Is PSA reliable?

How reliable is the prostate-specific antigen (PSA) test when it comes to detecting prostate cancer?

Kevin R. Loughlin, M.D., M.B.A., director of Urologic Research at Brigham and Women’s Hospital, responds:

Although PSA testing can help catch prostate cancer at an early stage, having an elevated PSA (generally considered more than 4 ng/ml) doesn’t necessarily mean that a man has cancer. Noncancerous conditions, including benign prostatic hyperplasia (BPH), or an enlarged prostate, and prostatitis, can raise PSA levels. In fact, studies have shown that about 70% to 80% of men with an elevated PSA who have a biopsy do not have cancer. However, many men undergo an ultrasound and prostate biopsy, to be certain.

Conversely, the PSA test doesn’t detect all cancers. About 20% of men who have cancer also have a normal PSA (less than 4 ng/ml), so the test may give some men a false sense of security. For this reason, some experts take a man’s age into account when considering a PSA level. And most doctors observe how a man’s PSA level changes over time, a measure called PSA velocity, rather than using it as a one-time indicator. PSA scores tend to rise more rapidly in men with cancer than in those with BPH, for example.

Some doctors also measure the level of free PSA. The PSA protein circulates in the blood in two forms: bound to other proteins or unbound (free). Several studies suggest that men with elevated PSA levels and a very low percentage of free PSA are more likely to have prostate cancer than a benign condition. Knowing your free PSA level won’t give you a definitive answer about cancer, but it may be useful when considering whether a biopsy is an appropriate next step.

Researchers are developing new screening tests for prostate cancer. Like the PSA test, they rely on biomarkers, such as antigens or proteins, which are elevated or may only be present in men who have prostate cancer. The hope is that these tests will better detect existing cancers without raising the alarm for cancer when it isn’t there.

Originally published November 2009; last reviewed March 16, 2011.

Comments
37
James Jennings

I am 70 this year; never taken medicine to correct any medical condition; am in excellent health; 5′-10″, 180 lbs; workout in a gym regularly; no noticeable urinary or sexual problems. I had an annual physical from age 50; never any issues; perfect health. I live
much of the year in Mexico and did a physical after a 7 year hiatus, which was good, as always; however, the PSA came back at 8.3. I have read a lot about prostate and find it to be quite a difficult thing to in down. The Mexican doctor was talking surgical procedure even before any discussion or additional/retests. I have excellent US health insurance, which I have seldom used for the past 50 years. I am looking to set up an office visit in Boca when I am back in the States mid-June. Some written material suggest at my age, the problem is best left as is. Any thoughts? Jim

Jim

You are 70 and in good health. your chances of dying from old age are better than dying from prostate cancer. Also, the PSA test is a bs test. The person who developed the test no longer supports PSA testing. what does that tell you?

susanne may

My boyfriend is having problems with pain in his platter , he also gets sharp pains in his penis and it feels weird when he has an orgasm. Would that be a problem coming from his prostate?

kapm

Two comments;

1. A psa test is only one test and should be seen as one step towards a diagnosis. A PSA test of and by itself is nothing. Anyone who does not have other diagnostic tests and goes by a single PSA test seems to acting from a place of fear, instead of a place of fact.

2. susanne, get your boyfriend into a doctor as soon as possible. These are not symptoms that should be taken lightly. While they could be signs of an infection, if the infection is left untreated it is not a good idea. The sooner you both get information the better. Just about any disease or infection that is left untreated can get worse. Please don’t let your boyfriend whimp out of this. Men are terrible when it comes to dealing with “male” problems.

Joe

Went to the urologist due to overactive bladder. He gave me a PSA test and it came back 5.5 and the Percentage Free PSA was 16%. He recommended an ultrasound and biopsy. I told him I would hold off and maybe consider it down the line. Should I have the ultrasound/biopsy done sooner? What are my considerations. Thanks.

Chaminda manage

I have been suffering from pain in my prostate since april this year. I am 45 years old.I have done all the tests to find out bacteria infection, but did not found bacteria in the prostate.I would like to know why my pain intensify in the night after eat high carbohidrate diat. Plea give me answer becaus i am suffering too much.

Andre' Gentile

I have been on hormone therapyabout 18 months I get a check up in november. regardless of the outcome they told me, they being my oncologist that I will get another six month injection. I take cholesteral and blood pressure meds and antidepressents. My cancer was alledgedly in my lower lymph node based in its inflammation. no biopsy. I feel poorly most of the time and am not able to do much without tiring easily. I dont know if its physical or mental Are there any drugs to offer energy

vishash

ten years ago we found out my uncle is having 4 stones in his pancreas, & went with the medication available at that time as no surgery was developed at that time and there was no pain as such but four months earlier he started having chronic pain in his back ,we had certain examinations done to that and found certain small mass been developed in pancreas any went for biopsy by cutting open the stomach and after report came it is showing highly suspicious, any chemotherapist is not performing chemo as reports are not conclusive & after 4 months also we do not have any exact reason for the pain & about the tumor, He is suffering from severe back pain ,can some one please suggest something

Ardy

Oh Pamela. I’m sorry to hear this, and especially with how far away you are from your filamy. I hope you get some good news, soon. And in the meantime, hiccups are nice.

Fred

I had a radical prostectomy 4 years ago. The surgeon told he didn’t think he got it all. So, I’ve been watching my PSA results as an indicator. PSA has been steadily rising from 0 to now 2.3. This last reading spiked from 1.3 to 2.3 within 6 months. Is the cancer gaining momentum? Then I wonder how accurate are PSA tests if I don’t have a prostate?

Michelle

My father was diagnosed with prostate cancer in 2005. He had the seed implant, went through radiation. His PSA levels had been good. Late March he was having problems sitting. The end of May he couldn’t urinate, they thought swollen prostate. After being shuffled around for 6 weeks, they discovered the cancer was back and spread to the lymph nodes liver and lungs. His Urologist told him the PSA had them fooled. He got a horrible UTI, I asked his dr that day if I shoyld take him to the hospital he told me no, he had lost 40 pounds and was weak. I brought him home and for 6 days watched him decline. I took him in. He had c diff. He was in the hospital 6 days. I brought him home with hospice. He died 6 days later. My dad was my everything. He was amazing. He worked hard, went to the gym. Never sat still. He was 76. PSA does not work!

Ron

10 yrs ago my psa was 3.7 I’m 67 now doctor did a biop and came up neg. now my psa is 4.0 urinate allot up a few times a night,no other problems.If I don’t drink coffee in the morning I go for hours. the reason I haven’t been to a doctor for this in years is because the bio was so hard on me. I’ll never do it again.

George

I had a radical prostectomy done 3 years ago and Dr. said he was able to remove all cancerous cells and no margins left. Since then I have been watching my PSA. Lately my psa has been little high as 0.06. I went to see my urologist and he refered me yo a an oncologist. Should I worry or just ignore the PSa results.

andres

I am Dutch and I red in the book of Dr.Greger MD: HOW NOT TO DIE that eating less than an egg a day double the risk of prostate cancer due to choline found concentrated in eggs.
He writes : higher levels of choline in the blood has been associated with increased risk of developing prostate cancer in the first place. The choline in eggs is converted into a toxin called trimethylamine by bacteria that exist in the guts of those who eat meet.

Please comment to this info from the a/m book. Thank you for your info.

Lawrence

PSA is steady at 8. Have had two biopsies. Horrific experiences. Got sepsis from the first one and nearly died. No more. My PSA goes up slowly each year. I am 60. Now there is a new urine test where a score of under 15 says 97% chance you are safe. I got 30. Not sure what that means. This whole area is tough to figure out. Seems like we all have it, issue is how aggressive is it. I do know that if my Doc and I conclude that I have it or need treatment I am going for proton beam therapy, not cutting it out and losing sexual function and peeing my pants.

Robert

Initially at age 70 had a PSA of 6, and over 2 years had 6 monthly checks. Spiked at PSA of 8 at which time my UK doc sent me for ultrasound followed by a prostate biopsy (bit uncomfortable but bearable) which was negative. Subsequent PSA of 6 which although on the high side my doctor considered I had BPH (urine flow & ED) and is treating me with Tamulosin which I am hoping will sort it.

Rajinder Kachroo

I am 69 years old and have Benign Prostate. I have been taking medicines for the last 7 years. The result is that now I have ED & also whenever I try to have sex I get a weird feeling when I reach orgasm but there is no Simon ejeculation

Jess

I am 58. At my annual physical exam the doctor did a prostate exam and found a lump or nodule on the upper right side. My PSA level had gone from 0.7 last year to 1.9 this year. Because of the lump it was recommended that I have a biopsy done and I did. Although mildly unpleasant overall the biopsy went ok with few side affects and the results for cancer came out negative. Although from here on out I will always wonder. The plan of action is to monitor via velocity, or routine PSA tests. I am concerned that the doctor who invented the PSA test has now come out with a book called “The PSA hoax.” He claims the PSA test is not reliable. Hope some more reliable tests are available soon.

William Leahy

Rajinderss comment aplied to me 6 mnths back, but now Siemens at slow rate is appearing and Jess’s comment applies as to a lump recently found, Urin test showed clear but PSA registered 18. Specialist at RMH Melbourne AUS ready to do a Rectal U/sound Biopsy Nov.8th. My concern for infection was dis-quelled by surgeon stating they would use a stronger anti infection agent.I think I should give it a miss but I think Biopsy tells if benign or not!I am 80 yrs old March 2017..So What Thoughts people?? Bill

William Leahy

Further conversation with Australian friend where he relates to another Aust. having a PSA count of 500 after getting very short survival time decided to start taking Metformin 100mg. HE has survived 6 years to date and count is in low figures.?? Comments anyone???

Terry

@Rajinder
Sounds like retrograde ejaculation. Semen goes down into bladder rather than coming up and out. Likely caused by your meds for BPH weakening the bladder sphincter muscle so you can pee better.
Wikipedia has a good article on it.

Mike Zell

Mike Z
About 2 years ago, with a PSA of about 11 or 12, my Doctor arranged an appointment with an Urologist who performed a biopsy. There was no real discomfort in the procedure which confirmed cancer on one side. He recommended X-Ray Radiation treatments combined with hormone treatments. However, only radiation treatments(35 @ 5 per week)were done, as recommended by my Oncologist. My PSA result 6 months later was 0.71 and the one year result was 0.55. Another test will be at the 18 month point March. I am now 77, play table tennis regularly, look after a large garden with a 300 foot hedge half-way around, shovel snow etc. despite 2 hip and one knee replacements. I feel fortunate especially since a close and much younger friend (61) is on heavy chemotherapy for his much more advanced condition. At the “prostrate cancer support group” we all have learned that PSA results are only a “guideline”.

Henry Lion

I am a 58-year-old healthy man. I was diagnosed with prostatitis in early November 2016.
I was discharged from hospital four days later, feeling good. Just prior to prostatitis my PSA was 0.8, coincidentally I had had my annual blood test a few days before diagnosis of prostatitis. One month later my PSA was 4.0 (is this high number an expected PSA level following prostatitis?) At this time the GP conducted a DRE and no nodules were detected, but a larger than normal prostate was mentioned.
Following discharge from hospital my thirst was higher than normal and I would urinate around three times per night, sometimes four times. This has settled down (thirst normal and urination only once per night now).
Six weeks later (last week in January 2017) the PSA reading was slightly higher at 4.1. Urine sample detected no infections. I am waiting another four weeks for the next PSA to see if the reading goes down. Typically, would this be normal that the PSA level is so high following prostatitis? Could this be cancer, BPH or something else? Should I go for a prostate biopsy now or should I wait until March to consult with a Urologist?
Thank you.

Joe

The PSA is individually based. I had my prostate out late December 2016. First biopsy in February 2016 showed Gleason 6. The PSA at that time was a 2.1. Second biopsy in October 2016 revealed Gleason 7 BUT my PSA DROPPED to a 1.5. PSA is not universal

Rkrao

I am 81and in good health.I walk two to three Km. Daily and agile enough to play table tennis. A month back i fell on my back while repairing a gadget. It was very hard fall .I developed a bad lower back ache. As the ache is persisting the Doc suggested a PSA test which gave an alarming reading of 25.The urologist did a DRE and advised a biopsy. I do not have any symptoms of p. Cancer like frequent urination etc. Can the high psa result of the fall ! Should i subject myself to biopsy.Are there any non intrusive alternatives.

Corrine

My husband had a surgeon do a radical retropubic prostectomy with nerve sparing in 2011 September
He was put on high dose of Cialis to take when sexual relations were to happen. This gave him headaches and flushing so they changed his dose to everyday Cialis.
Our question is this “why is his erection now fleeting,
it comes then it goes” He has admitted to missing a few pills here and there, would this be the reason?

Shaji

I am 52. My PSA level in 2015 was 2.7, in December 2016 it was 3.3 and in March 2017 it showed 3.67. Is there anything for further checkup? Please help
Shaji

bc

In my opinion any guy NOT having a yearly PSA test is very foolish.

Consider my case…………

Advice from a guy who (just barely) survived prostate cancer

Guys, if you care at all about your health and living, and your family, you owe it to yourself to spend a minute reading this.

For years I have been having a fairly complete physical exam each year. At my last yearly physical, for reasons completely unknown to me as I had no symptoms whatsoever, no family history, and no known risk factors, I asked (almost had to insist actually), to have a PSA test for prostate cancer done. It’s a simple blood test and can be done along with all the other blood work during a physical. Sadly, this test showed my PSA number had gotten very high.

My last PSA test had been done 8 years previously, but right about that time many family practice doctors, mine included, stopped giving this test. Their reasoning is that the test sometimes gives a false positive, and having a positive means that you then need to then have a biopsy done by a urologist to determine whether you do or do not have prostate cancer. In my opinion their abandonment of the PSA test is DEAD wrong, and I am one who almost wound up DEAD because of it. Although any medical procedure has certain risks, the modern day biopsy, if needed, is a simple routine out-patient test done at a hospital. I was put to sleep for the procedure, total time spent at the hospital was less than 4 hours, and most of that time is spent being put under and then slowly waking up again. I had very little pain afterwards, I was back doing whatever I wanted the same day, and was given antibiotics to take for 3 weeks.

Another reason I have heard for doctors not giving PSA tests anymore is that they feel patients who have to have a biopsy, and find out from it that they do not have prostate cancer will be angry. This is absurd and defies common sense, I would have been elated to have the biopsy and find out I did not have cancer, just as I think any guy would be.

Anyway, my biopsy showed I DID have advanced fast growing prostate cancer. My ONLY option was to have my prostate completely removed as soon as possible, and it was done by robotic assisted surgery. Afterwards, doctors told me I had probably had this cancer for over 4 years, and if I had been having yearly PSA tests the test would have shown a large spike 4 years ago when the cancer started. I could have then been treated AT THAT TIME with much simpler, cheaper, less invasive procedures, and not needed what turned out to be a $100,000 operation and it’s possible complications. They also told me that I had saved my own life by asking for a PSA test when I did, and if I had waited even one more year it would have been TOO LATE. One urologist even told me that 26,000 guys are dying needlessly each year due to PSA testing not being done.

So please guys, despite what your doctor may tell you, ask for a yearly PSA test and watch for a sudden rise in the number each year and if that occurs get to a urologist quickly. And if your doctor tries to talk you out of a yearly PSA test, my advice is to absolutely change doctors.

Rick Horwitz

When a urologists suggests a biopsy prior to an MRI, it’s time to move on to another urologist.

It’s as simple as that.

“One urologist even told me that 26,000 guys are dying needlessly each year due to PSA testing not being done.”

But they don’t tell how much damage was done by a needless biopsy.

I went to two urologists as a result of an increased PSA. Both wanted to perform a biopsy. Discussed with my GP and she suggested that it just might be an infection and was surprised that neither urologists considered that possibility. In about 40 days the PSA, with meds, went from 12 to 5. (I am 70).

Second time PSA climbed when to another Urologist – let’s do a biopsy…
My GP suggest a picture rather than a poke. One can always poke. And if there is an issue, the pokes will be fewer (less damage) because the image indicates where to poke. (usually, 3 vs 12)

Result of a 3d mri – no cancer, simply a prostate King Kong would be proud of.

And done without damage to the prostate.

dk

Sorry guys who are writing that a PSA test caught their cancer. A routine prostate exam will usually indicate whether a ultrasound of the prostate is needed. This should be the first test after an abnormal prostate exam, NOT a biopsy.

The PSA test lacks two important measures of relevance to medical diagnostic procedures: sensitivity and specificity. Consider that the PSA level in your blood can vary widely throughout the day, hence its lack of sensitivity. And an elevated PSA can indicate cancer, prostatitis, BPH, that you have had sex sometime in the last 12 hours or that you haven’t had sex in several days. Hence the lack of specificity.

The PSA test is not reliable and too many urologist do unnecessary biopsies, which are extremely painful and potentially dangerous. They can cause serious infections and, if you have a slow-growing cancer that is well encapsulated (little chance of metastasis), the biopsy itself can rupture the capsule making metastasis much more likely.

So just say no to the PSA test. The physician who developed it no longer recommends it.

Robert Motzel

In 2011 I had a PSA test that gave a reading of 3100 I have never had a biopsy. It is now 2017 I have hormone injections off and on over this period and some radio therapy on two occasions. I now have a PSA reading of over 1300 after having been down as low as 3. I have no Idea what is going on and the oncologists can not understand how I manage to survive such high PSA readings
Early in 2011 I got a very bad mosquito bite in Dili East Timor that reduced to a cripple as in a very bad case of Dengi or Ross River virus and every thing progressed from there.

I don’t know what to make of my situation and the oncologists want me to start on chemo, I do not want to do a chemo course as I am not 100% sure I even have cancer.

any advise would be good

Thank you

Paul Emery

I’m 45. My story is i had not had sex for a couple of years due to depression. Then within a two week period I had had sex twice with my wife and then went on a fasting diet. I started getting stomach cramps or pain in the groin. This started before the diet but after the sex. I assumed I had bruised myself having sex after such a long gap. Went to female doctor she said it was probably diet ( I had not mentioned the sex as embarrassed). Within a week the pain had got a bit more intense, pressure when weeing etc. Went back
To male doc told him everything in precise date order , he did a rectal exam and blood tests and said it could be prostatitus. Blood tests all ok . PSA of 0.5. Urine tests clear. I’m going for ultrasound in a few weeks. I’ve had it 3 weeks in total still got groin pain but comes and goes in severity. Bit worse at night after meal or beers. I’m very anxious and stressed reading about all the harmless things or serious things it could be. The symptoms are all so similar. I’m terrified it’s prostate cancer naturally but I am 45 so realise it’s less likely but not impossible. if the ultrasound is clear do I relax and get on with life not truly knowing if I should be asking for a biopsy or just hoping it will go away on its own. I’m aware wasting time is potentially dangerous but also aware I’m a real hypercondriac. Any serious, helpful advice from medical people or similar cases appreciated. Paul

Joe

I am 64 yrs old married man and lead a fairly healthy lifestyle. Have had BPH for last 6yrs . Take alphablocker. My psa was 2.0 in nov 2016.
In June 2017 developed a severe UTI and prostatitis . PsA shot upto 36. UsProstate indicated acute prostatitis but no . malignancy . PsA in July and august is normal at 1.0 ng.
My Urologist asked for 3T mp MRI of prostate in early august. This shows an infiltrative process in left lobe of prostate. I have strong FHx of ca prostate.
So I have been given 2 options.
1) get biopsy done straight away to remove any doubts .
2) wait for rpt MRI in 6wks time. If still abnormal then do biopsy otherwise just follow up with Urologist.
I have chosen the wait and watch option as Im nervous about unneccesary biopsies and risk of sepsis with my history of prostatitis. I am on longterm Nitrofurantoin twice daily for next 6 months and my urine culture is consistently negative now. My Urologist agrees with my decision.
What is the right option. Have I made the right decision??

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