5 Best Tests for Prostate Cancer - Screening and Diagnosis

Prostate Cancer is one of the most common forms of cancer in men, above the age of 50. It is the leading cause of cancer in 48 countries, and the most frequently diagnosed cancern. Early detection and screening can allow treatment and prevent mortality and morbidity. In this article we enlist the 5 best tests for early screening and detection of prostate cancer. These include the Total PSA Level, Free PSA level, Prostate Density Test, PSA Velocity Test, and Prostate Biopsy Test. Each test is either a combination of blood tests and radiological tests or single blood tests.

Published Date : 2023-12-14T11:06:23.113Z

Updated Date : 2023-12-14T13:51:14.161Z

Total Prostate Specific Antigen or PSA Level

The total PSA Level is the first line screening test for the diagnosis and detection of prostate cancer. The test is not specific for prostate cancer. The value of the test may be elevated in non-cancer conditions like infection, simple growth of the prostate gland and after injuries.

Is an elevated PSA level diagnostic of prostate cancer?

No, an elevated PSA Level does not mean you have prostate cancer. The level of total PSA increases with age, as per the table below. There are several non-malignant causes of an elevated PSA Level which have to be ruled out. The test is highly sensitive(meaning that those with cancer will usually show some elevation), but not specific(meaning that those without cancer will also show an elevation)

What is the normal range of the PSA level stratified by age?

The normal ranges of Total PSA are listed in the table below.

Age Group	PSA Level (ng/mL)
Males 40-49 years	no more than 2.5
Males 50-59 years	no more than 3.5
Males 60-69 years	no more than 4.5
Males 70-79 years	no more than 6.5

What are non-cancerous causes of an elevated PSA level?

Cause	Description
Benign Prostatic Hyperplasia (BPH)	Non-cancerous enlargement of the prostate gland.
Prostatic Inflammation or Infection (Prostatitis)	Inflammation or infection of the prostate gland.
Perineal Trauma	Injury to the area between the scrotum and anus (perineum).
Ejaculation and Sexual Activity	Temporary increase in PSA levels after ejaculation or sexual activity.

At what level of Total PSA should I go for further investigations?

A total PSA level of as low as 1.19 can be associated with malignancy. However as per medical guidelines, a level of 4-4.5 is accepted as a cut-off above which further tests can be done.

Free PSA

Free PSA is the fraction of the PSA that is not bound to proteins in the blood. It is the part of the PSA that exerts its actions directly and is a better indicator of the active component of PSA.

Why is Free PSA important?

Free PSA is a part of what we measure as the Total PSA. The higher the percentage of Free-PSA, the less the chances of an elevated PSA level being caused by cancer.

When should free-PSA be tested?

As per most guidelines, free-PSA can be recommended for patients whose total PSA level is above 4 and less than 10. In such patients, a higher free PSA percentage makes it less likely that the elevation in total PSA is due to cancer. The table below summarizes this :

Free % PSA	Cancer Risk
Less than 10%	50%
Greater than 25%	Less than 10%

Prostate Biopsy Test - The gold standard and best test for prostate cancer diagnosis

A prostate biopsy is done when your doctor suspects that you may have a cancer or a mass in your prostate, that needs further investigation. It is considered to be the gold standard for diagnosis, as the pathologist can directly see the prostate at a microscopic level. It can only be done by a qualified surgeon, and involves excising a small bit of the prostate for pathological analysis

Is a prostate biopsy painful?

No, a prostate biopsy is usually done under regional anaesthesia, so you won't feel anything. After the procedure you may feel some soreness or pain for a few days.

What do the results of a prostate biopsy tell my doctor?

The pathologist will issue a biopsy report, that will include details such as the appearance of the prostate tissue and whether a frank cancer can be seen. Even if a frank cancer is not seen, the pathologist will opine on whether changes preceeding a full blown cancer are present in the prostate. This will allow your doctor to take a decision on whether the entire prostate needs to be excised or a wait and watch approach can be followed.

Why is the prostate biopsy the gold standard?

A prostate biopsy is the only diagnostic modality that allows us to directly see what the prostate tissue looks like at a microscopic level. No blood test, or even radiological scans can produce this level of detail. Hence it is called the gold standard, and has the highest diagnostic sensitivity and specificity.

Prostate Density Test

A prostate density test combines the value of MRI and the total PSA level. It is a ratio that is obtained by dividing the total PSA level by the volume of the prostate gland.

How is the Prostate Density Calculated?

To calculate the prostate density, an MRI or ultrasound will have to done to get the measurements of the gland. The volume of the prostate is calculated by multiplying the height, width and depth by 0.52. Once this is obtained, the total PSA Level is divided by the volume.

What is a good value for the Prostate Density?

A good value for prostate density is less than 0.15 ng/ml/cc. Values above 0.15 are suspicious for cancers.

What is prostate velocity and prostate doubling time test?

The prostate velocity is the rate at which the PSA value increases over time. A very fast rate of increase is suspicious of cancers, a slow rate is more natural. Simllarly the PSA doubling time is the time that it takes for a particular value of PSA to double. A short doubling time is dangerous.

What is a good PSA velocity?

An increase of 0.75 ng/ml per year, or 25% higher than the previous year is considered to be a safe prostate velocity.

What is a safe PSA doubling time?

A doubling time of 2 years or more is considered safe. The shorter the doubling time the worse the mortality from and risk of prostate cancer.