PSA Testing and When to See a Doctor for Screening

September 02,2021 |
Doctor talking to her patient.

All of the systems in your body rely on each other to function properly. In a healthy adult, everything is constantly working towards homeostasis. When things aren’t operating as they should, it creates a cascading effect throughout the body. This leads to the onset of symptoms, pain, or unease. You may begin to feel fatigued or have problems with one or more bodily functions. When this disconnect occurs, it’s important to see your doctor for any tests or screening procedures. Getting the proper diagnosis early on is the best way to improve rate of recovery. This is especially true when it comes to prostate cancer. Here we’ll discuss a common question among aging men who are concerned about prostate health: what is a PSA test?

What is a PSA Test?

PSA is an abbreviation for prostate-specific antigen, which is a protein that’s produced within prostate cells. It’s found in your blood stream at all times and the levels fluctuate based on the presence of certain diseases, infection, or prostate cancer. A PSA test is a way to measure the levels of PSA present in your blood at the time of screening. Small levels of PSA are natural, but heightened levels could be an indication of cancerous cells. However, the PSA test is not as straightforward as it sounds and there is still a lot of debate within the scientific community about its efficacy.

Risks of a PSA Test

The PSA test is performed on a sample of blood. The primary risks of undergoing these tests are the same risks associated with the general act of drawing blood. This includes fainting, excessive bleeding, or lightheadedness. After blood has been drawn, it’s important to protect the area to avoid infection. If the PSA test results indicate a problem, it could lead to biopsies, which can be uncomfortable and require a period of recovery.

Advantages of a PSA Test

The advantage of the PSA test is the detection of prostate cancer. Some experts believe that the PSA test can help identify certain types of prostate cancer that are more likely to metastasize or grow quickly. This means that early detection is essential for recovery. Early detection also requires less aggressive treatments, which lead to fewer or less severe side effects.

Limitations of the Test

The primary limitation of the PSA test is that it doesn’t tell you why PSA levels are heightened. Since elevated PSA can be an indication of other conditions like benign prostatic hyperplasia, prostatitis, and infection, the test can lead to a misdiagnosis. Similarly, certain types of prostate cancers don’t produce any PSA, which can give patients a false sense of security. Due to the limitations of this test, and surrounding controversy, many doctors rely more on other tests and procedures.

Factors That May Affect PSA Levels

As mentioned, there are a number of different factors that may affect PSA levels. Your urologist should keep these in consideration while discussing your results to avoid a false-positive or false-negative diagnosis. Always get clarification for anything that you want elaborated and ask questions as they come.

Some factors that can raise PSA levels include:


  • Enlarged Prostate – benign prostatic hyperplasia (BPH) is a non-cancerous enlargement of the prostate that can raise PSA levels.


  • Age – as men age, their PSA levels slowly increase—regardless of prostate abnormalities.


  • Prostatitis – infection or inflammation of the prostate can increase PSA levels.


  • Ejaculation – PSA levels raise following ejaculation.


  • Cycling – riding a bicycle has been shown to increase PSA levels for brief periods of time.


  • Urologic Procedures – certain procedures, especially those that target the prostate, can increase the PSA levels in your body.


  • Medications – certain medication can cause a spike in PSA levels.


Some factors that can lower PSA levels (even with prostate cancer) include:


  • 5-Alpha Reductase Inhibitors – these are commonly used to treat BPH or other urinary problems and can lower your PSA levels.


  • Herbal Mixtures – certain teas or dietary supplements can lower PSA levels.


  • Medications – while some medications increase PSA levels, others reduce them. To make sure that you don’t receive a false-negative, always tell your doctor what kind of medications and supplements you’re taking, even if it seems inconsequential.


Why is a Prostate-Specific Antigen Test Needed?

PSA tests are most beneficial in men who are between the ages of 50 and 74. If you’re under 50 or over the age of 75, a PSA is only recommended if you have a high risk of prostate cancer. This is due to the limitations of the test and types of prostate cancers. Typically, the fast-growing prostate cancers affect men of younger ages and require more immediate attention. Other types of prostate cancers grow slowly and therefore are better diagnosed using different tests. If you are experiencing any urinary symptoms or prostate problems, schedule an appointment with your urologist.

Variations of the PSA Test

In addition to the standard PSA test, there are a few variations that can be done to get a more comprehensive overview of the results. This is important to help improve the accuracy and avoid unnecessary biopsies.


  • PSA Velocity – this is a way to measure the change in PSA levels over a period of time. It allows doctors to look for fluctuations that may give more information to circumstances other than cancerous cells.


  • Percentage of Free PSA – free PSA (fPSA) is unattached to blood proteins. If both PSA and fPSA are high, it likely indicates a non-cancerous cause. If your PSA levels are high and your fPSA levels are low, prostate cancer may be a more accurate diagnosis.


  • PSA Density – density helps to measure the volume of PSA present in the blood, which can be an indication of cancer. Benign prostate conditions often don’t produce as much PSA per volume of tissue. This variation of testing usually requires either an MRI or transrectal ultrasound.


What to Expect Post Testing

After your PSA test, your doctor will likely want to discuss the results in person. This is because of the variability of the test. False-positives and false-negatives don’t always give you a concrete diagnosis and many times require further testing. To avoid causing any unnecessary phycological distress, expect to discuss results in person.

If you do have elevated PSA levels, your doctor will recommend follow-up testing to get a more accurate idea of what’s going on. Some of the tests that you may need to undergo include:


  • A Digital Rectal Exam – this is often done prior to PSA testing, but your urologist may recommend another one as a follow up to have a second look.


  • An fPSA Test – PSA and fPSA levels are compared to get a better idea of what’s happening as a whole.


  • Repeated PSA Tests – undergoing another PSA test may help identify temporary spikes in PSA due to outside circumstances.


  • Prostate Biopsy – a prostate biopsy is done to definitively determine whether or not prostate cancer is present. It involves removing a small sample of cells from the prostate to be examined in a lab.


A Few Words Regarding PSA Controversy

As we mentioned earlier, there is still a lot of controversy that surrounds the PSA test. Some experts believe that the potential misdiagnosis that accompanies high PSA levels may not be worth the benefits of such early detection. Since prostate cancer has such a high cure rate when caught early through routine digital rectal exams or other symptoms, the time difference a PSA test may provide could be negligible. What this means is that the sensitivity of the test may detect cancer that’s so small it would never become life-threatening. Heightened PSA levels can also be an indication of other prostate conditions, so the controversy comes with the distress a cancer misdiagnosis would cause. It’s now recommended that men be educated by their urologist prior to undergoing the test so that they can make this decision for themselves.

When to See a Doctor for PSA Screening

There are a few different instances where you should schedule a doctor for screening. If you have a family history of prostate cancer, or have already had prostate cancer yourself, talk to your doctor about PSA testing. If you’re experiencing any symptoms of prostate cancer or urinary problems in general, see a urologist. Finally, if you’re 45 – 50 and have never seen a doctor for a digital rectal exam, it’s time to schedule your first appointment. Prostate cancer has a fairly high curability rate, but only when it’s caught early. Seeing a urologist regularly will help ensure that you’re in the best position for recovery regardless of what’s causing your symptoms.

For more information on understanding your prostate and other urinary conditions, or if you need products to help during your treatment of urologic conditions, contact Byram Healthcare today.