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All About PSA !!!

This document discusses prostate-specific antigen (PSA) testing. It notes that PSA is produced by prostate cells and exists in free and bound forms. While elevated PSA can indicate prostate cancer, it can also be increased by other benign conditions like prostate enlargement. The document provides guidance on who should be screened, when to repeat a PSA test, and factors that can improve the specificity of PSA for detecting cancer. It also discusses next steps like imaging and biopsy if cancer is suspected and answers common patient questions about PSA testing.

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Halawatul Iman
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40 views21 pages

All About PSA !!!

This document discusses prostate-specific antigen (PSA) testing. It notes that PSA is produced by prostate cells and exists in free and bound forms. While elevated PSA can indicate prostate cancer, it can also be increased by other benign conditions like prostate enlargement. The document provides guidance on who should be screened, when to repeat a PSA test, and factors that can improve the specificity of PSA for detecting cancer. It also discusses next steps like imaging and biopsy if cancer is suspected and answers common patient questions about PSA testing.

Uploaded by

Halawatul Iman
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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All about

PSA !!!
Dr. Lim Li Yi
Urology Specialist
Hospital Kuala Lumpur
What is PSA
• Glycoprotein
• Secreted by prostatic ductal epithelial cells
• liquefy the seminal coagulum within the
ejaculate
• PSA exist in free and bound forms
• Prostate specific but not prostate cancer
specific
• Causes of raised PSA
• Malignancy
• BPH
• Urinary retention
• Infection
• Inflammation
• Instrumentation / catheterisation
When to take PSA?

PCa
Diagnosis
Screening
Red flags for advanced PCa
• Bone pain
• Acute neurological symptoms
• Renal failure
• Hematuria (without UTI)
Who need PSA for screening?
Important points for counselling
• Increased diagnosis of PCa
• Detection of more localized disease and less advanced PCa

• ? PCa specific survival benefit


• Any reduction in mortality may take up to 10 years to accrue
• Men with life expectancy <10-15 years unlikely to be beneficial

• Overtreatment and treatment related harms


• Impact on QoL
What is normal PSA
• No PSA cut-off that completely predicts the absence of PCa
• Continuous parameter, higher levels, greater likelihood
• Balance tradeoffs between sensitivity and specificity, and
avoids subjecting men to unnecessary biopsies

PSA ≥4ng/ml
Most widely
accepted standard
• Correction for 5 alpha reductase inhibitors
• Finasteride & dutasteride
• Procedure ≥50% reduction in PSA after 3-6 months
• Reduction of prostate volume
• Interference with prostatic intracellular androgen response mechanism
• establishing a new baseline 6 months after
• any rise from new baseline - higher risk of PCa or higher-grade Pca - refer
• PSA × 2 for 1st 2 years, × 2.5 on long term use
Improving specificity of PSA
1. Free/Total PSA
• No clinical use if total serum PSA >10ng/mL
• Men with PSA 4-10ng/ml

F/T PSA % PCa

<0.1 56%

>0.25 8%
2. PSA Density
• Serum PSA divided by prostate volume
• Higher the PSA density, more likely PCa is clinically significant
• PSAD of >0.15 ng/mL/mL is more likely to diagnose with PCa
Prostate cancer calculator
PCPT Cohort ERSPC Cohort

http://www.prostatecancer-riskcalculator.com/seven-
https://riskcalc.org/PCPTRC/ prostate-cancer-risk-calculators
When to refer to Urology?

PSA ≥ 4ng/mL
Rise in PSA while on 5-alpha reductase inhibitor
Abnormal DRE
Red flag symptoms (urgent)
What’s next for patients?
• Assessment
• mpMRI of prostate (kiv)
• Prostate biopsy
• Commonly transrectal ultrasound guided
• Office procedure
• Risk: bleeding, infection
Common questions
Raised PSA, need to repeat?
• PSA should be taken under standardised conditions:
• No ejaculation
• No manipulation
• No UTI
• Limited PSA elevation should be verified after few weeks - same lab and assay
• Empiric use of antibiotics in asymptomatic patient in order to lower PSA
should not be undertaken
Can take PSA after DRE?
• YES
• DRE - insignificant changes in PSA
• Transient elevation of 0.26-0.4ng/mL 1 2

1. Effect of digital rectal examination on serum prostate-specific antigen in a primary care setting. The Internal Medicine Clinic
Research Consortium. Arch Intern Med 1995; 155:389.
2. Chybowski FM, Bergstralh EJ, Oesterling JE. The effect of digital rectal examination on the serum prostate specific antigen
concentration: results of a randomized study. J Urol 1992; 148:83
Can take PSA at time of AUR?
• NO
• PSA raised during AUR - ? secondary to prostatic infarction
• a delay of 2 weeks - half-life of PSA is 2-3 days.
When to stop screening
• up to 70 years, or 75 years if patient desires
• Study found screening survival benefit only among men 55-69 years
• Aggressive treatment of PCa in men age >70 years would decrease QoL

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