cryotherapy.
If on subsequent testing the PSA test is positive and shows increasing levels, it means that not all of the cancer was successfully removed and it is recurring. In addition, depending on the PSA level of the increase, it is possible that the cancer has now spread outside of the prostate.
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