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Problems With the Results of a PSA Test

PSA is the acronym for prostate-specific antigen, a protein that is naturally produced by prostate cells and found in the blood. The United States Food and Drug Administration has approved PSA testing as a means of detecting prostate cancer, along with rectal exam to determine if swelling or lumps exist. Testing PSA levels offers positives and negatives to cancer screening.

  1. Conditions Affecting PSA

    • A condition known as benign prostatic hyperplasia, or BPH, is common in aging men. The prostate produces more protein, causing the prostate to swell. The swollen prostate in turn causes other symptoms to arise, such as frequent urination when it puts pressure on the bladder. The condition is not cancer, and the National Cancer Institute reports there is no reason to believe that BPH produces cancer. It is possible, however, for BPH and prostate cancer to co-exist. PSA levels are affected by prostatitis and physical activities that put pressure on the prostate, such a riding a lawn mower. Levels vary between laboratories depending on the testing process.

    PSA Levels

    • The average PSA is 4.0 ng/mL, though prostate cancer has been detected in lower levels. The Mayo Clinic describes two types of protein levels in the blood that are detected through the PSA test. One is free-floating and the other is protein attached to blood protein cells. A high PSA with a low free-floating PSA sometimes indicates cancer. A sudden rise in a PSA indicates cancer. The New England Journal of Medicine in 2004 reported results of a large study that showed 15 percent of men with a PSA of 4.0 ng/mL and less had cancer. In addition, 25 to 35 percent of men with PSAs between 4.0 and 9.9 ng/mL had cancer.

    Problems

    • Testing through PSA screening sometimes produces false-positives, meaning the PSA level is high but no cancer is evident. A high PSA results in further testing that eventually leads to a biopsy. It sometimes also leads to other tests, causing a financial burden and anxiety on the patient. A false-negative PSA, meaning the level is normal yet cancer is evident, results in failure to diagnose cancer. A physician discontinues any further investigation, leaving the cancer time to grow. In some cases, cancers grow slowly over decades.

      An elevated PSA sometimes leads to over-diagnosing tumors. According to the Mayo Clinic, 29 to 44 percent of tumors detected as a result of a high PSA never cause any symptoms throughout a lifetime.

    Risks

    • Certain risks accompany the detection of prostate cancer through PSA testing and tissue biopsies. Treatment for prostate cancer leads to incontinence, problems with bowel movements, erectile dysfunction and death. Early detection leaves an uncertainty in the prognosis of the disease. It is debatable if certain treatments are necessary when weighing the side effects, according to the Mayo Clinic.

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