Testing (PSA and Physical Exam)

Value of PSA Test

The PSA test and advances in treatment have led to a 40 percent reduction* in prostate cancer deaths since the mid-1990s, and 90 percent* of all prostate cancers are now discovered before they spread outside the gland. The survival rate is nearly 100 percent* when prostate cancer is detected early, while the tumor is still localized and hasn’t spread. (*American Urological Association)

The results of the Göteborg Randomized Population-based Prostate Cancer Screening Trial, released in July 2010, showed a 44 percent decline in prostate cancer deaths as a result of PSA testing. In this Swedish study, partially funded by the National Cancer Institute, an analysis of some 20,000 men was conducted during a 14-year period. (“Mortality results from the Göteborg Randomised Population-based Prostate Cancer Screening Trial.” The Lancet Oncology. July 1,2010. Hugosson, J. et al.)

Click here to review additional PSA test research, including the European Randomized Study of Screening for Prostate Cancer (ERSPC) study and subsequent analyses, that showed as much as a 70 percent reduction in the prostate cancer death rate and as much as a 90 percent reduction in the number of advanced prostate cancer cases.

PSA Blood Test

Know your score. The PSA (or Prostate Specific Antigen) blood test doesn't show whether or not you have prostate cancer. It only shows if there is an abnormality for which you need further testing, such as an enlarged prostate, an infection, or perhaps cancer. The PSA test is still your best option for early detection of a prostate problem. Some say that it casts too wide a net, causing too many men to get biopsies or other tests that may be unnecessary or involve pain or risk.

The PSA test and medical advances in treatment have led to a 40 percent reduction in prostate cancer deaths since the mid-1990s, and 90 percent of all prostate cancers are now discovered before they spread outside the gland, according to the American Urological Association. The survival rate is nearly 100 percent when prostate cancer is detected early, while the tumor is still localized and hasn’t spread.

The American Urological Association and the National Comprehensive Cancer Network (NCCN) say men at age 40 should consider a PSA test in order to establish a “baseline” level for future comparison and to determine PSA velocity (the rate at which a man’s PSA score increases).

Based on guidelines set by the NCCN, if the PSA level is 1.0ng/mL or greater, an annual follow-up with the doctor is needed. If the PSA level is less than 1.0 ng/mL, the next testing should occur at the age of 45.

Afterward, doctors typically recommend further testing for men with a total PSA level that is higher than 2.5 ng/mL. This cut-off level was set by NCCN.

PSA Test Standards

There are two PSA tests in use today, and each one has a different cut-off level. It is important for you and your physician to know which type of test your clinic's lab uses and how to correctly interpret the results.

The Hybritech PSA test established 4.0 ng/mL as the cutoff for a normal test. This means men with a score above 4.0 should be referred for further testing, such as a biopsy. Men with a result lower than 4.0 may not be referred for biopsy, depending on their physician's instructions. As other manufacturers developed PSA tests, they aligned their tests to the same standard, which became known as the "Hybritech standard," and the other manufacturers used the same recommended cutoff of 4.0.

By the mid-1990s, some researchers began to recognize that test results from different test manufacturers could be slightly different and joined together to create a common calibration standard to better align results among the different PSA tests. This standard was adopted by the World Health Organization (WHO) and soon became known in the medical community as the "WHO standard" PSA test.

To establish this new standard, a different scientific process to measure molecular weight of PSA was used and that weight was found to be 20 percent higher than that used for the Hybritech test. Because of the way this is calculated, a WHO test would show a proportionately lower PSA concentration level than would a Hybritech test for the same sample. As a result, the cutoff point at which men are referred for further testing would more appropriately be set about 20 percent lower than the 4.0 used for the Hybritech test.

To find out which type of test you have received, your physician should contact his or her lab to determine which brand of test was used for their PSA testing and whether it is WHO or Hybritech calibrated.

PSA: There's More to Your Score

Two Types of PSA Tests: Changes in Some PSA Tests May Require Changes in How Results are Interpreted

The PSA (prostate specific antigen) test is one of our best weapons in the battle against prostate cancer, but in recent years, changes to some PSA tests mean some test results had to be interpreted differently than doctors had become accustomed to. For many years, 4.0 was the cutoff many physicians and medical professionals used for a "normal" test result. But today, a 4.0 isn't always a 4.0 on all tests. Physicians and patients who do not know which type of test was used may not interpret the results accurately, which could potentially lead to a delay in care for men who do have prostate cancer.

It has always been important for men to know their PSA test result and to discuss this with their doctor. Now, as importantly, they also need to know which type of test they received so the correct PSA interpretation can be made.

Additional Check for Prostate Cancer: DRE or Physical Exam

The Digital Rectal Exam (DRE) is a quick and painless physical exam, where the doctor feels for bumps or abnormalities on the surface of your prostate that might be tumor growth. The word "digital" refers to the use of a finger, not a computer. Even if a bump is found, a biopsy is still needed to determine whether it is cancer. Like the PSA test, the DRE doesn't show whether or not you have prostate cancer, only whether or not you need further testing.

The prostate exam, when used with the PSA test, can increase the accuracy for your early detection of prostate cancer.

Testing Guidelines

Know when to get tested. The right age to start PSA testing depends on your level of risk:

• Early detection should start at 40 for the general population.
• African-American men, and men with one or more risk factors (such as family history, smoking or overweight) should start annual PSA testing at 40.
• Some men choose to take a single test at an earlier age, 35 or 40, to get a PSA level when prostate cancer is not present and establish a "baseline" level for future comparison.

Men can get their annual PSA test in a variety of locations. ZERO operates the Drive Against Prostate Cancer, which travels the country offering free mobile prostate cancer testing. Check the Drive schedule (link) to see if it's coming to a city near you. If the Drive isn't making a pit stop in your community, you can schedule a test with your primary care physician, who can do both the PSA test and the physical exam. If you can't afford a doctor visit, call your local hospital and clinic to see if they offer any free testing programs. (LINK)

Risk Assessment

Men newly diagnosed with prostate cancer face difficult choices and, in consultation with their physicians, need better, more objective information.

Prostate Px+ provides critically important information at diagnosis, offering patients and their physicians objective, actionable data when they need it - prior to treatment selection.

At diagnosis, Prostate Px+ can:

• Predict disease progression after prostatectomy
• Assist objective, informed treatment decisions
• Identify high-risk patients presenting as lower risk
• Assess the actual risk of "intermediate-risk" patients
• Assess favorable pathologic stage which may indicate indolent disease
• Help alleviate anxiety