PSA Test Result Interpretation (PSA Levels reading)
December 5, 2009 by Prostate Dr.
False Positive and False Negative PSA
PSA is indeed a great biomarker for any kind of cancer, but it is not perfect. There are other reasons why prostate PSA test results may be high and in these cases it gives a false indication of cancer; just as there are causes that may hide the PSA and make it appear to be normal even though cancer might be present.
Now it is known that older men with a PSA as high as 5 or 6 most probably don't have cancer. BPH may also cause a higher PSA. The PSA score for BPH can go up, because of the increased number of cells producing PSA, which can reach levels as high as 10 to 15 ng/ml or more.
However, the fact is this: prostate cancer cells produce 10 times more PSA than BPH cells . In some prostate tumors there is a fairly close correlation between the volume of the cancerous tumor and the PSA.
Diseases such as prostatitis that can also cause a rise in PSA output. Also prostatic massage can cause a temporary change in the PSA. Irritations such as the one produced by a cystoscope (used by doctors to examine the prostate or bladder) can cause a change in the prostate PSA test levels. Because of this, it is sometimes best to wait a few days after one of these procedures in order to get a more accurate PSA reading. Passive Gay men may have a change in PSA levels due to the prostate stimulation.
Some men have been found to have significant cancer with a PSA as low as 2. There are several hormones, drugs and natural medicine alternatives which can alter the PSA levels, e.g. Proscar and Saw Palmetto (both may cause the PSA to be reduced by as much as 50%).
Free PSA and Bound PSA
There seems to be a way to differentiate between the PSA score for BPH and PSA test levels in Prostate cancer.
Here's the story: there are usually two different forms of PSA in the blood stream, the free PSA and bound PSA. Bound by a proteinase inhibitor that is. Normal PSA tests measure the total PSA. Some companies can now differentiate between free PSA and bound PSA.
Studies done by Dr. W. J. Catalona and others seem to indicate the following:
if the free PSA is elevated in respect to the bound PSA, then the PSA is probably being produced by BPH.
if there is a high level of bound PSA, then it is likely to be manufactured by prostate cancer cells.
But in many cases the patient will have BPH and prostate cancer at the same time.
PSA Velocity (PSAV)
PSA velocity is the rate of change in PSA after several tests.
A constant PSA test level after several tests indicates that not much is happening. However, if the the PSA gets higher with each test, this is an indication that the prostate cancer is growing.
Make a chart and carefully follow any change that takes place. Even if the PSA level is fairly low, if the trend is ascendant then you should become concerned. If the PSA test levels double, then you should become very concerned, especially if the doubling interval is short.
Department of Urology of the University of Amsterdam, The Netherlands has done a study concerning bph + psa velocity. The objective was to study the value of PSA velocity (PSAV) in the prediction of benign prostatic hyperplasia (BPH) progression in patients managed with alpha(1)-blockers compared to those in watchful waiting (WW).
PSAV range was -5.24 to 43.06 ng/ml/year in alpha(1)-blocker patients and -6.11 to 19.55 ng/ml/year in watchfull waiting patients. There were no significant differences in retreatment-free survival and the risk of BPH-related invasive therapy between the tertiles (Stable/Decrease/Increase) in both treatment groups.
In conclusion, bph and psa velocity aren't very strongly related since psa velocity did not predict BPH progression in either alpha(1)-blocker treated patients or WW group.
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