Every year, nearly 218,000 U.S. men are diagnosed with prostate cancer --- and more than 32,000 die from the disease. While those statistics might seem alarming, it should also be noted that more than 2 million men in the United States have been diagnosed with prostate cancer at some point in their lives and are still around to talk about it today. Part of their success may be attributed to the PSA test, which plays a major role in helping doctors detect prostate cancer in its early stages.
The cells in a man's prostate gland --- which, like all cells in the human body, are constantly dying and being replaced --- produce a substance called prostate-specific antigen, or PSA. Although most of it is released through semen, a small amount of PSA can be found in blood. When cells become cancerous, they continue to multiply but fail to die, which is why cancer spreads. In the case of the prostate gland, cancerous cells also continue to produce PSA, leading to a higher level in the blood. So if a PSA test reveals a higher-than-average level of PSA in a man's blood, there's a chance he may have developed prostate cancer.
What the Numbers Mean
A PSA level that's considered "normal" can vary depending on a few factors. Because PSA levels tend to rise as men get older, a number that's considered elevated for a 45-year-old might be considered normal for a 70-year-old. Also, race can play a part in determining whether a test result should be considered alarming. Since a high percentage of African-American and Asian men develop prostate cancer, doctors generally set the level of concern for men in this group a little lower than they do for European-American men. The general guidelines for normal levels are as follows: 40-49 years old: 0-2.5 PSA; 50-59 years old: 2.6-3.5 PSA; 60-69 years old: 3.6-4.5 PSA; and 70-79 years old: 4.6-6.5 PSA.
Margin of Error
A high PSA level doesn't necessarily mean prostate cancer is present. Some medications, herbal supplements, steroids and even aspirin can lead to a higher PSA count. Men with enlarged, inflamed or infected prostate glands often have above-normal levels. Even certain activities, such as riding a bicycle or undergoing a prostate exam, can cause the prostate to release more PSA into the bloodstream. That's why doctors use the PSA test merely as an indicator to determine whether further tests should be performed.
The PSA Controversy
While those in the medical profession agree the results of a PSA test should not be considered the last word on whether a man has prostate cancer, there are some who question whether the test should be used at all. Because prostate cancer is usually slow growing, it's possible for a man to live his entire life without ever knowing he had it. But since the advent of the PSA test, its opponents argue, many of these men are now undergoing potentially painful testing procedures and, in some cases, unnecessary treatment. Plus, just as there are factors that could inflate a man's PSA level, there also some that could lower it --- even if cancer is present. As a result, a man who has prostate cancer --- and who even displays symptoms of having it --- might not be treated because his PSA test indicates otherwise.
The Bottom Line
While the PSA test can be helpful in catching prostate cancer early, by no means should its results be confused with a diagnosis of cancer. If you find your PSA level is higher than normal, talk with your doctor about what your next step should be. In addition to your age and race, he will likely also consider the severity of your symptoms and your family history of prostate cancer before determining if more intensive testing is needed. In many cases, your doctor will simply schedule another PSA test a few months down the road to determine if your level has continued to rise.
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