Prostate-specific antigen (PSA) is a protein produced by the cells of the prostate gland. Levels of PSA in the blood are used to detect early prostate cancer (which is usually asymptomatic) as higher PSA levels are associated with a greater likelihood of prostate cancer.[1]
However, the PSA test has poor specificity. Infection, trauma, inflammation (i.e., prostatitis), and benign prostatic hyperplasia can all increase PSA levels. A PSA level ≥ 4.0 ng/mL is generally the threshold for which further evaluation for prostate cancer should occur,[2] but prostate cancer has been detected in men with PSA levels as low as 1.1 ng/mL[3] and not every man with very high PSA levels will have prostate cancer.
Although PSA testing appears to have a small potential benefit on reducing the risk of death from prostate cancer,[4] there are potential harms of testing due to frequent occurrence of false-positive results,[5] including psychological distress, additional testing and prostate biopsy, and treatment complications (e.g., incontinence, erectile dysfunction).[6] Many men with prostate cancer never become symptomatic and wouldn’t know they have the disease if they weren’t screened for it. In these cases, treatment would only result in harm without benefit.
For these reasons, it’s recommended that, in men aged 55–69, undergoing PSA testing should be a personall choice, rather than a blanket recommendation.[6]
References
- ^Stamey TA, Yang N, Hay AR, McNeal JE, Freiha FS, Redwine EProstate-specific antigen as a serum marker for adenocarcinoma of the prostate.N Engl J Med.(1987-Oct-08)
- ^David MK, Leslie SWProstate Specific AntigenStatPearls.(2022-04)
- ^Thompson IM, Ankerst DP, Chi C, Lucia MS, Goodman PJ, Crowley JJ, Parnes HL, Coltman CAOperating characteristics of prostate-specific antigen in men with an initial PSA level of 3.0 ng/ml or lower.JAMA.(2005-Jul-06)
- ^Ilic D, Djulbegovic M, Jung JH, Hwang EC, Zhou Q, Cleves A, Agoritsas T, Dahm PProstate cancer screening with prostate-specific antigen (PSA) test: a systematic review and meta-analysis.BMJ.(2018-Sep-05)
- ^Kilpeläinen TP, Tammela TL, Roobol M, Hugosson J, Ciatto S, Nelen V, Moss S, Määttänen L, Auvinen AFalse-positive screening results in the European randomized study of screening for prostate cancer.Eur J Cancer.(2011-Dec)
- ^, Grossman DC, Curry SJ, Owens DK, Bibbins-Domingo K, Caughey AB, Davidson KW, Doubeni CA, Ebell M, Epling JW, Kemper AR, Krist AH, Kubik M, Landefeld CS, Mangione CM, Silverstein M, Simon MA, Siu AL, Tseng CWScreening for Prostate Cancer: US Preventive Services Task Force Recommendation Statement.JAMA.(2018-05-08)