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Prostate cancer: Improving PSA test accuracy

prostateBy Healthafter50 with Scientific American

Most experts agree that prostate-specific antigen (PSA) screening should be used in conjunction with other information (for example, family history, race and age) to assess the overall likelihood that prostate cancer is present, and it should be performed following a discussion with the patient about its benefits and risks.

Researchers have also developed several ways to improve the PSA test’s accuracy, although none of these takes the place of a simple PSA measurement for screening. These improvements include assessments of:

PSA density
This measurement takes the size of a man’s prostate into account when evaluating his PSA level. This measurement helps doctors distinguish between benign prostatic enlargement and prostate cancer. The higher the PSA density, the greater the chance of cancer.

What NOT to Do Before Your PSA Test

Did you know… Having sex within 72 hours of your PSA test can produce a false reading? ED can be a symptom of prostate cancer? By age 70, the average man’s prostate has doubled in size. Early detection of prostate cancer is a KEY factor in treating this disease successfully.

PSA velocity
This measurement takes into account annual changes in PSA values, which rise more rapidly in men with prostate cancer than in men without the disease.

Percent free PSA or complexed PSA
PSA in the blood is either bound (attached) to proteins (known as complexed) or unbound (known as free). PSA assays usually measure the total PSA (both free and complexed). Other assays measure the percentage of free PSA or the percentage of complexed PSA. Compared with men who have BPE, men with prostate cancer have a higher percentage of complexed PSA and a lower percentage of free PSA. Research suggests that determining the ratio of free to total PSA in the blood helps distinguish between PSA elevations due to cancer and those caused by benign prostate enlargement.

Other biomarkers
Biomarkers are substances like PSA that can be measured in a body fluid and used to detect or monitor a disease. Prostate cancer researchers are testing several potential biomarkers to supplement the use of PSA in prostate cancer screening. One of these biomarkers, pro-PSA (a precursor of PSA), has been shown to be useful in distinguishing between blood samples that have prostate cancer and those that do not. A urinary marker called PCA3 has also been useful in this regard. Some of these tests have received or are pending FDA approval.

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