The Prostate Specific Antigen (PSA) test is a simple blood test that is commonly carried out to screen for the presence of benign prostatic hyperplasia (BHP) and of prostate cancer. While the test cannot by itself be used for diagnosis it is an excellent indicator and, together with other tests, PSA test can suggest the need for further investigation.
The test is usually recommended for men at particular risk (like those with a family history of the condition) once they reach the age of about 40 to 45 and for men in general once they reach 50.
An isolated PSA test will give a snapshot of prostate specific antigen levels in the blood and may show a problem straight away if you record particularly high psa numbers. However, in most cases, and where a prostate problem is in its initial stages of development, a single PSA test result will prove to be inconclusive and a second test will generally be recommended in a few weeks time. Indeed, ideally PSA testing should be carried out at regular intervals two or three times each year so that PSA levels may be seen over a reasonable period of time.
Providing you have a normal PSA score all is well, but when your PSA scores begin to increase they need to be watched very closely. The speed with which PSA scores increase is normally called the 'PSA velocity' and providing the increase is gradual and the velocity slow then it is once again frequently sufficient just to watch the situation as a variety of things can effect levels of PSA and apparently increasing levels will frequently be seen to fall back to normal in time.
However, when PSA test levels begin to increase rapidly and the velocity is said to be fast then further investigation is required.
PSA testing and monitoring has been followed for a long time but, despite the fact that the test has long been held as a good indicator of the requirement for further investigation, it was not until fairly recently that we have been in a position to link specific PSA velocity readings to prostate cancer in a fashion that can foretell how aggressive a cancer is.
In a recent study data about 950 men with prostate cancer who had undergone either surgery of radiation treatment between 1988 and 2004 at four hospitals was analyzed.
In every case the patients had been diagnosed as having aggressive prostate cancer on the basis of an isolated very high PSA score, the presence of an advanced stage tumor, a biopsy indicating signs of an aggressive cancer at cellular level, a noticeable increase in PSA velocity in the year prior to diagnosis or a combination of two or more of these signs.
This study also looked in detail at the outcomes for all 950 men and discovered that a rapidly increasing PSA level that jumped by 2 or more points in a year was the clearest indicator or the presence of an aggressive cancer.
Until now we have been able to associate increasing 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 is likely to be aggressive and need equally aggressive treatment.
Now however we are able to say with reasonable certainty that if a PSA level increases by more than 2 points in a twelve month period then prostate cancer is almost certain to be aggressive and requires speedy and vigorous treatment.
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