Prostate Specific Antigen (PSA) – Essential Reading
Dr Vijayant Govinda Gupta is a Urologist in Delhi and the best person to interpret you Elevated PSA levels in Delhi and Gurgaon. IF you have Elevated PSA in Delhi or Elevated PSA in gurgaon, Contact today.
Prostate Specific Antigen (Serum PSA)
Prostate specific antigen or PSA or PSA test or PSA level is a blood test that is usually used to detect and treat prostate cancer. PSA and prostate cancer are usually considered to go hand in hand, but it is not always so. PSA or PSA test is nuanced test and PSA level needs to be evaluated very carefully before making a diagnosis of prostate cancer.
Origin of PSA
PSA is actually produced by the prostate cancer and goes in your semen and this is the enzyme which makes your semen white and liquid and allows intercourse. But in prostate disease, inflammation or prostate cancer, PSA leaks into the blood causing rise in PSA level.
Normal PSA level
There is no normal PSA level for one person. It is a range. Usually levels less than 4 ng/ml are considered safe. But, many patients may have cancer even at below these levels.
If you are below 55 years of age, have symptoms or have had family history of prostate cancer, even levels upto 2.5 may prompt further evaluation.
PSA levels may rise in diseases other than prostate cancer. Inflammation, infection, recent sex, stress may lead to elevated PSA levels. In such scenario, it is wise to repeat levels from a good lab after consulting your urologist.
If you are above 70 years or have a large proste gmand, psa levels above 4 ng/ml may actually be normal for you.
But, still if you have had a PSA test and your levels are elevated, consulting a urologist would be prudent decision.
Contact me for a free e consult at [email protected]
Sometimes PSA levels may be elevated, but you may have had a negative biopsy or your clinical condition may not indicate cancer. Or the other way round, your PSA levels are below 4 but clinically your urologist may have a strong suscpicion of cancer.
In these circumstances, there exist PSA variants such as Free PSA, Percentage free PSA and PrePRoPSA that in combination may help in making a decision.
PSA screening Delhi
You may have been advised PSA screening. It is the in thing today and PSA testing may form part of your insurance testing or may have been advised by your local doctor.
PSA screening is defined as doing a PSA test in a man, who has no symptoms, is healthy and has no family history. It is done with the notion, that early detection of prostate cancer, can allow early treatment and prevent death.
Science is unanimous in condemning this flawed approach. It has never been proven that PSA screening prevents death or that early diagnosis prolongs life in men. On the other hand PSA screening may cause stress, worry and financial troubles including subject you to unnecessary surgery and procedures. For this reason, in the US and much of Europe, PSA screening is not recommended.
I do not support PSA screening, but if you have had a screen and are now confused about your options, you can get a ethical clear consult from me that will clear many of your doubts.
At the same time, if you have a family history, symptoms, predisposing conditions or have been advised by your physician, kindly follow the advice of your physician.
Uses of PSA test/PSA level
It makes great sense to get your PSA done from a good trusted laboratory and keep records as PSA test/PSA level can have multiple uses such as
Follow up of PSA levels over the years can help in predicting cancer
Diagnosis and treatment
PSA is used to consider the need for hormone therapy
PSA levels can be used to predict life expectancy
PSA TEST AND PSA SCREENING IN DELHI NCR GURGAON
VIDEO BY DR VIJAYANT GOVINDA GUPTA FOR PATIENT INFORMATION
READ TRANSCRIPT BELOW
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TRANSCRIPT OF THE VIDEO ON YOUTUBE
THIS IS ANOTHER EPISODE FROM DRVIJAYANTGOVINDA.COM.
TODAY WE ARE GOING TO DISCUSS PSA, AND THIS
IS AN INITIATIVE FROM DR VIJAYANT GOVINDA
GUPTA TO HELP YOU TAKE CONTROL OF YOUR HEALTH.
WHAT IS PSA, PSA IS ALSO CALLED AS PROSTATE
IT IS PROTEIN THAT IS PRODUCED BY THE PROSTATE
GLAND, THE PROSTATE GLAND, IS AN ACCESSORY
SEX ORGAN, WHICH IS PRESENT IN THE MALE GENITALIA,
THE MALE GENITALIA, IS COMPOSED OF THE PENIS,
TESTIS PROSTATE AND THE BLADDER, TESTIS PRODUCE
THE SPERM THAT ENTERS THE PROSTATE, AND THE
PROSTATE PRODUCES A LOT OF FLUID WHICH ALONG
WITH THE SPERM, PRODUCE THE SEMEN THAT IS
EJACULATED, OUT, OUT OF THIS FLUID, THAT IS
PRODUCED, BY THE PROSTATE, IS A PROTEIN THAT
IS THE PROSTATE SPECIFIC ANTIGEN, A PROTEIN
IS NOTHING BUT AN ORGANIC MOLECULE, COMPOSED
OF MANY DIFFERENT VARIETIES OF CHEMICALS ESPECIALLY
CARBON AND NITROGEN, THA THAS A LOT OF DIFFERENT
KID OF FUNCTIONS IN THE BODY.
PSA IS NORMALLY PRODUCED IS EXCRETED IN THE
SEMEN OR EJACULATE, HAVE YOU WONDERED THE
WHITE LIQUID SEMEN, BECOMES COMPLETELY TRANSPARENT
AFTER A WHILE.
ITS IS THIS PSA THA TIS SUPPOSED TO BREAK
DOWN THIS WHITE SEMEN INTO A CLEAR LIQUID,
THAT ALLOWS THE SPERM TO TRAVEL, AND FINALLY
PROVIDE FERTILITY, TO MEN.
WHAT IS A PSA TEST, A PSA TEST IS A BLOOD
TEST, IN THIS TEST, SOME BLOOD IS DRAWN AND
IN THE BLOOD SAMPLE, WE DETECT PSA, LEVELS,
NORMALLY ALL THE PSA, PRODUCED IN THE PROSTATE,
WILL BE EJACULATED OUT, AND A VERY LESS AMOUNT
OF PSA IS ACTUALLY LEFT IN THE BLOOD.
BUT IN DISEASES OF THE PROSTATE LIKE PROSTATE
CANCER, THESE LEVELS WILL RISE BECAUSE THIS
PSA, GETS LEAKED INTO THE BLOOD.
AND INTO THE CIRCULATION,
THE NEXT QUESTION IS WHAT IS NORMAL PSA.
MORE COMMONLY PSA IS CONSIDERED TO BE LESS
THAN 4 NANO GRAMS PER ML.
TO BE CONSIDERED NORMAL.
BUT MORE RECENTLY IN ESPECIALLY IN YOUNGER
MEN THE NEW CUT OFF IS 2.5 NG / ML.
BUT, THERE IS NO ONE NORMAL, IT IS ANORMAL
SO IF WE DO PSA IN MAYBE A HUNDRED PATIENTS
50 WILL HAVE IT AORUND 1, ANOTHER 50 WOULD
HAVE IT AROUND 2, SOME MAY HAVE IT AROUND
3 SO WHAT IS THEY FOUND WAS THAT, IF WE TAKE
100 MEN, AND WE DID PSA IN EACH OF THESE HEALTHY
MEN, WHO HAD NO PROSTATE CANCER, THE RANGE
MAY VARY FROM 1 TO 4.
THERE MAY ALSO BE A FEW MEN WHO MAY HAVE APSA
HIGHER THAN THIS AND YET BE NORMAL.
SOME OF THESE SITUATIONS IN WHICH THE PSA
IS MAYBE ELEVATED AND STILL BE NORMAL IS DUE
TO AGE, ESPECIALLY IN ADVANCED AGE, DUE TO
PROSATE SIZE., OR A LARGE PROSTATE GLAND,
A PATIENT WHO MAY HAVE HAD INFECTION OF HIS
PROSTATE GLAND, OR IF THE PSA TEST IS DONE
IMMEDIATELY AFTER HAVING SEX OR IF AN INTERVENTION
HAS BEEN DONE INTO THE PROSTATE, GLAND.
AND THESE CIRCUMSTANCES
THE PSA LEVELS MAY
PSA SCREENING, IS THE BUZZ WORD TODAY.
EVERYWHERE YOU GO, THEY WILL BE LABAROTARIES,
ADVISING PSA SCREENING.
AS A WAY TO DETECT CANCER, DEFINED ACCURATELY
PSA SCREENING WOULD BE DOING THE PSA TEST
IN HEALTHY PEOPLE, HEALTHY MEANS THAT YOU
HAVE NO DISEASE NO PROBLEM, AND YOU JUST WALK
INTO A LAB AND GET YOUR PSA DONE, THE REASON
GIVEN FOR DOING PSA SCREENING IS THAT IT HELPS
TO DETECT PROSTATE CANCER, EARLY AND HENCE
PROVIDES YOU AN OPTION, TO GET EARLY TREATMENT,
AND PREVENT THESE BAD EFFECTS OF PROSTATE
CANCER BUT DOES IT REALLY HAPPEN, UNITED STATES
PREVENTIVE SERVICES TASK FORCE, RECOMMENDS
AGAINST PSA SCREENING, AND VERY STRONGLY SO.
AND IT HAS BEEN SO STRONG THAT PSA SCREENING
HAS ALMOST DISAPPEARED FROM UNITED STATES.
BUT, AT THE SAME TIME, OTHER MANY PROFESSIONAL
BODIES LIKE THE AUA, THE EUA, AND THE NCCN,
GO AHEAD AND RECOMMEND PSA SCREENING.
THERE REASONS ARE DIFFERENT, THAT WE WILL
AND THEY ALSO GIVE VERY VARYING RECOMMENDATIONS
AND GUIDELINES FOR THE FREQUENCY AND THE AGE
CUT OFF TO GET PSA SCREENING.
ARE THEIR ANY BENEFITS OF PSA SCREENING.
YES, EARLY DETECTION.
BUT DOES PSA SCREENING PROLONG LIFE?
THIS IS THE QUESTION, THA THAS BEEN ASKED.
AND TO UNDERSTAND THIS, WE HAVE TO UNDERSTAND
SOMETHING OF A CONCEPT KNOWN AS LEAD TIME
BIAS THAT I WILL DESCRIBE TO YOU IN THE FOLLOWING
EG, A MAN IS SUPPOSED TO LIVE FOR 60 YEARS,
AND HE GETS PROSTATE CANCER AT THE AGE OF
40, NOW PROSTATE CANCER is a slow disease
SO MAYBE FOR THE NEXT 15 YEARS OR SO HE SUFFERS
AND AT THE AGE OF 55 WE FIND OUT BECAUSE OF
HIS SYMPTOMS THAT HE HAS PROSTATE CANCER,
AND WE DIAGNOSE HIM AND THEN HE LIVES FOR
ANOTHER 5 YEARS AND DIES.
NOW IF WE DO PSA SCREENING AND WE DETECT PROSTATE
CANCER AT 40 THIS MAN WILL RECIEVE 20 YEARS
OF TREATMENT FOR THE NEXT 20 YEARS BUT HE
WILL STILL DIE AT 60 SO EVEN THOUGH IT APPEARS
THAT HE LIVED LONGER FOR 20 YEARS BUT ACTUALLY
HE DID NOT GET ANY BENEFIT IN TERMS OF SURVIVAL
OF LIVING LONGER.
ON THIS SINGLE FACT THE EVIDENCE IS CONFLICTING
AND THIS IS THE REASON WHY SO MANY DIFFERENT
PROFESSIONAL BODIES AND SCOIETIES RECOMMEND
OR DO NOT RECOMMEND PSA SCREENING.
THE PROBLEM OF PSA SCREENING IS THAT A MAN
WHO IS ANYWAYS GOING TO DIE AT 60 YEARS HAS
TO LIVE WITH THE DIAGNOSIS OF CNACER FOR 15
MORE YEARS WHICH LEADS TO UNNECESSARY TESTS
UNNECESSARY BIOPSY UNECESSARY ANXIETY AND
BUT IF YOU HAVE HAD A PSA SCREENING DONE AND
YOU DO NOT KNOW THE WAY FORWARD AND YOU ARE
CONFUSED I RECOMMEND THAT YOU MEET A UROLOGIST
I DR VIJAYANT GOVINDA GUPTA AM A MCH UROLOGIST
AND A CONSULTANT UROLOGY PRACTICING IN DELHI
NCR AND GURGAON SO U CAN TAKE AN APPOINTMENT
WITH ME AND WE CAN SIT AND DISCUSS
THE WAY FORWARD.