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PSA Test for Prostate Cancer

Many doctors recommend that every man over 40 get a blood test called Prostate Specific Antigen to check for prostate cancer. However, PSA levels can be raised abnormally high by:
• prostate infections,
• a benign enlarged prostate,
• riding a bicycle,
• making love, or
• having a doctor check the prostate.

Prostate Specific Antigen is made by prostate cells and is released into the bloodstream. Large prostates have more PSA, so a rise in PSA means that the gland is enlarging rapidly, which can be a sign of cancer or that the prostate is irritated by rubbing or infection. Any manipulation of the prostate raises blood PSA levels (1). PSA levels can be raised for several hours just by having your prostate checked by a physician (2,3), so PSA blood tests should be drawn before the doctor examines the prostate (4). Having a climax raises PSA for up to 48 hours (5,6,7,8,9,10,11,12). Infections raise PSA and there is no way to tell the difference between a PSA raised by cancer or by infection (13).

PSA can be classified into two different fractions called free and bound PSA. Free PSA is made by a normal prostate, while bound PSA is made primarily by prostate cancer cells. The usual rule is that if a man's PSA is above 4 (normal 0-4), the free PSA should be at least 18 percent of the total PSA. This rule usually holds for every situation except infection. The ratio of free PSA to bound PSA is the same for prostate cancer and infections (14).

If you have an elevated PSA blood test, your doctor will check your prostate and order a sonogram to see if you have a nodule that may be a sign of cancer. Most urologists recommend a biopsy done in their offices. If your PSA is low, you may have difficulty ejaculating and fathering a child. A normal ejaculate clots and traps sperm. PSA liquifies the clot and allows the sperm to swim toward the egg (16). PSA also causes the muscles of ejaculation to contract(17).

Patients who have been diagnosed with prostate cancer or who are considering whether to be screened for prostate cancer should be told that most older men who have prostate cancer do not have their lives prolonged by treatment. Men under 65 who are treated for prostate cancer may have their lives prolonged when compared to those who were not treated.
See Prostate Cancer Treatment

1) MM Webber, A Waghray, D Bello. Prostate-specific antigen, a serine protease, facilitates human prostate cancer cell invasion. Clinical Cancer Research 1: 10 (OCT 1995):1089-1094.

2) FI Rodriguezrubio, JE Robles, A Gonzalez, J Arocena, G Sanz, F Diezcaballero, A Martinmarquina, JM Berian. Effect of digital rectal examination and flexible cystoscopy on free and total prostate-specific antigen, and the percentage of free prostate-specific antigen - Differences between two PSA assays. European Urology 33: 3 (MAR 1998):255-260.

3) GN Collins, PJ Martin, A Wynndavies, PJ Brooman, PH Oreilly. The effect of digital rectal examination, flexible cystoscopy and prostatic biopsy on free and total prostate specific antigen, and the free-to-total prostate specific antigen ration in clinical practice. Journal of Urology. 157: 5 (MAY 1997):1744-1747. Cystoscopy had no effect on total PSA, while dre had a slight, biopsy uniformly increased total PSA There was a significant increase in free-to-total PSA ratio after each maneuver.

4) I Cevik, LN Turkeri, H Ozveri, Y Ilker, A Akdas. Short-term effect of digital rectal examination on serum prostate-specific antigen levels - A prospective study. European Urology 29: 4 (1996):403-406.

5) Z Kirkali, G Kirkali, A Esen. Effect of ejaculation on prostate-specific antigen levels in normal men. European Urology 27: 4(1995):292 -294.

6) R Simak, S Madersbacher, ZF Zhang, U Maier. The Impact of Ejaculation on Serum Prostate Specific Antigen. Journal of Urology 150:3

7) RF Kropman, W Dekieviet, RCM Pelger, PL Venema. The Effect of Orgasm on Prostate-Specific Antigen. World Journal of Urology 12: 6 (DEC 1994):313-315 and (SEP 1993):895-897.

8) MB Tchetgen, JT Song, M Strawderman, SJ Jacobsen, JE Oesterling. Ejaculation increases the serum prostate-specific antigen concentration. Urology 47: 4 (APR 1996):511-516. mean baseline PSA was 1.8 ng/mL. Changes at 1 hour, 6 hours, 24 hours, and 48 hours after ejaculation was 0.8, 0.3 ng/mL, 0.2, and 0.4 ng/mL.

9) MB Tchetgen, JT Song, M Strawderman, SJ Jacobsen, JE Oesterling. Ejaculation increases the serum prostate-specific antigen concentration. Urology 47: 4 (APR 1996):511-516. Ejaculation causes a significant increase in the serum PSA concentration in men between 49 and 79 years of age that may persist for up to 48 hours.

10) NR Netto, F Apuzzo, E Deandrade, GB Srulzon, PL Cortado, ML Lima. The effects of ejaculation on serum prostate specific antigen. Journal of Urology 155: 4 (APR 1996):1329-1331.

11) A Zisman, Y Soffer, YI Siegel, A Paz, A Lindner. Postejaculation serum prostate-specific antigen level. European Urology 32: 1 (1997):54-57.

12) JD Herschman, DS Smith, WJ Catalona. Effect of ejaculation on serum total and free prostate-specific antigen concentrations. Urology 50: 2 (AUG 1997):239-243.

13) V Pansadoro, P Emiliozzi, L Defidio, P Scarpone, G Sabatini, A Brisciani, S Lauretti. Prostate-specific antigen and prostatitis in men under fifty. European Urology 30: 1 (1996):24-27.

14) K Jung, A Meyer, M Lein, B Rudolph, D Schnorr, SA Loening. Ratio of free-to-total prostate specific antigen in serum cannot distinguish patients with prostate cancer from those with chronic inflammation of the prostate. Journal of Urology 159: 5 (MAY 1998):1595-1598.

15) EK Leventhal, TA Rozanski, AF Morey, V Rhollle. The Effects of Exercise and Activity on Serum Prostate Specific Antigen Levels. Journal of Urology 150: 3 (SEP 1993): 893-894.

16) Diamandis EP, Yu H. New Biological Functions of Prostate-Specific Antigen. Journal of Clinical Endocrinology and Metabolism. 1995;80(5):1515-1517.)

17) J Fichtner, H Graves, L Shortliffe, T Stamey. Physiological functions of prostate-specific antigen. Aktuelle Urologie 26: Sp. Iss. 1 (SEP 1995):58-60.).

Checked 7/12/17

May 16th, 2013
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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