Prostate cancer and PSA testing

  • Prostate is a small walnut sized organ present in men and is the part of male reproductive organ. It helps in the male fertility. Normal prostate size varies from 15-20 gm.
  • Prostate cancer is the most common cancer in men after skin cancer.
  • PSA (Prostate specific antigen) is the blood test which is specific for the prostate.
  • Though PSA is organ specific, it is not disease specific.
  • PSA is raised in many conditions such as prostatitis (prostate infection), prostate cancer, prostate abscess, BPH (benign prostate hypertrophy), acute retention of urine, urine infection, hematuria, prostate surgery etc.
  • Normal PSA value range from 0-4 ng/ml for an average sized prostate and its upper range value corresponds to the advanced patient age.
  • PSA is used for screening of prostate cancer as it is raised in these patients.
  • Raised PSA need thorough evaluation to rule out any other cause of elevation of PSA other than prostate cancer. These tests include DRE (digital rectal examination), urine routine/culture.
  • Absence of urinary infection or in an asymptomatic men with no prior urologic surgery, raised PSA suggests the possibility of harbouring prostate cancer and need further workup for same. These tests include mpMRI (Multiparametric MRI) prostate if PSA is more than 4 ng/ml and less than 10 ng/ml.
  • Any patients with raised PSA and having prostate which is hard on DRE or harbouring nodule, need prostate biopsy directly. Also, patient with PSA more than 10 ng/ml or more than 4 ng/ml and MRI showing high suspicion for prostate cancer need biopsy of prostate.
  • Free PSA (fPSA) is often useful for patients having PSA in range between 4-10 ng/ml. This blood test tells about the risk of prostate cancer in such patients.
  • Final diagnosis is with prostate biopsy in men having raised PSA and is done by the TRUS (Transrectal Ultrasound) under local anaesthesia.

Published by Dr Varinder Attri

MS MCh (PGI Chandigarh), Urologist and Andrologist

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