about PSA test and diagnosis

Hi, Dr:

What is PSA density?  For diagnosis, PSA+ free PSA is enough or cPSA+PSA is needed?  Which one will be more accurate?

Is Prostate enlargement mean DRE abnormal?

Thank you in advance for your time and advise.

[HeinrikMD]

Hi,

If you are interested in screening for prostate cancer and you have no symptoms at all, then the usual tests would be a DRE and a PSA.
Cancer is diagnosed with a biopsy, and the tests raise the issue of when to perform the biopsy.
In general, an abnormal DRE would call for a biopsy.
Not all enlargement would trigger the biopsy based on DRE.

Another trigger is a PSA that is more than 4.
There are other forms of PSA testing, such as density which tries to correlate PSA value with prostate size. Another is free PSA. There is no consensus as to what these tests can really do. One practical use is to reinforce treatment decisions. Some doctors may use them for cases where PSA is a little less than 4 to help determine if biopsy is needed. However, the higher the PSA values, the better these PSA-derivative tests become. While it is common to recommend a biopsy at a PSA of 4, a lot of men without cancer would be biopsied needlessly. Hence, the PSA derivative tests can predict how frequently an unnecessary biopsy is, to help patients and physicians decide what to do.

Bear in mind that prostate cancer screening has not been shown to improve survival. Discuss the risks and benefits of screening with your doctor.

[blueskyabq]

Hi, Dr,

It is great appreciated for your response.  I was read about PSA test fPSA and cPSA.  My friend had PSA test for past few years since age of 49, PSA range 1.3-1.4.  This year, PSA jump to 9.6, then repeat after 5 week, PSA come back 3.8, at the same time did free PSA, but fPSA is very low, and up %fPSA/PSA about 11%, and this may need biopsy.  But as I mention, PSA shows so much difference in such a short time. What is his means and the if PSA and fPSA really correct or accurate?  If hose test results can be trust to determine the biopsy.  I read about tests, and all point cPSA id better than PSA, to calculate % to determine if biopsy really needed. Specailly if PSA is under 4. %fPSA/PSA is not correct, only %fPSA/cPSA can tell.  Is this right.

BUT the big issue here is in our state, no Lab provide cPSA test, onlt PSA and fPSA.  Where I can abtain information that any Lab national wire can provide cPSA test and how local Dr's office can withdraw and send out for cPSA test?

Also, a lots other prostate infection or inflammation will lead to higher PSA value, which test or exam will be recommended to rule out other disease?

Your response and help are really appreciated.

Thank you in advance for your time and advise!

[HeinrikMD]

Hi,

It is important to remember that PSA is prostate specific, not prostate cancer specific. Hence, an enlargement of the prostate whether this is due to BPH or to an infection will also have a corresponding impact on PSA. The infection may also present with pain. It can be treated, so it is common practice to treat with antibiotics and then to repeat the PSA after treatment. The diagnostic standard for infection is an isolation of the infectious agent, but the chances of getting the organism are pretty small, so it is not common practice to obtain such tests.
PSA does not have a threshold at which given a certain level cancer is present, at a certain level it is absent. The risk is a continuum (put another way there will be cancers even with PSA of 1 but the number of men with cancer are much lower than those who have cancer at a PSA of 2, in turn the proportion of men with cancer for those who have a PSA of 4 would be higher than the proportion of men with PSA of 2).
The chances of finding the cancer are not improved by performing fPSA and cPSA (or any other derivative PSA test). So, if you are interested in finding out if there is cancer PSA is sufficient. PSA can suggest who to biopsy. Who not to biopsy is an altogether different issue.
Hence, those patients who are below a PSA of 4 and a biopsy is done, 70% to 80% will be unnecessary. If you do cPSA, 62 to 72% will be unnecessary. While the number of unnecessary biopsies do decrease, this would still mean a higher chance of getting an unnecessary biopsy. If your friend is happy with such odds, then I think the PSA would do fine.

[blueskyabq]

Thank you so much for your promptly response and explain in details.  Will discuss with Urology to see what will be the next, and proper test to diagnosis.

Thank you again for your time and advice!!!!