All PSA Blood Test and Free PSA Test Explained

Are you confused and anxious about PSA blood test result? so I would like to give you advice if you have a risk of a prostate cancer or not?
PSA is important indicator for prediction of prostate cancer and the tumor marker of choice, and we will go further in explaining how PSA assess prostate cancer.
What does PSA mean?
PSA meaning is a medical term for Prostate-Specific Antigen.
What is a PSA test?

  • PSA is a blood test for measuring Prostate-Specific Antigen, the protein liquefying human semen.
  • PSA test is different than the DRE test which is a rectal examination by a healthcare practitioner finger.
  • PSA Lab name is: serum prostate specific antigen (PSA test)
  • PSA blood test is used for early detection of abnormal prostate cells such as in benign prostate hyperplasia(BPH) or prostate cancer, Blood tests for tumor markers

Does PSA test require fasting or other precautions?
Sampling requirements: no ejaculation 24-hour prior sampling, no DRE or biopsies after the PSA test to avoid false PSA results.
No Fasting is required prior taking a blood sample for PSA blood test.
PSA test results can be obtained by a home PSA test or get tested at the doctor office as well.
When to take a blood test for PSA test?

  • Have been complaining from difficult, painful, and/or frequent urination, back pain, and/or pelvic pain. see explanation for blood in urine of male.
  • A man after age 30 for families with cancer history, Checkup periodically for prostate tumors.
  • A man after age 50 for even with no symptoms exist, as PSA is used as an early tumor marker for prostate cancer.
  • Thickness consistency of seminal fluid.
  • Muscle builders who take a testosterone must check for their PSA level periodically.

What is prostate specific antigen test?
Male Prostate Gland exclusively produce a protein called prostate specific antigen, the shortcut is PSA, PSA is used for liquefying the semen following ejaculation. Large PSA amount go into semen and low amount go through the blood stream which can be detected by PSA blood test in nanograms per milliliter of blood. So that the Normal PSA level in healthy man and after the treatment completion is to be very low . Any steadily increase after treatment is considered recurrence.

What is Free PSA blood test?

The difference between total PSA test and Free PSA test is that: Benign prostate cells produce only free PSA form, tumor cells produce complexed PSA form (cPSA), the higher form predict the source of increase, see the individual interpretation below. So that the Free PSA test is a blood test measures the prostate specific antigen produced only by benign prostate cells.
Why do Free PSA blood test? 

  1. PSA Blood Tests is designed to measure Free PSA or Total PSA (both free and complexed), therefore, when total PSA is within grey levels we still need Free PSA test results to know which the values of PSA are driven from cancer or not?
  2. Minimize the need for biopsy in patients in grey zone or borderline results of PSA values.
  3. When total PSA is rising rapidly even the free PSA results is relatively low it still prognostic.
    For instance: in a male case PSA fluctuated from 5.7 to 7.8 and Free PSA from 0.98 to 1.41. after months PSA went up to 8.48 and after a year PSA went up to 9.59, the doctor suggests to perform a Biopsy. while Free PSA test can postpone the need to biopsy.

What does Free PSA test result mean?
The Higher the free PSA the lowest the Probability of prostate cancer.
How can PSA blood test tell I have prostate cancer or not?
You have the higher probability of prostate cancer if your PSA results are high in both free and total measurements or if the total PSA is the only high.
Can PSA blood test predict prostate cancer alone?
Evaluation of PSA blood test results depends on many diagnostic factors, basically there are many Prostate cancer indicators.PSA Blood test

  1. Family history of prostate cancers.
  2. Ethnicity.
  3. Urinary symptoms: Urine analysis test is for exclusion of prostatitis or other UTI. blood in urine test explained.
  4. Digital Rectal Exam findings (nodules vs. no nodules).
    DRE or digital rectal exam, “digital” means finger.
    Check for growths in or enlargement of the prostate gland in men.
    A tumor in the prostate can often be felt as a hard lump.
    DRE results: My DRE check up with Urologist specialist was normal or non-remarkable
  5. Age: The higher the man’s age the normal the PSA elevation for age, but not with excessive high levels.
  6. The correlation between free PSA percentage and Total PSA levels
  7. PSA Series testing results: to measure how fast PSA levels is doubling? if repeated PSA over a year is rapidly increase, it means confirmation of prostate cancer or a more aggressive form of cancer.
  8. Ultrasound determined volume of prostate correlated with high PSA level to confirm prostate cancer.
  9. 4KScore test is consists of four prostate-specific kallikreins measurements in the blood: Total PSA, Free PSA, Intact PSA, and Human Kallikrein 2 (hK2) and combined with age and DRE results, to detect up to 95% of aggressive Gleason score 7 or higher prostate cancer in men upon biopsy and help minimize over 50% of biopsies.

What is watchful waiting for PSA results?
Watchful waiting: series of PSAs be done over time to determine whether the level goes down, stays elevated, or continues to increase. to monitor its progress rather than pursue immediate treatment

  • High PSA result for the first time should be repeated in a period between 6 weeks and 3 months, before deciding any medical decision, as high PSA in many cases return to normal after a time which was probably just infection.
  • Annual routine checkup by PSA blood test is recommended for men over 50 of age according to the average age set by cancer associations around the world.
  • Periodic Checkup for men over 30 is preferred for those have a family history of prostate cancer.
  • To determine which men actually have cancer and which don’t, physicians traditionally perform a biopsy. Undergoing a biopsy isn’t as traumatic as surgery, but it causes discomfort and can provoke anxiety. while Free PSA test can sway decision of performing painful biopsy.
  • Take a blood test for PSA at regular intervals after treatment from prostate cancer to detect recurrence of the cancer.
  • Follow up treatment by PSA blood test in one laboratory to avoid minimum change between laboratories, the cancer recurrence may cause such minimum change.

There is no sharp blood test can tell if the prostate cancer cause man’s death, also many prostate cancers may exist while PSA levels still not high. I recommend you to follow my next interpretation about PSA levels chart.

Dr.Megan Ralf

A Medical laboratory Scientist who devoted his life to medical and laboratory sciences, writes his everyday expertise dealing with various pathological conditions through laboratory diagnosis of different body fluids, also participating in many workshops for first aids, infection control, and urgent care. Also Dr Megan Ralf coaching many medical teams.

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