The PSA, Free and Total test contains 1 test with 3 biomarkers.
Description: The PSA Free and Total test is a blood test that measures the levels of prostate-specific antigen (PSA) in the bloodstream. PSA is a protein produced by the prostate gland, and its levels can be elevated in various prostate conditions, including prostate cancer. The test provides two measurements: the total PSA level and the free PSA level, which is the portion of PSA not bound to other proteins.
Also Known As: Prostate Specific Antigen Test, PSA Free and Total Test, PSA Free Test, PSA Total Test, PSA Blood Test
Collection Method: Blood Draw
Specimen Type: Serum
Test Preparation: No preparation required
When is a PSA Free and Total test ordered?
A PSA Free and Total test may be ordered in the following situations:
Screening for Prostate Cancer: The test is commonly used as a screening tool for prostate cancer in men, especially those at higher risk due to factors such as age, family history, or race.
Monitoring Prostate Health: The test may be ordered for men with a known history of prostate conditions, such as benign prostatic hyperplasia (BPH) or previous prostate cancer, to monitor disease progression or recurrence.
Evaluating Prostate Symptoms: If a patient presents with symptoms suggestive of prostate problems, such as urinary difficulties or abnormal digital rectal exam findings, a PSA Free and Total test may be ordered to help assess the cause.
What does a PSA Free and Total blood test check for?
Prostate specific antigen is a protein produced predominantly by cells in the prostate, a tiny gland that surrounds the urethra in males and generates a fluid that is part of the sperm. The majority of PSA produced by the prostate is discharged into this fluid, but minor amounts can also be found in the bloodstream. This test determines how much PSA is present in the blood.
The PSA test is used to screen for and monitor prostate cancer as a tumor marker. It's a good tool, but it's not perfect, and most experts agree that asymptomatic men should only be screened after having a detailed discussion with their healthcare professionals about the benefits and dangers, and after making an informed decision to do so. PSA levels that are higher than normal are linked to prostate cancer, but they can also be detected in prostatitis and benign prostatic hyperplasia. PSA levels rise with age in all men, but men of African American ancestry may have greater levels than other men, even at a younger age.
PSA is not a cancer indicator. The prostate biopsy, which involves taking small samples of prostate tissue and examining them under a microscope for abnormal cells, is the gold standard for detecting prostate cancer. The total PSA test and the digital rectal exam are combined to help determine whether a prostate biopsy is necessary.
The purpose of prostate cancer screening is to discover the disease when it is still contained within the prostate. Once the diagnosis of prostate cancer has been verified by biopsy, a treatment decision must be determined. As men get older, prostate cancer becomes more common, and many, if not all, of the tumors are slow-growing. While prostate cancer is the second leading cause of mortality in men, slow-growing prostate cancer is a rare cause of death. A pathologist may be able to tell the difference between cancers that grow slowly and spread to other regions of the body and cancers that grow quickly and spread to other parts of the body.
Overdiagnosis and overtreatment are two challenges that health professionals are currently dealing with. In certain situations, the treatment is worse than the cancer, with substantial side effects including as incontinence and erectile dysfunction possible. In general, neither the PSA test nor the DRE can indicate how a person's condition will progress.
PSA is found in the blood in two forms: complexed and free. The total PSA test, which analyzes the sum of complexed and free PSA in the blood, is the most often used PSA test.
When the total PSA is only slightly raised, the free PSA test is occasionally used to help assess whether a biopsy should be performed. PSA is an enzyme that is inactivated by circulating proteins that bind to it when it is released into the bloodstream. In BPH, benign prostate cells emit PSA that is not active, but malignant prostate cells release PSA that is already coupled to a protein.
As a result, men with BPH tend to have greater levels of free PSA, while men with prostate cancer have lower levels. Even if total PSA is not dramatically raised, a relatively low amount of free PSA raises the chances of cancer.
Lab tests often ordered with a PSA Free and Total test:
Conditions where a PSA Free and Total test is recommended:
A PSA Free and Total test is primarily used in the evaluation of prostate health and the detection of prostate cancer. It can also help assess the risk of prostate cancer in individuals with certain risk factors or monitor the progression of prostate conditions.
How does my healthcare provider use a PSA Free and Total test?
Health care providers use the results of a PSA Free and Total test to:
Screen for Prostate Cancer: Elevated PSA levels, particularly when combined with other clinical findings, may indicate the need for further evaluation, such as a prostate biopsy, to confirm or rule out prostate cancer.
Monitor Prostate Health: Serial testing of PSA levels allows health care providers to monitor changes in prostate-specific antigen levels over time, helping to detect any significant increases that may warrant further investigation.
Assist in Treatment Decision-making: In cases where prostate cancer is detected, PSA levels can provide valuable information for treatment planning and monitoring the response to treatment. Changes in PSA levels after treatment can indicate disease progression, recurrence, or treatment efficacy.
It's important to note that an elevated PSA level does not necessarily indicate the presence of prostate cancer. Further diagnostic tests, such as a biopsy, are usually needed to confirm the diagnosis. Additionally, the decision to pursue further evaluation or treatment is made in collaboration between the patient and their health care provider, taking into consideration individual risk factors, preferences, and overall health.
What do my PSA test results mean?
PSA test results can be interpreted in a variety of ways, and the cutoff values used by different laboratories may differ.
Total PSA levels below 4.0 ng/ml are considered unlikely to indicate the existence of prostate cancer. Some argue that this limit should be reduced to 2.5 ng/ml in order to detect more prostate cancer cases. Others contend that this might result in more malignancies being diagnosed and treated that aren't clinically important.
Men with a total PSA level of more than 10.0 ng/ml are thought to be at a higher risk of prostate cancer.
Prostate cancer, benign prostate hyperplasia, or inflammation can all be indicated by total PSA readings between 4.0 and 10.0 ng/ml. These problems, as well as an increase in PSA levels, are more common among the elderly. The "gray zone" is defined as total PSA levels between 4.0 and 10.0 ng/ml. The free PSA may be beneficial in this range.
Prostate cancers generally produce a lot of complexed PSA rather than free PSA. Prostate cancer cells create more free PSA, which does not bind to proteins. As a result, when men in the gray zone have lower levels of free PSA, they have higher levels of cPSA and a higher risk of prostate cancer. When individuals have high amounts of free PSA but low cPSA, however, the danger is reduced. The ratio of free to total PSA can assist the patient and his healthcare professional in determining whether or not a prostate biopsy is necessary.
Most Common Questions About the PSA Free and Told test
Understanding the PSA Free and Total Test and Its Purpose
What is the PSA Free and Total test?
The PSA (prostate-specific antigen) Free and Total test is a blood test used to measure the levels of prostate-specific antigen in the blood. The test measures both "free" PSA, the form not bound to proteins, and "total" PSA, which includes both free and bound forms.
What is the purpose of the PSA Free and Total test?
The primary purpose of the PSA Free and Total test is to screen for prostate cancer. It can also help monitor the progress of patients who have been diagnosed with prostate cancer or assess their response to treatment.
Who should get a PSA Free and Total test?
Typically, men aged 50 and older are recommended to discuss the benefits and potential harms of the PSA test with their doctors to make an informed decision about whether to be tested. Men at higher risk, such as African American men and those with a family history of prostate cancer, may need to have this discussion at a younger age.
Interpreting Test Results
What do the results of a PSA Free and Total test mean?
PSA is a protein produced by normal and malignant cells of the prostate gland. Higher levels of PSA can indicate prostate cancer, but can also suggest other conditions like an enlarged or inflamed prostate. A higher proportion of free PSA to total PSA can sometimes indicate a lower risk of prostate cancer.
What is considered a normal PSA level in the PSA Free and Total test?
Generally, a PSA level of 4.0 ng/mL (nanograms per milliliter) and below is considered normal. However, some doctors might consider a PSA level of 2.5 or lower as normal. A continuously rising PSA level over time can also be a sign of a problem, even if the total PSA is below 4.
Understanding the Implications and Health Impact
What health implications are associated with the results of a PSA Free and Total test?
A high total PSA level or a low percentage of free PSA may indicate prostate cancer, but other conditions can also cause these results. It's important to remember that the PSA test is only one tool used to screen for early stages of prostate cancer.
Does a high PSA level definitely mean I have prostate cancer?
No, a high PSA level does not definitively indicate prostate cancer. PSA levels can also increase due to other conditions, such as an enlarged prostate (benign prostatic hyperplasia) or an infection in the prostate (prostatitis).
Risk Factors, Prevention, and Treatment
Can certain conditions or lifestyle factors affect the results of a PSA Free and Total test?
Yes, conditions like prostatitis, urinary tract infections, and procedures such as prostate biopsy or digital rectal exam can raise PSA levels. Certain medications can also affect PSA levels.
How do the results of a PSA Free and Total test guide treatment for prostate cancer?
Results of the PSA Free and Total test can help guide treatment decisions. If PSA levels rise during or after prostate cancer treatment, it may suggest that the treatment is not working or that the cancer has recurred.
10. Can I prevent an elevated PSA level? Some evidence suggests that certain lifestyle choices like maintaining a healthy weight, exercising regularly, and eating a diet rich in fruits and vegetables could lower the risk of prostate cancer, which might lead to lower PSA levels.
The PSA Free and Total Test in Medical Practice
How does the PSA Free and Total test assist in the diagnosis of prostate cancer?
The PSA Free and Total test is one tool that can assist in the early detection of prostate cancer, especially when combined with a digital rectal exam (DRE). However, it's important to remember that PSA levels can also be elevated due to non-cancerous conditions.
How often should I get a PSA Free and Total test?
The frequency of PSA testing depends on your initial PSA level and your overall risk for prostate cancer. This is a decision that should be made in consultation with your healthcare provider.
Does the PSA Free and Total test have any limitations?
Yes, the PSA Free and Total test does have limitations. It is not a definitive test for prostate cancer, and it has a significant rate of false positives. High PSA levels can also occur in benign conditions, and some men with prostate cancer may have low PSA levels.
Can the PSA Free and Total test be used for conditions other than prostate cancer?
Yes, the PSA test is also used to monitor men who have been diagnosed with benign prostatic hyperplasia (BPH) or prostatitis, and to monitor the effectiveness of treatments for these conditions.
Can the PSA Free and Total test be used to determine the severity of prostate cancer?
Yes, the PSA level can sometimes help estimate the extent or aggressiveness of prostate cancer, as higher levels generally suggest more advanced disease. However, other diagnostic tools are also important for determining the severity of the cancer.
Further Insights into the PSA Free and Total Test
Why isn't the PSA Free and Total test suitable for general population screening?
There is debate about the value of PSA screening in the general population because it can lead to overdiagnosis and overtreatment of prostate cancers that may not have caused any harm if left undetected. The decision to screen should be individualized, taking into account the man's values and preferences, overall health, and risk factors for prostate cancer.
How does the PSA Free and Total test differ from the standard PSA test?
The standard PSA test measures the total amount of prostate-specific antigen in the blood, both free and protein-bound. The PSA Free and Total test, on the other hand, measures both the total PSA and the amount of free PSA, providing a more detailed analysis that can improve decision-making in borderline cases.
How can PSA levels change over time?
PSA levels can vary over time due to a variety of factors including age, prostate size, and the presence of inflammation or infection in the prostate. Therefore, a single elevated PSA result does not necessarily indicate prostate cancer, and it may be necessary to perform repeat testing over time.
What other tests might be ordered along with a PSA Free and Total test?
If the PSA level is elevated, other tests such as a digital rectal exam (DRE), a prostate biopsy, or imaging studies might be ordered to further evaluate the prostate.
Can the PSA Free and Total test predict the risk of future prostate cancer?
While the PSA test can detect early-stage prostate cancer, it's unclear whether it can predict the risk of future prostate cancer. Some men with elevated PSA levels never develop clinically significant prostate cancer, while others with low levels do.
Is the PSA Free and Total test enough to diagnose prostate cancer?
No, if PSA levels are elevated, additional diagnostic procedures are necessary to confirm the presence of prostate cancer. These could include a digital rectal exam (DRE) and a prostate biopsy.
What is the relationship between age and PSA levels in the PSA Free and Total test?
PSA levels tend to rise with age, even in the absence of cancer, due to an increase in the size of the prostate gland. This is why age-specific reference ranges are sometimes used when interpreting PSA levels.
What factors can falsely lower PSA levels in the PSA Free and Total test?
Certain medications, such as finasteride and dutasteride, can lower PSA levels. It's important to let your doctor know about any medications you're taking before the test.
What does a decrease in PSA levels mean after prostate cancer treatment?
A decrease in PSA levels after treatment usually indicates that the treatment is working and the cancer is responding.
Can the PSA Free and Total test be used to monitor the effectiveness of treatment for prostate cancer?
Yes, following PSA levels over time can help determine whether prostate cancer treatment is working. An increase in PSA levels might suggest that the cancer is not responding to treatment.
We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.