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Prostate-specific antigen (PSA)

Introduction

PSA is an organ-specific enzyme produced by epithelial cells of the prostate. In healthy men, most of PSA is secreted into seminal fluid liquifying semen and only a small amount of it leaks into circulation. Normal PSA levels in the blood amount between 0-2.5 ng/ml. As a man ages, his prostate is getting larger, leading to slightly higher normal levels of PSA. 

Based on age, what PSA level might trigger visiting urologist? Austrian researchers found the following age range PSA trigger levels which may significantly reduce the incidence of biopsies.

 Age Range PSA Trigger Levels

Less Than 59 Years PSA 1.75 ng/mL

Between 60-69 years PSA 2.25 ng/ml

Greater than 70 years PSA 3.25 ng/mL

So the architecture of the prostate tissue keeps PSA confined to the gland. However, any disease condition of the prostate, whether it’s cancer, inflammation (prostatitis), or benign prostatic hyperplasia (BPH) may compromise the integrity of the prostate tissue and increase the level of PSA leaked into circulation and detected by PSA test. Moreover, prostate massage, biopsy, or transurethral resection of the prostate can also elevate the serum PSA level. So, actually, none of the PSA triggering factors boost the real PSA synthesis in the prostate cells; PSA expression in cancer cells was found even slightly depressed.  Moreover, the incidence of prostate cancer in men with PSA levels below the accepted level of 4.0 ng/mL was found to be comparable to that of patients with PSA between 4.0-10.0 ng/mL. All the said alow to state that PSA should not be used as a prostate cancer marker. 

The most relevant information about the PSA test you can read in the post of the National Cancer Institute presented below.

 

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Conclusions

Summing up all of the above, one can conclude:

  1. PSA may be used as a sign of prostate tissue integrity.
  2. Leakage of excess PSA into the bloodstream may be caused by various factors including prostate cancer.
  3. Do your PSA test only to know the health status of your prostate, without any reference to prostate cancer.

In my opinion, it was a great mistake to approve the use of the PSA test to screen asymptomatic men for prostate cancer. We know that a high rate of PSA may indicate the presence of a prostate tumor. But it is the same as we know that people who have more than 100 birthmarks are more prone to skin cancer. It is good to be aware of that to take care of skin health and avoid harmful contacts that may trigger malignant transformation. However, this is not a cause of constant concern, affecting the quality of life, and forcing long visits to doctors.

Do your PSA test to assess the health status of your prostate.

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