Prostate Specific Antigen (PSA) Free, Serum

The PSA test along with Digital Rectal Exam (DRE) is used as a screening test for prostate cancer in both asymptomatic and symptomatic men. PSA is a protein produced by the prostate gland. Most of the PSA is released into semen, but small quantities of PSA are released into the blood. PSA exists in the blood in two forms as free and bound forms. Lab tests can measure both free PSA and total PSA. Total PSA includes both free and bound forms of PSA. PSA levels are elevated in prostate cancer. They may also be elevated in other benign conditions like benign prostatic hyperplasia and prostatitis. An elevated PSA may be followed by a biopsy for further conclusion. However biopsy has a risk of complications such as pain, fever, blood in the urine, or urinary tract infection. PSA levels can be elevated temporarily for several reasons. So an initial elevated PSA levels are usually followed by another PSA test to determine if the PSA levels are still elevated. Continuous monitoring of PSA levels through a series of PSA tests is essential in a slow growing prostate cancer. A free PSA test may be used to calculate the ratio of free to total PSA, if the Digital Rectal Exam is normal but the PSA level is moderately elevated. This can help to differentiate between prostate cancer and other benign conditions where PSA levels are elevated. Other tests such as urinalysis and ultrasound may be done if PSA levels and DRE are abnormal. Total PSA levels are used to monitor treatment and to detect recurrence in cases of prostate cancer.

1. What are the treatment options for prostate cancer?

Radiation, hormone therapy, and surgery are the treatment options.

2. Can PSA testing detect all prostate cancers?

No. Sometimes the PSA test will be negative, when cancer cells produce minute quantities of PSA.

3. Is PSA testing compulsory?

PSA testing is required only if a person has symptoms indicating a prostate problem.

4. What are the other tests that may be done to decide the treatment of prostate cancer?

Gleason scoring which is given after processing and reviewing the biopsy of the prostate, is helpful to decide the grade of prostate cancer and plan the treatment. Prostate gene expression profile using the biopsy sample is important the prognosis.