The Prostate Specific Antigen (PSA) test is a blood test that is frequently used as a screening test to detect the presence of benign enlargement of the prostate and of prostate cancer. Though the test cannot by itself be used to diagnose these conditions it is a very good indicator and, along with other screening tests, PSA testing can suggest the need for additional investigation.
The PSA test is usually recommended for men in high risk groups (like those with a family history of the condition) from the age of around 40 to 45 and for all men over 50.
An isolated PSA test will give a snapshot of prostate specific antigen levels in the blood and can indicate a problem immediately if you record a particularly high PSA level. However, in most cases, and when a prostate problem is in its early stages of development, a single PSA test result will prove to be inconclusive and a further test will generally be recommended in a few weeks time. Indeed, if possible PSA testing should be done regularly two or three times every year so that PSA levels can be viewed over time.
Providing you register a normal PSA score then all is well, but as soon as your PSA levels begin to rise they must be monitored very closely. The speed with which PSA levels rise is generally referred to as the 'PSA velocity' and as long as the rise is steady and the velocity slow then it is once again frequently sufficient simply to watch the situation as many things can effect PSA levels and seemingly rising levels will frequently be seen to fall back to normal given time.
However, where PSA test levels start rising rapidly and the velocity is fast then further investigation is required.
PSA testing and monitoring has been performed for some considerable time but, although the test has long been held as a good indicator of the requirement for additional investigation, it was not until very recently that we have been able to link specific PSA velocity to prostate cancer in a way that can foretell how aggressive prostate cancer is.
In a study carried out recently data concerning 950 men with prostate cancer who had undergone either radiation treatment or surgery between 1988 and 2004 at four hospitals was carefully analyzed.
In all cases each patient had been diagnosed as having aggressive prostate cancer on the basis of a single very high PSA score, the results of a biopsy indicating an aggressive cancer at cellular level, the presence of an advanced stage tumor, a noticeable rise in PSA velocity in the year prior to diagnosis or a combination of two or more of these pointers.
The study also looked in detail at the outcomes for all 950 men and discovered that a rapidly rising PSA level that rose by 2 or more points in a twelve month period was the best indicator or the presence of an aggressive cancer.
Up until this point we have been able to connect rising PSA test scores with an indication of the possible presence of prostate cancer but it has been necessary to guess to some extent about whether or not such a cancer might be aggressive and require correspondingly aggressive intervention.
Now however we can say with relative certainty that where a PSA level increases by more than 2 points in a year then prostate cancer is almost certainly aggressive and requires swift and vigorous treatment.
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