Older men who come to the urologist with urinary discomfort are often asked if they have had a PSA test. Many people don’t know much about it and don’t know what it does. The PSA is an abbreviation for prostate specific antigen, a special protein secreted or produced by prostate cells, hence the name. The PSA ultrastructure Since men only have a prostate, this test is only for men. The PSA test is a blood test, and unlike blood tests such as liver function, the PSA test does not require fasting and fasting. Why is it important to have a PSA test? PSA can be produced by both normal prostate and prostate cancer cells, and in normal people, PSA is present in small amounts in the blood and increases gradually with age and prostate enlargement. PSA is now used as one of the tumor markers. PSA levels in the blood of prostate cancer patients are often significantly elevated, which is suggestive. In middle-aged and older men with prostate disease, doctors often recommend testing for PSA to rule out prostate cancer. Blue Ribbon – Prostate Cancer Awareness Where does PSA come from? PSA was approved by the U.S. Food and Drug Administration (FDA) in 1986 to detect tumor progression in patients who had been diagnosed with prostate cancer. In 1994, the FDA approved PSA in combination with a rectal exam to diagnose prostate cancer in asymptomatic men and to help determine the nature of PSA in men with existing prostate symptoms. PSA is a prostate-specific antigen, not a prostate cancer-specific antigen, but there is a fundamental difference between the two. In addition to prostate cancer, a number of other benign pathologies can cause elevated PSA levels, the most common of which are prostatitis and prostate enlargement (BPH). Both of these conditions have no evidence of developing prostate cancer, but a patient may have both benign and malignant lesions and later develop prostate cancer. What is the difference between a PSA test and a PSA screening test? While PSA screening refers to a doctor prescribing a blood test for symptomatic patients, PSA screening refers to a regular screening test for people of a certain age group (mostly 50 years and older). In the United States and Western Europe, where prostate cancer is highly prevalent, many doctors or professional organizations are more supportive of conducting PSA screening for men over the age of 50, with those with high-risk factors (black Americans, fathers or brothers with prostate cancer) starting at age 40-45. However, after years of summarizing the pros and cons, many professional organizations have become cautious about PSA screening in the general population. Although there is still a fair amount of screening, there is a broad consensus to provide patients with a detailed account of the potential risks and benefits. Many institutions have also included PSA as part of their routine physical examinations for employees, which to some extent can be called PSA screening. However, the good intentions of the units sometimes bring some specific questions and confusion. What is a normal PSA result? On the laboratory test, most medical institutions mark the normal PSA value as less than 4.0ng/ml, so when the PSA exceeds this value, some doctors recommend a puncture biopsy to find out if prostate cancer is present. In other areas, doctors begin considering biopsy when PSA exceeds 2.5 or 3.0 ng/mL. Recent studies have shown that some men with PSA below 4.0 ng/mL also have prostate cancer, while many with high values do not have prostate cancer, and about 15% of prostate cancers are PSA less than 4.0 ng/mL. In addition to this, many factors can make PSA fluctuate. For example, PSA can be elevated during prostatitis or other urinary tract infections; prostate biopsy or surgery, transurethral manipulation (cystoscopy or urethral insertion), and even prostate palpation massage, intense sexual intercourse, and ejaculation (within 48 hours) can have the same result. Conversely, some medications such as finasteride (Paulownia) will lower PSA in the treatment of prostate enlargement. and PSA results can vary between different hospital laboratories. Another factor that has to be considered is that normal PSA levels have been established from white populations, although expert opinion is divided and there is no general consensus on exactly what PSA levels are best for puncture biopsy recommendations for all different races. However, overall, the higher the PSA level in men, the more likely they are to have prostate cancer, and a persistently elevated PSA is a sign of prostate cancer. What if the screening test results show an elevated PSA? If a man (>50 years old) without any prostate cancer symptoms is screened for PSA and is found to have an elevated PSA, his doctor will recommend a repeat test to confirm. If the PSA is still high, depending on how high it is, regular monitoring will be done for a certain amount of time in conjunction with a rectal exam. Other tests such as urine and ultrasound will also be performed to rule out infection or prostate enlargement, etc. If the PSA continues to be elevated or a lump is palpable during the observation period, the doctor will perform additional imaging (transrectal ultrasound or MRI-MRI). Those who do suspect prostate cancer will have a prostate puncture biopsy to confirm. Instead of a crude puncture guided by a finger in the rectum, most hospitals now perform it under the guidance of transrectal ultrasound, or even MRI. The puncture route can be through the rectum or perineum, using a hollow biopsy needle inserted into the prostate and then pushed out to remove multiple pieces of tissue (or more accurately, multiple strips of tissue). The removed tissue strips are divided into multiple vials and the pathologist uses a microscope and different special stains to determine the benign and malignant grade of the tissue jin.