PSA (Free)


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Prostate-specific antigen is a glycoprotein and occurs in three forms in the blood:

1) PSA complexed with the serine protease inhibitor or alpha-1-antichymotrypsin,

2) free or uncomplexed PSA, and

3) PSA complexed with alpha-2 macroglobulin.

The first two are detectable and the third is undectectable in conventional immunoassay.

Elevated levels of PSA in serum or plasma indicate a pathological condition of the prostate (e.g. carcinoma, benign prostatic hyperplasia (BPH), or prostatitis). Inflammation or trauma to the prostate, such as following a biopsy or colonoscopy, can result in PSA elevations. PSA levels are also checked to monitor therapy in patients with prostate cancer.

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Purpose of the test

The Prostate-Specific Antigen (PSA) test measures the level of PSA in the blood. PSA is a protein produced by both normal and malignant cells of the prostate gland. Originally, the PSA test was approved to monitor the progression of prostate cancer in men already diagnosed with the disease. Later, it was approved to aid in the detection of prostate cancer in conjunction with a digital rectal exam (DRE) for men aged 50 and above. The test helps in early detection of prostate cancer, though it can also detect benign conditions like prostatitis and benign prostatic hyperplasia (BPH).

Who Should Get Tested

The PSA test was initially recommended for men starting at age 50. However, as understanding evolved, many professional organizations began to advise against routine PSA screening, emphasizing the importance of discussing the risks and benefits with a doctor. Certain high-risk groups, such as Black men, men with germline variants in BRCA2 (and to a lesser extent, BRCA1), and men with a family history of prostate cancer, might begin PSA screening earlier, around age 40 or 45. The decision to undergo PSA screening should be individualized, considering both potential benefits and harms.

Blood Test Preparation Guidelines
Time of day
It is recommended to schedule your appointment for blood tests in the morning hours between 7:00-10:00.
It is recommended to fast for approximately 12 hours before blood sampling. The last meal of the previous day should ideally be consumed around 6:00 p.m. On the day before the test, avoid heavy and fatty meals as well as alcohol.
Stay hydrated
Drinking water prior to testing can help with sample collection.
Other factors
Tests should not be performed after a sleepless night or intense physical activity. It is recommended to avoid exercise and stress immediately before blood collection and to not smoke. A short rest is recommended.
Medications and supplements:
Blood samples should be collected before the morning dose. Some drugs can interfere with test results. Consult with your doctor whether you can delay your dose because of lab tests.
Biotin supplements:
High doses of biotin supplements can affect test results, causing false elevation or reduction. It's recommended to avoid taking biotin for at least 72 hours before blood collection. If you are taking biotin, inform the personnel collecting the blood so that they can provide specific instructions.
Interpreting Test Results

The Prostate-Specific Antigen (PSA) test measures the amount of PSA in the blood, which is a protein produced by the prostate gland. When evaluating PSA test results, both total PSA and free PSA levels are considered. The free PSA is the portion of PSA that is not bound to other proteins in the blood.

A higher percentage of free PSA can suggest that the increase in total PSA is due to a non-cancerous condition, such as benign prostatic hyperplasia (BPH) or prostatitis. Conversely, a lower percentage of free PSA can indicate that the rise in total PSA might be due to prostate cancer. However, it's essential to note that while the free PSA test can provide additional information, it does not conclusively determine the presence or absence of prostate cancer. Other factors, such as age, prostate size, and family history, should also be considered. A biopsy is the only definitive way to diagnose prostate cancer. It's crucial to discuss the PSA test results, including free PSA levels, with a healthcare professional to understand the implications fully and decide on any further diagnostic or treatment steps.

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