From the Guidelines
The main prostate tests include the Prostate-Specific Antigen (PSA) blood test, Digital Rectal Examination (DRE), prostate biopsy, and imaging tests like MRI. The PSA test measures a protein produced by the prostate gland, with normal levels typically below 4 ng/mL, though this varies by age 1. Rising PSA levels may indicate prostate cancer, infection, or benign enlargement. The DRE involves a doctor physically examining the prostate through the rectum to check for abnormalities in size, shape, and texture. If these initial tests suggest concerns, a prostate biopsy may be performed, where small tissue samples are collected and examined for cancer cells. Advanced imaging like multiparametric MRI helps visualize the prostate in detail before biopsy. Additional tests include the free PSA test (measuring the percentage of PSA not bound to proteins), PCA3 test (examining urine for prostate cancer genes), and the 4Kscore test (combining multiple biomarkers) 1. These tests work together to help diagnose prostate conditions and guide treatment decisions.
Some key points to consider when evaluating prostate tests include:
- The PSA test is not a cancer-specific marker, and most men with elevated PSA levels do not have prostate cancer 1
- Prostate biopsies are not perfect tests and may sometimes miss cancer when present 1
- The decision to screen for prostate cancer using the PSA test should be based on the risk for prostate cancer, a discussion of the benefits and harms of screening, the patient's general health and life expectancy, and patient preferences 1
- Clinicians should not screen for prostate cancer using the PSA test in average-risk men under the age of 50 years, men over the age of 69 years, or men with a life expectancy of less than 10 to 15 years 1
Overall, the choice of prostate test and the decision to screen for prostate cancer should be individualized and based on a discussion of the potential benefits and harms of screening.
From the Research
Prostate Test Names
- Prostate-specific antigen (PSA) test: measures the level of PSA in the blood, with elevated levels potentially indicating prostate cancer 2, 3, 4
- Free PSA (FPSA) test: measures the level of free PSA in the blood, which can help distinguish between prostate cancer and benign prostatic hyperplasia (BPH) 2, 3, 4
- Percent free PSA test: calculates the percentage of free PSA in relation to total PSA, which can improve the detection of prostate cancer 3, 4
- Total PSA (TPSA) test: measures the total level of PSA in the blood, including both free and bound PSA 2, 3, 4
- Complexed PSA test: measures the level of PSA bound to other proteins in the blood, which can also help detect prostate cancer 4
Types of PSA Tests
- PSA-RIACT: an immunoradiometric assay used to measure total PSA levels 2
- FPSA-RIACT: an immunoradiometric assay used to measure free PSA levels 2
Uses of Prostate Tests
- Early detection of prostate cancer: PSA tests, including total PSA, free PSA, and percent free PSA, can help detect prostate cancer in its early stages 2, 3, 4
- Diagnosis of prostate cancer: PSA tests can help distinguish between prostate cancer and BPH, and can be used in combination with other tests, such as digital rectal examination (DRE) and biopsy, to diagnose prostate cancer 2, 3, 4
- Monitoring of prostate cancer treatment: PSA tests can be used to monitor the response to treatment and predict overall survival in patients with prostate cancer 5