PSA value
What is the PSA value?
The PSA value indicates the level of prostate-specific antigen (PSA) in the blood. PSA is a protein that is produced by the glandular cells of the prostate (prostate gland) in men. An increased value can indicate a disease of the prostate such as inflammation or prostate cancer.
The determination of the value can be carried out as part of the cancer prevention. However, this is considered controversial, as there are often elevated values without a disease worth treating (false positive result). If the values are elevated, it is often recommended to take a sample from the prostate in order to investigate suspected cancer.
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When is the PSA value determined?
In Germany, every man aged 45 and over is entitled to an annual prostate examination as part of the early cancer detection program.
In addition to a palpation of the prostate with a finger over the rectum, the doctor asks the patient about possible symptoms that could indicate a disease of the prostate or cancer.
If these early cancer detection measures do not reveal any abnormalities, the PSA value is usually not determined. If the patient nevertheless wishes to have a blood sample taken, this is usually only possible at his own expense. The situation is different if the palpation examination as well as the medical consultation reveal abnormal findings that should be further clarified. In this case, the PSA value is usually determined as part of further diagnostics. Other conditions that make it necessary to determine the PSA value are check-ups, for example after treatment for prostate cancer.
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What statement does the PSA value make?
The PSA value is a specific organ marker for the prostate, i.e. an increase always comes from the prostate.
However, it is not a cancer marker, which means that an elevated value can be an important indicator of the presence of cancer, but is by no means proof of it. Conversely, prostate cancer can be present even with normal PSA levels.
If the PSA values are elevated (over 4 nanograms per milliliter:> 4ng / ml), a diagnostic clarification of the cause of the increase should be carried out. Often, for example, there is a benign enlargement of the prostate, which in many cases should be treated in good time to prevent or alleviate symptoms.
If the values are higher, additional laboratory tests are carried out. For example, the ratio of freely available PSA (fPSA) to total PSA can be determined. Part of the PSA is bound to another substance in the blood and another part is free. If the proportion of fPSA is below 15%, prostate cancer is likely to be the cause of the increase. The lower the percentage, the higher the probability.
In addition, the PSA doubling time can be calculated by determining the PSA value at different points in time. In the case of very long doubling times (over 24 months) and rather low PSA values (> 6 ng / ml), immediate clarification is not necessary. If the doubling time is shorter and the values are higher, a sample should be taken from the prostate by means of a punch biopsy in order to detect or rule out cancer at an early stage.
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PSA standard values
PSA levels naturally increase with age. Therefore, individual normal values also apply to the different age groups.
The PSA value is given in nanograms (nano = billionths) per milliliter of blood. Since the PSA value is usually only determined in men over 40 years of age (e.g. as part of a preventive medical check-up), there is only a reference value between 40 and 49 years of age. This is 2.3 to 2.5 ng / ml. For men between 50 and 59 years of age, the PSA value should be between 3.3 and 3.5 ng / ml. Between 60 and 69 years of age, the range of normal values is between 4.5 and 5.4 ng / ml. Men between 70 and 79 years of age are even in the normal range with PSA values of 6.0 and 6.5 ng / ml.
It should be noted, however, that these are only reference values and that in addition to age, a large number of other factors influence the PSA value. Whether a measured PSA value is conspicuous in a patient or whether further clarification is required must therefore always be assessed by the attending physician in an overview of all factors and influencing variables.
What are the causes of a PSA increase?
The PSA level is influenced by a number of factors which can lead to an increase in the level in the blood. A disease does not always have to be the cause of this increase. In addition to a natural increase with increasing age and size of the prostate, mechanical stress or stress on the organ in particular leads to a short-term higher PSA value.
This includes, for example, the palpation examination at the urologist, which is why the blood sample for the PSA determination should always be carried out before the examination. Other irritants can lead to increased PSA levels through hard stool and constipation, cycling and sexual intercourse.
In particular, ejaculation in the 48 hours before the blood sample can lead to significantly higher PSA values. The value can also be increased by other influences that do not directly affect the prostate. This includes, for example, a visit to the sauna or a hot bath before taking a blood sample.
The influencing factors mentioned should therefore be avoided about 2 days before the PSA determination in order to obtain a value that is as unadulterated as possible. Any increase found nevertheless makes a disease of the prostate probable and extensive examinations should be carried out. In addition to inflammation of the organ, there is the possibility that prostate cancer is the cause of the increase in the PSA value, which can be demonstrated by taking a sample from the prostate (Punch biopsy) can be checked.
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Which symptoms can accompany an increased PSA level?
If a disease of the prostate is the cause of an increased PSA level, other accompanying symptoms may be present. Which symptoms these are depends on the type of illness.
Inflammation of the prostate (Prostatitis) usually leads to severe pain. It can also lead to fever and chills. Prostatitis caused by bacteria should be treated with an antibiotic, which usually reduces the PSA level and the accompanying symptoms.
Another common cause of an increase in PSA levels is a benign enlargement of the prostate (benign prostatic hyperplasia) which can particularly affect older men. The accompanying symptoms are usually problems with urination. The prostate encloses the part of the urethra that is in the body and can press it off when it is enlarged. In addition to prolonged and difficult urination, many men complain of a feeling of incomplete emptying and an increased need to urinate. Often times, patients with enlarged prostates have to get up several times at night to go to the toilet.
When prostate cancer is the cause of an increase in PSA, however, there are often no accompanying symptoms at all in the early stages. Sometimes the first symptoms are severe bone pain, for example in the back, which can occur when the cancer has already spread to the bones.
However, benign causes such as signs of wear and tear are much more often responsible for back pain. Nevertheless, in the event of increased PSA values and accompanying back pain, prostate cancer should be considered as the cause and an X-ray taken if necessary.
How can one selectively lower the PSA value?
An increased PSA value is usually the result of a disease or damage to the prostate.
In order to effectively lower the PSA level, the most important measure is to treat the underlying disease. In the case of inflammation of the prostate caused by bacteria (bacterial prostatitis) the appropriate measure would then be to take an antibiotic.
When the disease has healed, the PSA value usually drops again. Before the next PSA value determination, activities that could increase the value, such as cycling, should also be avoided. Sexual intercourse and masturbation should also be avoided about two days before the determination, as ejaculation can also increase the PSA value.
Furthermore, the PSA value can be effectively lowered if you pay attention to your diet. In addition, certain drugs such as anti-inflammatory pain relievers (ibuprofen, aspirin) lower the PSA value. However, these medications may only be taken over a longer period of time on a doctor's order. An elevated PSA value alone is not an indication for drug treatment.
Is it possible to lower the PSA level through diet?
A lowering of elevated PSA levels through diet alone is rather not possible and not recommended, but certain foods protect against prostate disease and can therefore prevent an increase in PSA levels.
If a disease is already present, a healthy diet can support healing and in this way indirectly also lower the PSA value. A balanced diet with plenty of fruit and vegetables is recommended. Fresh spinach, for example, is particularly protective of the prostate. In addition, some foods increase the risk of prostate cancer. This includes, for example, high-fat meat.
By consuming in moderation you can reduce your risk of cancer and thus your diet can indirectly contribute to a low PSA level. The treatment of the PSA value itself does not make sense, however, since it is only a marker for the prostate as an organ. In the case of increased PSA values, the focus must be on determining the cause of the increase. Depending on the cause, targeted treatment can ultimately also lower the PSA value. The nutritional recommendations mentioned can also be heeded.
Can homeopathy lower the PSA level?
Depending on the cause of an increase in the PSA value, an attempt at treatment with homeopathy can be undertaken. If the prostate is inflamed, for example, preparations can be taken that help the body fight the inflammation. However, inflammation caused by bacteria should definitely be treated with an antibiotic. Homeopathic remedies can also be taken if necessary.
In the case of cancer, homeopathic treatment alone is also strongly advised against, as a cure or at least containment of the disease can only be achieved with targeted therapy.
Read more on the topic: Homeopathy for prostate enlargement
Can one lower the PSA value through medication?
Since the cause of an increase in the PSA value is often a disease of the prostate, the disease can in some cases be treated with specific medication.
As a result, the increase in the PSA value usually decreases.
An example is inflammation of the prostate caused by bacteria (Prostatitis). Targeted treatment is carried out using drugs from the group of antibiotics. Other drugs that can lower the PSA level are anti-inflammatory pain relievers such as aspirin or ibuprofen.
In the case of benign prostate enlargement, the PSA value will also decrease in most cases with appropriate treatment. There are various drugs available to curb the growth of the prostate.
However, it should be noted that the PSA value itself should never be treated, but only one disease that may be responsible for the increase.
Read more on the topic: Therapy of prostate enlargement
What is the PSA level after a prostate removal?
After a surgical prostate removal (Prostatectomy) the PSA value usually falls within a few weeks to a range that can no longer be detected.
The PSA is no longer formed after the organ has been removed and is therefore no longer released into the blood. The PSA still present in the blood is slowly broken down and excreted. In most cases, the PSA value of 0 is not specified for values that can no longer be detected, such as after the prostate removal.
The value is often given, for example, as less than 0.2ng / ml. As long as the value does not rise again over the course of time, there is no need to worry. It is important to follow the recommended check-ups after a prostate removal. If the value should rise again, you can react early and consider further options. Another harmless explanation for detectable low PSA levels in the blood after a prostate removal is that PSA can be formed in very small amounts in small glands in the area of the urethra.
Which drugs can increase PSA levels?
Medication can affect the PSA level.
It is therefore very important to tell the doctor who is carrying out the PSA determination exactly which medicines you are taking. An example to be mentioned are drugs that are supposed to lower intraocular pressure and are used in glaucoma (glaucoma). In some cases, as a side effect, these drugs can increase PSA levels.
Even if the medication can have an influence on the PSA value, a noticeably increased value should be followed up through further diagnostics or at least a new determination in the course. An explanation of the increased value as a result of taking the medication alone is not sufficient.
How does stress affect the PSA value?
A direct influence of stress on the PSA value has not yet been established.
The value does not change significantly if you are under particularly stress at or before the blood draw. However, it is possible that stress can indirectly increase PSA levels in other ways. In addition to many other general risk factors, stress is also partly responsible for the development of cancer. If prostate cancer develops, the PSA value usually also rises.
If stress has contributed to the development of the disease, it has an indirect influence on the PSA value. However, this does not mean that everyone who experiences a lot of stress will get cancer. Many other factors such as hereditary stress are other important risk factors.
However, since stress can be detrimental to health in many ways in the long run, one should always ensure balance and relief.
Can alcohol increase PSA levels?
The consumption of alcohol has no direct influence on the PSA value and therefore does not lead to its increase.
Contrary to previous scientific views, however, recent research has shown that regular alcohol consumption, even in small amounts, increases the risk of developing prostate cancer. If a cancerous ulcer forms in the prostate, the PSA value usually also rises. Therefore, long-term alcohol consumption can also increase the PSA value secondarily.
What if the PSA level is too low?
There is no lower limit for the PSA value that can be viewed as questionable.Although there are reference values, which are mostly based on the average of healthy men in the various age groups, a value lower than this range has no medical significance.
In some men, very little PSA is released into the blood, so the measured value is very low. Even after surgical removal of the prostate, the PSA value is usually below the reference or even detection range. Here, too, the value is not too low, but rather normal.
Is there a PSA value in women?
The prostate-specific antigen (PSA) on which the PSA value is based is almost exclusively produced by the prostate gland (prostate) educated. Since this organ is only present in men, determining the PSA value in women is of no relevance.
In some women, PSA is formed in small glands next to the urethra and small amounts of it can be found in the urine.
However, such measurements were only carried out in the context of studies and are of no importance for the diagnosis and treatment of diseases. For women, instead of a urological examination, a regular gynecological examination for cancer screening is recommended.
What does a PSA value determination cost?
The costs of a PPE value determination vary and can be between € 15 and € 45.
The best way to find out about the price is directly from the urologist as the doctor responsible for prostate diseases. In Germany, the costs for determining the PSA value as part of the screening for cancer screening are not covered by the statutory health insurance.
Private health insurances partially cover the costs, depending on the contract concluded.
The statutory early detection program enables every man over the age of 45 to have an annual prostate examination, which is paid for by the health insurance companies. If the attending physician (usually the urologist) discovers abnormalities that should be further clarified, the PSA determination is also taken over by the statutory health insurance. In this case, however, it is no longer an early detection procedure but a clarification investigation.
Do you have to be sober to determine your PSA level?
In contrast to many other blood tests, you do not have to be sober to determine the PSA value. Whether or what you ate on the day the blood was taken does not affect the value. The time of day also plays no role in determining the PSA value.
What is the relationship between PSA levels and exercise?
The prostate responds to pressure and mechanical irritation.
Physical strain can sometimes lead to an increased release of PSA and thus influence the PSA level in the blood. Therefore, physical exertion should be avoided prior to testing. Sport does not have to be avoided in general, but certain types such as cycling should be avoided one or two days before the examination.
