1. PSA - Prostate Specific Antigen Bill Graden, M.D. BYU Student Health Center

2. What is PSA? Prostate-specific antigen (PSA) is a protein produced by the prostate. PSA helps liquefy the semen and enters the bloodstream at variable rates depending on the health of the prostate.

3. PSA - Prostate Specific Antigen PSA is present in both benign and cancerous prostate cells. However, cancer cells usually make more PSA than do benign cells, causing PSA to rise early in the course of prostate cancer.

4. PSA - Prostate Specific Antigen Conditions other than prostate cancer also can cause PSA levels to rise, including benign enlargement of the prostate and inflammation of the prostate (prostatitis).

5. PSA - Prostate Specific Antigen Some prostate cancers may not produce much PSA, so the digital rectal examination remains an important part of evaluating the prostate.

6. PSA - Prostate Specific Antigen A few medicines such as finasteride (Proscar and Propecia) used for prostate enlargement and hair loss can decrease levels of PSA. Some experts recommend that if you are using one of these products, your measured PSA levels should be doubled to reflect a more accurate result.

7. Prostate Cancer Risk Factors Age. Risk increases substantially after age 50. 70% of prostate cancers are found in men 65 and older. Race. African American men have highest risk of developing and dying of prostate cancer, Asian & Native American the least Family history. If your father or brother has prostate cancer your risk is greater. Diet. A high-fat diet and obesity may increase your risk.

8. Why should I get a PSA? Getting a PSA may help identify aggressive cancers. Catching a prostate cancer early may make it easier to treat. If the cancer spreads outside of the prostate there are less treatment options.

9. Why shouldn’t I get a PSA? Prostate cancer usually grows very slowly. Even if a man has prostate cancer it may never affect his health. Most men with prostate cancer die of other causes. Treatment may result in adverse side effects.

10. Why shouldn’t I get a PSA? A man who has prostate cancer may be worse off if he gets treated than if he did not get treatment. Some men think the treatment side effects are worse than having the cancer.

11. Risks of Treatment Radiation Treatment Impotence, 40/1000 Any incontinence, 50/100 Complete incontinence, 1/100 Urinary Stricture, 5/100 Death, 2/1000 Rectal injury, 11/100 Surgical Treatment Impotence, 30-90/100 Any incontinence, 32/100 Complete incontinence, 7/100 Stricture, 12-20/100 Death, 1/100 Rectal injury, 30/100

12. PSA – Test Results A high PSA is 4 or greater. * You should see your doctor to discuss your results. Your doctor may recommend repeating your testing or testing to look for other prostate problems. If cancer is suspected a biopsy is needed.

13. PSA – Test Results * Prostate cancer has been found in those with PSA below 4. Many doctors are now using the following ranges with some variations: 0 to 2.5 is low 2.6 to 10 is slightly elevated 10 to 19.9 is moderately elevated 20 or more is significantly elevated

14. PSA – Test Limitations For every 100 men who have a PSA test 90/100 will have a normal test. Of these 90, 1 will still have cancer (false negative) and 89 will not have cancer. (true negative) 10/100 will have an elevated test. Of these 10, 3 will have cancer (true positive) and 7 will not. (false positive)

15. Future Screening Tests PSA velocity-how fast is it changing Age-adjusted PSA – increases with age PSA density – PSA/size of prostate Free versus attached PSA – cancers produce more attached PSA

16. PSA Questions? Email: graden@byu.edu