What is PSA

The PSA test, which stands for prostate specific antigen, is a simple blood test that can save lives '??" yet also raise unnecessary anxiety. It is the mainstay risk assessment for prostate cancer because high levels of PSA are present in prostates with cancer. Equally however, a raised PSA can be caused by a non life-threatening condition called benign prostatic hyperplasia (BPH).

To complicate matters further, prostate cancer can, in some cases, be very slow growing and present no short or medium term risk to health. So '??" how do you know whether a raised PSA level is something to worry about?

The first point to make is that PSA levels rise with age simply because the prostate grows and a larger prostate will produce more PSA. To reflect this, there is a set of ''age-related thresholds''?? which guide doctors. If your PSA is above the age related threshold for your age, it is considered to be raised. PSA is measured in terms of nanograms per millilitre (ng/ml) and upper limits per age group are as follows:

Age 40-49: 2.5

Age 50-59: 3

Age 60-69: 4

Age 70 +: 5

Your PSA level is only a risk assessment, not a diagnosis of prostate cancer. There are a number of other factors and tests which are taken into consideration when assessing your risk and deciding whether to do a biopsy for a full diagnosis. Your GP may carry out a DRE (digital rectal examination). If your prostate feels hard or irregular, your GP will refer you to a urologist who is a prostate cancer specialist.

Another trigger for referral is if there is a history of prostate cancer in your family, especially a father, brother or first cousin who has had the disease. Family history is a significant risk factor. Your doctor will also consider how your PSA is behaving over time. A PSA which is slightly above the age-related threshold but remains at the same level over the period of a year or two will be less of a concern than a PSA which rapidly rises over a period of months, yet may be within the threshold.

If you have any urinary symptoms, such as getting up to go to the toilet very frequently at night and urgency, this will be considered although these symptoms are usually more likely to be signs of BPH rather than prostate cancer.

A urologist will carry out a number of additional tests. These assessments may include transrectal ultrasound imaging of your prostate and some specialist clinics are also referring patients for MRI prostate mapping before diagnosis to help understand an individual''??s risk. There is also a test called PCA3 which is genetically based and measures risk in a different way to the PSA test. Combining PCA3 and PSA provides a very detailed picture of your individual risk when assessed by the experienced urologist.

Urologists are keen to avoid unnecessary biopsies but at the same time, identify significant prostate cancer. This has sometimes been described as ''?telling the prostate cancer tigers from the pussy cats.''? A biopsy is a set of tissue samples from your prostate which are examined in the laboratory for signs of prostate cancer. Your diagnosis will involve staging and grading, which means assessing how far the cancer has spread and evaluating how aggressive the disease is.

In conclusion, a raised PSA should be treated as an ''early warning sign''?? which offers the opportunity of identifying prostate cancer, but may be a false alarm.

A raised PSA certainly does not mean you have prostate cancer. Very high levels, such as 20 and above, are a major cause for concern, but are fairly uncommon. If your PSA is raised, it is very important that you have a prompt referral to a urologist who specialises in the treatment of prostate cancer and can offer a wide range of the most advanced tests.

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