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Questions about PSA Antigen test
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Questions about PSA Antigen test

Dr., thank you for recent advice about testicular lumps. A testicular ultrasound revealed epdidimal cysts, so nothing serious.

Two days ago I had my annual physical. I am nearly 44 years old. The Nurse Practitioner performed a DRE and said my Prostate was normal. However, I noted on the lab tests she ordered, she requested a PSA Antigen test. I thought that such tests are typically not ordered until the age of 50. I have no history of prostate cancer in my family, and, as I said, the DRE seemed normal.

My questions:

1) Does current guidance suggest PSA tests before 50 for low-risk patients, in addition to the DRE.

2) I have read that both DREs and RECENT ejaculation can raise PSA readings if the test is performed shortly after either. In my case, both apply, so is it likely my readings might be higher than normal? If so, would it be advisable to perform the test again?

3) If a PSA reading seems higher than normal for my age group, what would typical next steps be - and are there other conditions that can cause high readings beside malignancy? Is it something that just gets 'monitored'?

4) How reliable or useful is the PSA antigen test? I have read conflicting reports.

Thanks again in advance for your opinion.
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To answer your questions:
1) There are different recommendations as to who then PSA is ordered.  Most expert groups recommend discussion of screening with PSA and DRE after age 50.  Some recommend earlier screening if there are risk factors (i.e. age 45).  

2) There are many things that can raise the PSA - including recent DRE before the PSA test.  If the PSA is high, you may indeed want to repeat the test.

3) If the PSA is confirmed to be high, I would be evalated for infection and consider a referral to a urologist to see whether further testing (i.e. a biopsy) is necessary.

4) There is no clear evidence that PSA screening for prostate cancer saves lives.  That is why this test should be discussed with your physician to fully evaluate the risks and benefits of obtaining this test.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
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