The PSA test

The diagnosis of many diseases starts with a single test. Unfortunately, at this time, there is not a single inexpensive test that proves, or otherwise, the presence of Prostate Cancer.

However, it has been found that an antigen, Prostate Specific Antigen, or PSA, is present in the bloodstream, and that its concentration is usually raised in the presence of cancer. Hence this test is almost universally the test of choice to begin the path of diagnosis for Prostate Cancer.

A “normal” PSA is usually below 3 for men in their 50’s rising to 5 past 70 years of age. If raised, at least one further test is required to prove the presence of cancer, as it can be raised for reasons that are benign and non cancerous. Note that the actual PSA value has a very large range. For example both my cousin and I had equally serious Prostate Cancer at first diagnosis. I had a PSA of 7.6 whereas he had a PSA of 100. Numbers in the thousands can occur, but in all cases wait until all the facts are known before concluding anything about any cancer that may be present.

In the past, the “next” test was to perform a biopsy on the Prostate Gland, a methodology that had some “hit and miss” characteristics leading to something of a “bad press” for the PSA and many GPs therefore felt that the PSA test was not warranted. This is a bad line to take as without a PSA reading, the possible presence of cancer cannot be established with any reasonable certainty unless a far more expensive procedure is employed.

In recent years MRI technology has advanced to a point at which it is possible to prove the existence of cancer at a very high level of certainty opening up the possibility for many more men to come forward, even if they have no symptoms, and be tested for the presence of this disease. An abnormal PSA level is normally a precursor to having an MRI scan. However, a man could opt to have an MRI scan as his first test and cut out the PSA test, but this is an expensive route to diagnosis if applied to all men. In the long term, also, it is advisable to have the history of PSA levels so that the disease can be tracked more carefully. So having an initial PSA value is advisable, even if it is in the normal range and an MRI scan is being performed in view of other suspicions.

So, in terms of “my” journey, the path taken was to measure my PSA level – which was 7.6 and well above the point, 5, at which it would be considered normal, and then move to an MRI scan. Although I had no significantly positive symptoms of the disease, the MRI scan showed that I was already well advanced with the disease and at Stage 3 – meaning that the cancer had already broken out of the Prostate Gland.

I regularly read on the various prostate cancer sites and forums of men, like myself, who had no symptoms and who are eternally grateful that they insisted on having a PSA test “just to make sure”. If you are over 50, and definitely if over 60, and you are asking yourself “Do I need a PSA test?” then think no longer – have one – you may have no symptoms but be harbouring the disease. The earlier this disease is caught the better. However, whatever stage you catch it, if you have a significant cancer, you will definitely live longer if it is diagnosed and treated.

Thanks to MRI there is hope: hope for early/ accurate/ non-invasive diagnosis; hope for cure. Proceed with optimism. Take the PSA test. 

You may watch the video on the PSA test provided by the Prostate Cancer Research Institute.

The importance of the PSA test after Treatment

The PSA test is very important after a man has been diagnosed and treated. For most commonly used treatments, the PSA should very slope to zero – so initially it can indicate the efficacy of the treatment. “Zero” is often written as “unrecordable”.

Then, if at some point there is movement and velocity of the PSA reading from its established nadir, it can be a warning of recurrence, and this should be investigated at the earliest opportunity. There are plenty of ways of dealing with a recurrence whether or not a radiation modality or surgery was the primary mode of treatment.