Analysis for the dog is normal. What does PSA analysis show and how to decipher the results? Products to lower the concentration of antigen in the blood

Modern medicine sets itself ambitious goals to cope with the most dangerous health problems and increase the life expectancy of a person.

Oncology is a real "scourge" of humanity, claiming several million lives every year. It is impossible to overcome cancer without its prevention and detection of the process at the earliest stages.

For this, various diagnostic procedures and tests have been developed. They are also included in the blood of men.

What is PSA

The abbreviation PSA stands for "Prostate Specific Antigen". The substance has a protein nature and is produced by the cells of the prostate gland.

Normally, PSA enters the seminal fluid and creates conditions there for the normal movement of spermatozoa (dilutes the sperm). If the process of functioning of the prostate is not disturbed, the level of PSA in the blood is minimal.

The PSA norm in men is presented in the table.

IMPORTANT! In elderly patients (over 70 years of age), total PSA values ​​up to 6.5 ng / ml are considered acceptable.

The PSA level of 4.0 ng/ml was considered the threshold until recently. According to studies, 90% of men at the age of 40 have indicators below.

This is a screening figure, which in itself does not allow for a “terrible” cancer diagnosis. Further, in men with such analysis data, additional studies of the fractions of the prostate specific antigen and their ratio are carried out.

The modern approach (as of 2017) does not completely eliminate prostate cancer even with PSA values ​​of 2.5 ng/ml.

Additional factors affecting the "norm" of PSA

When screening for the determination of prostate specific antigen, the doctor must take into account that several factors influence the normal value of the indicator.

1. Androgens can lower psa. In men who took drugs containing this hormone, the level of the antigen was reduced by 50%.
2. Racial factor. Black men have an elevated PSA compared to Europeans.
3. Age. The older the patient, the more the antigen level is determined in the blood. This is due to the degenerative processes of the prostate, which are an integral part of the overall aging of the body.
4. Body mass index. With obesity, men often have a high level of estrogen (female sex hormones), androgens, on the contrary, decrease. Therefore, obesity is considered a factor that lowers the level of PSA in the blood.

As we can see, modern approaches in urology and the latest research in this area greatly "blur" the concept of the normal value of the prostate-specific antigen in the blood of men.

It is not worth it to decipher the results of the analysis on your own. It is better to consult a urologist.

What diseases cause an increase in PSA

To correctly decipher a blood test for psa, you need to understand the mechanism that leads to an increase in the concentration of this substance in the blood.

With the normal functioning of the prostate gland and the healthy structure of the glandular tissue, almost all of the specific protein enters the seminal fluid.

If the tissues of the prostate gland are affected by any pathological process, the permeability of the vascular wall increases and the antigen enters the blood.

PSA is not specific, it rises with any violation of the structure of the prostate.

This can be inflammation (prostatitis), hyperplasia (growth) of glandular tissue, a benign tumor (adenoma) and a malignant process (prostate cancer), ischemia and infarction of an organ (with vascular pathology).

The level of prostate-specific antigen can be influenced by physiological conditions (ejaculation) and manipulations affecting the prostate (massage, surgery).

Indications for the appointment of a PSA blood test are as follows:

• suspicion of prostate adenoma;
• the presence of symptoms of prostatitis: frequent urination, pain in the perineum, problems in the genital area, a feeling of incomplete emptying of the bladder;
• after a conservative course of treatment of prostate adenoma (to control effectiveness);
• early diagnosis of a malignant process;
• monitoring the dynamics of the development of prostate cancer after treatment;
• all men over 50 years of age as part of the annual medical examination;
• men over 40 years of age, if the family history contains indications of relatives with prostate cancer.

IMPORTANT! The antigen level can increase in physiological conditions and diseases not related to the prostate gland: after ejaculation, with difficulty urinating, with potency disorders, after “shaking” on a bicycle, horse or car, in the elderly. This must be taken into account when prescribing a blood test for a total PSA.

Decreased antigen level

When deciphering the analysis of PSA in men, there are sometimes cases of detecting a low indicator. This indicates the complete health of the organ and the minimal risk of prostate pathology.

A decrease in the prostate-specific antigen is also observed after resection of the prostate gland (especially in the first few months).

PSA analysis

Analysis methodology

Determining the level of PSA in the blood in men is a very sensitive method.

To obtain reliable results, you must strictly follow the rules for passing the analysis:

1. . You can only drink water.
2. The diet consists in the rejection of alcohol, coffee, spicy foods. You can not smoke 2 hours before the analysis.
3. For three days, be sure to give up sexual activity. It is important to prevent ejaculation, which makes the analysis false positive.
4. Between the study and any effect on the prostate gland (massage, rectal suppositories) must pass at least a day.
5. The study of neighboring organs also irritate the prostate gland. Therefore, the time interval between rectal examination, cystoscopy and the determination of the prostate specific antigen is observed.
6. Ultrasound affects the content of PSA in the blood, so after any ultrasound should be at least 1 week.
7. After prostate surgery, PSA analysis in men is prescribed only after 6 months.

How the study is done

Blood is taken from a vein, usually in the morning. The amount of blood - 2 ml. The result is ready in one day. .

Deciphering the analysis of PSA in men

In oncology, it is important not only to determine the presence of a tumor, but also to determine the degree of its malignancy and aggressiveness (growth and metastasis rates). For this purpose, several additional indicators are defined.

PSA fractions (free, bound, total)

Often patients ask what is the difference between total and free PSA (what is it). We will try to describe these fractions in detail.

The protein antigen, entering the blood, binds to protease inhibitors - this is the associated psa (its share is 65-95%). A small part of the substance circulates in the blood in a free form (5-35%) and is also determined during the study. The sum of the concentrations of bound and free forms the total PSA.

The numbers given in the table refer to the determination of the total prostate-specific antigen. This is the combined value of free and bound PSA. There is always more bound protein in the blood (approximate ratio 9:1). The bound fraction of the indicator increases with a malignant process.

For a more accurate diagnosis of the nature of a prostate tumor (benign or malignant), it is important to determine another indicator - the ratio of fractions of free to common antigen, expressed as a percentage. Depending on the values, the prognosis of carcinogenicity is determined.

At the end of the last century, a "breakthrough" discovery was made linking the production of a specific antigen by the prostate and the type of prostate tumors.

It was found that 1 gram of glandular tissue in a benign process produces 0.35 ng / ml of PSA, and in a malignant tumor - 3.5 ng / ml. This pattern formed the basis for the use of this study for the early diagnosis of prostate tumors.

PSA density and rate of increase

psa density - this is an indicator that indicates the ratio of the level of antigen concentration to the volume of the prostate. It is a predictive criterion.

If the prostate volume is normal and the PSA level is elevated, then the risk of cancer detection increases compared with a parallel increase in the PSA level and prostate volume.

The volume of the prostate is most accurately determined using transrectal ultrasound. A special probe of the ultrasonic device is inserted into the rectum, which ensures maximum accuracy in measuring the size of the organ.

High values ​​of antigen density (more than 0.15 ng/ml/cm³) are an indication for final confirmation of the diagnosis. In addition, the level of PSA density clinicians determine the aggressiveness of prostate cancer.

psa growth rate . The name speaks for itself. The antigen level is measured over a calendar year and how much it has grown is calculated. The threshold value of this indicator is 0.75 ng / ml / year. If the rate is higher, then this is an indication for a prostate biopsy, since the risk of prostate cancer in this case is high.

In addition, the psa growth rate is indispensable for monitoring the dynamics of the patient's condition after surgery or conservative treatment of prostate cancer.

Detection of recurrence of prostate cancer by PSA study

After removal of prostate cancer (partial or complete resection of the prostate), the antigen level may drop to almost zero. Usually this "zero" period lasts 30 days after the operation. If then the PSA level returns to normal, then we can talk about a favorable prognosis for the course of the disease.

If a month after resection of the prostate, the level of psa increases significantly (more than 0.2 ng / ml), then doctors are forced to state a recurrence of the tumor process.

For the timely detection of recurrence, a PSA blood test is regularly prescribed for all men after prostatectomy.

Prognostically important is the start of treatment for recurrent prostate cancer before the moment when the prostate-specific antigen increases to 0.5 ng / ml.

The role of PSA in solving various clinical problems

In modern world urology, there are standards for the early diagnosis of prostate cancer, based on determining the level of prostate-specific antigen.

Here are some principles endorsed by the European and American Associations of Urology:

1. Diagnosis should begin in young men (they should have a high life expectancy). In this case, PSA screening should be carried out regularly. This will allow you to "not miss" the very initial stages of prostate cancer.
2. In men older than 40 years, the determination of a specific antigen is advisable in the case of an expected life expectancy of more than 10 years.
3. PSA is the most important informative indicator that gives grounds to make a diagnosis, determine the stage of the process, the risk of progression and the dynamics of the disease after radical or conservative treatment of prostate cancer.
4. The initial level of psa in men 40 years old predicts prostate cancer in the future.
5. It is necessary to analyze the level of the antigen in conjunction with the data of the anamnesis, age, hereditary predisposition and general health.
6. Determination of the level of prostate-specific antigen and its derivatives is an important criterion for the need for a prostate biopsy.
7. There is no such value of total PSA at which it is possible to guarantee the absence of prostate cancer to the patient.

In conclusion, it is important to emphasize that the problem of prostate cancer by 2017 has ceased to be a sentence for men. In many ways, this is the merit of the method for determining the prostate-specific antigen and its fractions in the blood.

Thanks to PSA, the earliest diagnosis of the tumor process became possible. This gave hope and saved the lives of many patients.

4 575

Prostate specific antigen (PSA) is a protein substance that belongs to serine proteases. PSA is a product of the synthesis of the prostate gland and is part of the secret. A blood test for PSA allows you to diagnose and monitor the course of prostate cancer and prostate adenoma. A high level of PSA in the blood makes it possible to diagnose a malignant cancerous process in the prostate gland.

Features of the functioning of the prostate gland

The prostate gland consists of numerous (approximately 50) small glands, as well as muscle tissue. It should be noted that muscle tissue is necessary to move the fluid produced by the prostate gland. Fluid can enter the internal ducts leading to the lumen of the urethra. Muscles can contract, resulting in ejaculation during intercourse.

The prostate glands can produce a secret that performs the following functions:

• is a component of the seminal fluid;
• is an important component of the nutrient medium for spermatozoa.

This composition of biologically active substances is complex. The vital activity of the germ cells of each man depends on it.

The secret partially enters the bloodstream in order to normalize the functioning of the testicles, bladder, and regulate sexual desire. improve blood circulation, nervous processes and psychological state. All this is necessary in order to be able to lead a regular sex life.

What is a PSA?

The chemical structure of the prostate-specific antigen is glycoprotein, which is a combination of protein and carbohydrates, according to biochemical properties - enzyme necessary for splitting large protein molecules into small fragments. As a result, the seminal fluid liquefies. One part of the secret enters the bloodstream, where a small amount of prostate-specific antigen enters. At present, it is not known what function the prostate-specific antigen performs, but it is necessary for diagnostic examinations, because it allows you to determine the condition of the prostate gland. Some fractions are characterized by antigenic properties, due to which it is possible to carry out identification using modern immunochemical methods. These properties, which have been identified by experts, have led to the fact that the substance is known as a prostate-specific antigen.

Forms of PSA

In serum, prostate-specific antigen exists in several forms. Currently, two forms can be determined by immunochemical methods.

1. Associated prostate-specific antigen (total PSA), entering into a chemical bond with another compound that blocks the enzymatic function.
2. Free prostate-specific antigen (free PSA) capable of being in an unbound state.

In sum, these two forms of the substance allow us to estimate the overall level.

What determines fluctuations in total PSA?

Every man is faced with changes in the work of the prostate gland, but they are not always a pathology. At the same time, prostate diseases can complicate life, and are very common. It is important to consider that small changes in total PSA may be due to non-pathological changes in the functioning of the prostate gland. Let's say the level depends on individual differences in prostate mass. A larger prostate may produce more PSA. In addition, the age of each patient is important, because the amount of PSA gradually increases. An increase can be provoked by mechanical action, for example, special massage, cycling. This effect causes ejaculation.

PSA in various diseases of the prostate

Total PSA can moderately increase with prostate adenoma, acute diseases, chronic inflammatory processes, and urinary tract infections. In fact, this PSA test is most valuable when it comes to confirming or disproving prostate cancer.

Many men get prostate cancer. This disease especially traps men over fifty years of age. In Russia, approximately 70% of patients with prostate cancer are diagnosed at the third or fourth stage. If the disease is identified early, treatment can be very effective. However, at first, the symptoms do not disturb the patients. In this regard, 70% of men apply when the tumor has begun to spread to surrounding tissues and distant organs. For this reason, the representatives of the stronger sex are advised to regularly take an analysis for PSA, which is one of the most important. Palpation of the prostate gland and ultrasound are of limited sensitivity, and therefore cancer can be diagnosed too late. PSA analysis allows for a reliable diagnosis of even the initial forms of diseases that occur without symptoms. Doctors recommend taking an analysis once a year, including it in a preventive examination. An excessive increase in the level of prostate-specific antigen in one year is an indicator that there is a risk of developing prostate cancer.

Among the reasons for the increase in PSA levels at the beginning of the disease, one can note a violation of the function of prostate cells, an increase in the permeability of blood vessels. All together leads to an excessive amount of specific substances released from the prostate into the extracellular environment. Tumor cells can synthesize PSA in smaller amounts compared to normal tissues. In this regard, the test can be called specific for normal prostate tissue, but not for cancerous tumors. The increase in tumor cells has a great influence on the production of PSA, as a result of which the results of laboratory analysis can change.

A high level of PSA in the blood makes it possible to diagnose a malignant cancerous process in the prostate gland. A slight increase does not allow to come to a reliable result, since these indicators can be observed with benign hypertrophy or prostatitis, which is the most common disease in men.

PSA may become more sensitive if it is necessary to test for total and free fractions. In this case, you can determine the ratio of results and draw the correct conclusion.
The proportion of free PSA in the blood serum in the presence of malignant tumor cells is much lower compared to the level that is established in other diseases. This allows a correct distinction between benign and malignant diseases, although the level of magnification may be minimal.

Total PSA testing is very important in the treatment of prostate cancer. This analysis shows how to assess the success of therapy. Reducing the level allows you to understand that therapeutic measures are highly effective. All men who have undergone surgical treatment should take a PSA test after completing all therapeutic measures in order to timely detect a relapse if the situation develops unfavorably.

What is the total PSA test used for?

Analysis can be used for many purposes:

• Early diagnosis of prostate adenoma and inflammatory processes.
• Early diagnosis of prostate cancer.
• Differential diagnosis of prostate cancer, as well as benign neoplasms, inflammation of the urinary tract.
• Evaluation of the effectiveness of prostate cancer therapy.
• Control over the results of surgical intervention, which is performed for cancer.
• Timely diagnosis of recurrence of prostate cancer. In this case, the analysis should be taken after surgery.
• Part of prevention for the purpose of early diagnosis of benign and malignant diseases of the prostate gland.

When should a total PSA test be ordered?

Analysis is usually prescribed in the following situations:

• with symptoms of prostate disease, among which should be noted frequent urination, a feeling of incomplete emptying of the bladder, problems with erection and sexual desire, pain in the perineum;
• when examining to confirm or refute prostate cancer;
• in the control of therapy, which is carried out for prostate cancer;
• when monitoring the condition of a patient who underwent surgery to treat prostate cancer;
• during a preventive examination.

What can the results of the analysis of the total PSA say?

Reference values ​​are 0 - 4 ng / ml.

Some increase in total PSA can occur in situations where a man does not suffer from prostate diseases. The degree of increase is directly proportional to the severity of the disease. A low level is an indicator that there is no or minimal risk of the disease, or that treatment is being carried out effectively.

Why can the level of total PSA rise?

• Enlargement of the prostate gland.
• Massage, cycling, ejaculation less than one day before analysis.
• Inflammation of the urinary tract.
• Prostate adenoma.
• Ischemia and infarction of the prostate.
• Prostate cancer.
• Prostatitis.

Why can the level of total PSA decrease?

• Minimal risk of developing prostate disease.
• High level of effectiveness in the treatment of prostate disease.

What is free PSA?

Prostate-specific free antigen is a fraction of a serine protease (prostate enzyme) that has no association with other substances. Free PSA circulates in the systemic circulation.

Features of free PSA analysis

For analysis, it is necessary to use venous blood.
In order for the results of the study to be reliable, it is necessary to undergo preliminary preparation:

• Do not eat fatty foods for 24 hours before the test.
• Half an hour before the analysis, physical and emotional overstrain should be avoided.
• Do not smoke 30 minutes before donating venous blood.
• If a prostate massage was performed, you must wait 10 days before the study.

Prostate-specific free antigen is an enzyme that belongs to serine proteases. It is a product of the secretion of the prostate gland, which contains a variety of nutritious, hormone-like substances. An insignificant part of the prostate juice, including free PSA, is absorbed into the blood, after which it begins to regulate the functioning of the reproductive system and other physiological processes responsible for sexual desire.

The chemical structure of free prostate-specific antigen is a combination of carbohydrates and protein. It can break down the protein molecules that make up the seminal fluid into small fragments. This process leads to liquefaction of the seminal fluid.
The function of free PSA is unknown, but it allows the detection of prostate diseases.

The free PSA test is very important because it allows you to diagnose prostate cancer in its early stages and differentiate it from other diseases whose symptoms are very similar to cancer. It is usually carried out simultaneously with the test for total PSA. For the correct interpretation of the results, it is important to determine the ratio of free prostate-specific antigen to total PSA. It is important to take two tests at once, as this allows you to come up with reliable indicators, compared with passing only one test, namely the total PSA. A high level of this parameter in the blood makes it possible to diagnose prostate cancer with confidence. If the difference in the level of total PSA from the norm is insignificant, the diagnosis cannot be carried out, since these indicators are noted in the early stages of cancer, with an inflammatory process and prostate adenoma. The reliability of the results can be significantly increased by calculating the ratio of free prostate-specific antigen to the total. With prostate cancer, this indicator is lower than with hypertrophy, as a result of which the two diseases can be distinguished in a timely manner. The accuracy of the results of the analysis increases significantly even if the increase in total PSA is minimal, so that cancer can be diagnosed at the earliest possible date.

Why should you use a free PSA test?

• For the early diagnosis of prostate cancer.
• For differential diagnosis of prostate cancer, adenoma, prostatitis.

When should I take a free PSA test?

• With symptoms that are characteristic of diseases of the prostate gland.
• To confirm or refute prostate cancer.

What do free PSA results mean?

Reference values ​​​​of free PSA to the total can be 12 - 100%.
A decrease in the ratio of free to total PSA can mean:

• prostate cancer or an increased risk of its onset and development.

An increase in the ratio of free to total PSA is an indicator of a low risk of developing prostate cancer.

When taking PSA tests, remember that:
A negative test result cannot completely exclude the inflammatory process of the prostate gland.
Results may vary as each laboratory uses its own analysis method. For this reason, repeat tests should be carried out in the same laboratory. Only in this case, the results of the repeated study will be reliable.

A blood test for PSA in men refers to the primary tests that are prescribed in combination with ultrasound of the genitourinary organs and rectal examination. After examining the results of the analysis, the doctor decides on the appointment of additional tests.

A man's blood contains total PSA, free PSA, and bound PSA.

The amount of total PSA in a blood test is equal to the total amount of bound and free antigen. The ratio of total PSA to free PSA is expressed as a percentage. This determines the prognosis for prostate cancer. If free PSA is more than 15%, the situation is unfavorable, the development of oncology is possible.

Now that you know what total and free PSA are, what role it plays in diagnosing diseases in men, let's take a closer look at the analysis process and deciphering the results.

When is a PSA blood test ordered?

It is necessary to determine the amount of prostatic antigen in the patient's blood in the following cases:

Men over the age of 50 with pre-existing prostate pathologies should be tested for PSA once a year.

If abnormalities are detected, it is necessary to seek advice from a urologist, andrologist or oncologist and undergo a full examination in order to avoid the development of the disease.

If malignant tumors are detected at an early stage, then in almost 100% of cases they can be eliminated without serious consequences.

Normal PSA in men

In the event that a man is healthy, most of the peptide enters the secretion of the prostate and sperm. In the blood, its amount is low and is measured in nanograms per milliliter.

Table in the blood of men, depending on age:

In men, with age, the prostate becomes larger by 3 mm per year, as a result of which the production of prostate antigen increases. A few years ago, 4 ng / ml was considered the norm, then this figure was lowered to 3 ng / ml. With age, this figure increases.

An increase in the level of prostate-specific antigen in the blood in men up to 10 ng / ml in 70% of cases occurs as a result of prostate adenoma.

This causes false positive findings and increases the number of biopsies.

Carrying out the procedure

To obtain an accurate analysis result, you must adhere to the following rules:

• For prostate interventions such as catheter insertion, cystoscopy, prostate massage or rectal examination, the test can be taken no earlier than a couple of weeks later. If a biopsy was performed, then this period increases to 30 days;
• 3 days before the test, you must stop having sex;
• 2 days before taking the material for analysis, it is necessary to stop drinking alcohol-containing drinks;

You will be interested in:

• The day before the sampling of the material, you need to adhere to a strict diet., exclude fried and fatty foods from the menu. The diet should consist of vegetables, fruits, cereals or low-fat dairy products;
• The analysis is taken in the morning on an empty stomach. After eating, drinking tea, coffee or carbonated drinks, there should be a break of at least 8 hours. You can drink a small amount of non-carbonated water;
• In order to determine the level of PSA, blood is taken from a vein at the elbow.. The results of the analysis are known within a day. Most often, the level of total PSA is detected. To clarify the diagnosis, it may be necessary to determine the level of free PSA.

Deciphering the analysis

A slight increase in PSA levels in a man can be triggered by an inflammatory process in the prostate or prostatic hyperplasia.

If the PSA values ​​are too high, then the possibility of developing prostate cancer is multiplied:

In order for the diagnosis to be confirmed, it is necessary to conduct a study of the rate of increase in PSA levels over a certain period of time. In the case when the difference between the indicators is small, but these figures change very quickly (from 0.70 ng / ml), the development of prostate cancer is suspected. The norm of free prostatic antigen is 0.93 ng/ml.

These numbers are subject to change. An increase in the level may indicate a benign tumor of the prostate, and a decrease becomes a sign of the presence of a malignant neoplasm.

Deviations from the norm

Deviations from the norm may occur in the following cases:

In the case when the PSA level exceeds 30 ng / ml, there is a suspicion of the development of cancer. With an advanced stage of cancer, these figures increase to 100 ng / ml.

Not always a deviation from the norm indicates that a man has pathological processes in the prostate area, therefore, additional examinations are carried out to confirm the diagnosis.

In some cases, in order to make sure that the indicators are correct, it is necessary to pass a control analysis in another laboratory.

The PSA test is only an auxiliary method for detecting prostate cancer, so you should not rely on its results completely.

Determination of the level of the tumor marker of prostate cancer in the blood, which allows you to assess the likelihood of detecting a neoplasm and decide on the advisability of prostate biopsy.

Research results are issued with a free doctor's commentary.

Russian synonyms

Prostate-specific antigen is common and free; PSA total + PSA free.

English synonyms

Prostate cancer screening.

Research method

Immunochemiluminescent analysis.

Units

Ng/ml (nanograms per milliliter), % (percentage).

What biomaterial can be used for research?

Venous blood.

How to properly prepare for research?

• Eliminate fatty foods from the diet 24 hours before the study.
• Eliminate physical and emotional overstrain for 30 minutes before the study.
• Do not smoke for 30 minutes prior to the study.
• The study should be carried out no earlier than 10 days after prostate massage (obtaining prostate secretion, seminal vesicle massage).

General information about the study

Composition of the complex: 2 studies

• Prostate specific antigen (PSA) common
• Prostate-specific antigen (PSA) free

Prostate cancer is one of the most common malignancies in men. In the world, it ranks 3rd-4th in terms of prevalence among malignant neoplasms, and in some countries of Europe and America it comes out on top among the causes of death from cancer among men of older age groups.

It usually develops very slowly, over many years. Symptoms of the disease appear only with a significant increase in the mass of the tumor, clamping of the urethra and a violation of the outflow of urine. A neoplasm of the prostate can be suspected when the patient complains of frequent, nocturnal, painful urination, a weak stream of urine, an admixture of pus or blood in the urine, discomfort in the lower abdomen, in the pelvis, and sexual dysfunction. At the same time, these symptoms are nonspecific and can occur with benign prostatic hyperplasia, urinary tract infections, prostate inflammation, genital infections. Early diagnosis of a neoplasm allows timely treatment and prevention of life-threatening consequences. Tumor growth without timely diagnosis and treatment can lead to metastases in bone tissue, kidneys, and lungs. More than 70% of cases of newly diagnosed prostate cancer are diagnosed in men over 65 years of age. In this regard, in men of older age groups, the appearance of symptoms of genitourinary dysfunction requires the mandatory exclusion of prostate cancer.

Some countries have developed guidelines for screening patients without clinical symptoms of prostate disease. The American Association of Urology identifies several risk levels for developing prostate cancer in asymptomatic patients: moderate risk (healthy men without a burdened hereditary history), increased risk (if one of the close relatives (brother or father) under the age of 65 has prostate cancer), high risk (if more than one relative has a neoplasm at any age). In the moderate-risk group, prostate-specific antigen (PSA) levels and digital examination of the prostate gland are recommended annually after reaching the age of 50; with increased risk - from 45 years; at high risk - from 40 years.

Prostate-specific antigen (PSA) is a glycoprotein produced in the prostate gland. It is mostly secreted with seminal fluid and only a small amount enters the blood. PSA in the blood consists of two fractions - associated with alpha-1-chemotrypsin and free (unbound to protein). With neoplasms of the prostate gland and some other diseases of the prostate, the content of total and bound PSA in the blood increases. The sensitivity and specificity of total PSA for the diagnosis of prostate cancer is only 20-40%, but increases with the simultaneous determination of the amount of free PSA. This laboratory test is not diagnostic, but screening. Only in a third of cases with an increase in total PSA, the diagnosis of prostate cancer is confirmed. The "gold standard" for diagnosing prostate cancer is a biopsy of the prostate with a histological examination of the material. Simultaneous determination of total and free PSA allows differentiation between prostate cancer and other non-cancerous diseases of the prostate. Determining the level of total and free PSA, together with a digital examination of the prostate, determines the feasibility of a prostate biopsy to clarify the diagnosis. The goal of this screening study is to reduce the number of unnecessary prostate biopsies.

The appropriateness of prescribing this test in patients without any symptoms depends on the presence of risk factors and is decided with the participation of the attending physician on an individual basis.

What is research used for?

• Screening for prostate neoplasms;
• decision on the advisability of a prostate biopsy;
• evaluation of the effectiveness of prostate cancer treatment;
• diagnosis of recurrent prostate cancer.

When is the study scheduled?

• If the patient complains of difficult, painful and frequent urination;
• with an increase in the size, consistency and structure of the prostate gland according to a digital examination or ultrasound;
• during a routine examination of men over 50 years of age (in the absence of risk factors), at the age of 45 years (at an increased risk) or at 40 years of age and earlier (at a high risk of developing prostate cancer);
• annually with an increase in PSA above 2.5 ng / ml or if there is a high risk of developing prostate cancer;
• during and after prostate cancer treatment.

What do the results mean?

Reference values

Prostate-specific antigen common (PSA common): 0 - 4 ng / ml.

The ratio of PSA free / PSA total: 25 - 100%.

Reasons for an increase in total PSA:

• benign prostatic hypertrophy
• Prostate cancer (about 80% of cases are accompanied by an increase in total PSA)
• Prostatitis, prostate injury
• Impotence
• Recent sexual activity
• urinary tract infection
• urinary retention
• Urological procedures

With a total PSA level of 4 to 10 ng / ml and a negative result of DRE (digital rectal examination):

free PSA / total PSA ratio

the ratio of PSA free / PSA total> 25% - low risk of prostate cancer.

(According to Guidelines on Prostate Cancer. European Association of Urology 2015).

What can influence the result?

With age, the level of total PSA in the blood gradually increases.

A false increase in total PSA is possible with:

• digital examination of the prostate, transrectal ultrasound of the prostate before taking blood for analysis;
• prostate biopsy a few weeks before the study;
• after research with the use of radioisotope preparations;
• recent cystoscopy, bladder catheterization, or urinary tract infection;
• ejaculation 24-48 hours before the test;
• sexually transmitted infections;
• after cycling.

Drugs that affect the level of total PSA: allopurinol, finasteride, cyclophosphamide, methotrexate, androgen antagonists.

Important Notes

• The need for this test and the frequency of its implementation should be determined by the attending urologist.
• Elevated PSA in men is not an absolute sign of prostate cancer. The diagnosis can be confirmed or ruled out only by the results of a prostate biopsy. Only 30% of patients with elevated PSA levels develop prostate cancer.
• If an elevated total PSA level is detected, some doctors recommend repeating the analysis 6 weeks to 3 months after the first test and then deciding whether to perform a biopsy of the gland.
• Determination of the PSA level not recommended carry out 24-48 hours after cystoscopy, ejaculation; within 7 days after digital examination of the prostate, ultrasound of the prostate and other urological procedures; earlier than 6 weeks after prostate biopsy; earlier than 8 weeks after prostatitis treatment.

Poor ecology and wrong way of life lead to the development of oncological diseases. Despite the possibilities of modern medicine, it is not always possible to completely cure these diseases. And the reason for this is the untimely appeal for medical help. Any cancer is easier to prevent than to cure. However, complete healing is also possible with treatment at an early stage of the disease.

To diagnose prostate cancer at an early stage allows a PSA blood test, which shows the level of its concentration in the blood. What does this strange abbreviation mean, and what is the importance of this study for the life and health of men?

The abbreviation PSA or PSA stands for Prostate Specific Antigen. In fact, this antigen is a protein produced by the prostate gland. This protein is a prostatic juice, and in simple words - a composition that dilutes the sperm after ejaculation, providing spermatozoa with free movement, and facilitating the fertilization of the egg.

The role of PSA in diagnosing the disease

Prostate-specific antigen is released into the ejaculate and blood. At the same time, most of the protein enters the ejaculate, while its insignificant amount, determined in nanograms, a measure of weight that is a billion times lighter than a gram, enters the bloodstream.

In the process of inflammatory diseases, the prostate gland increases in size, as a result of which more protein begins to flow into the blood. That is, when determining its concentration in the blood, it can be concluded that there is or is no pathology.

Molecular forms of PSA

In laboratory conditions, two forms of prostate-specific antigen are distinguished.

• A protein free from impurities that is produced by healthy gland cells.
• A protein associated with other substances that make up the blood. It is produced by cancer cells and is classified as a tumor marker.

Norms of prostate-specific antigen

The level of PSA concentration in the blood, first of all, depends on the age of the man. Normally, this indicator under the influence of various factors can increase or decrease. However, there are certain boundaries marked for each age category of men. Being within their limits, the concentration of protein in the blood is considered safe, allowing the examination to exclude the risk of cancerous tumors. At the same time, the level of protein in the blood of a man increases with age.

In general, this indicator has the following parameters:

• in men aged 40-50 years, PSA is 2.5 ng per 1 ml;
• upon reaching the age category from 50 to 60 years, it rises to 3.5 ng per 1 ml;
• with the achievement of the age of 60-70 years, this parameter increases to 4.5 ng per 1 ml;
• in elderly people who have crossed the 70-year mark, the antigen reaches 6.5 ng per 1 ml.

It should be noted that in some cases the protein concentration may be at zero, and this is also the norm for all age categories.

This analysis is usually not prescribed for men under 40 years of age, since at this age there is no risk of developing a malignant tumor.

What does an increase in PSA indicate?

A protein content test is carried out to confirm the results of other methods used to detect inflammatory processes in the prostate gland.

• An increase in the concentration of the antigen can occur due to increased protein production, which indicates an increase in the prostate gland that occurs during the development of adenoma, a benign neoplasm.
• In the case of inflammatory processes in the prostate, swelling of its ducts occurs, which makes it difficult for the antigen to enter the prostatic juice. For this reason, most of it is secreted into the blood.
• Oncological disease can be detected by oncomarkers - associated antigens, which contain serum proteins. It is this indicator that allows you to diagnose the disease at an early stage of development, until changes in the structure of the prostate gland begin.

The set of values ​​indicated by the results of the analysis

If, when deciphering the PSA blood test, an increased content of the antigen was found, this may indicate the presence of a malignant tumor. At the same time, a higher rate indicates a later stage of cancer development. If the indicator is slightly increased, then an additional examination is carried out, including a number of procedures.

• A general blood test is done to detect the presence of inflammatory processes in the body. These factors are indicated by an increase in ESR and the number of leukocytes. Based on these indicators, conclusions are drawn about the presence of prostatitis.
• The ratio of free antigen to bound is determined. To do this, both indicators are added, and then the free protein indicator is divided by the total amount, thus revealing the percentage. Normally, this figure is 15%. When a lower result is obtained, additional studies are carried out for the presence of a cancerous tumor. If the result is less than 10%, then a biopsy is prescribed, allowing you to get an accurate result.

• The density of the antigen is examined. For this, an ultrasound examination of the prostate gland is performed, on which its size is determined. Further, the indicator of the concentration of antigen in the blood is divided by the size of the prostate. A decrease in density indicates prostatic hyperplasia resulting from an adenoma. If the density is increased, perhaps the presence of a malignant tumor.
• It measures how quickly the PSA hormone in the blood increases over time. Considering that fluctuations in protein concentration are insignificant, it is customary to take a calendar year as a time interval. The stronger the concentration of the antigen increases during the year, the higher the likelihood of a malignant neoplasm.

The most accurate result is shown by a biopsy - a procedure in which a fragment of the prostate is taken with a thin needle, which serves as a material for research to determine the presence of a cancerous tumor and determine its type. However, given the morbidity of this procedure, it is prescribed only if the results of other tests indicate its presence.

The value of PSA in evaluating the effectiveness of cancer treatment

Treatment of a malignant tumor is carried out in several stages. The indicator of the concentration of the antigen in the blood allows you to evaluate the effectiveness of the treatment.

• Surgery, during which the tumor was removed, leads to a rapid decrease in PSA levels. Moreover, the indicator decreases for a long time.
• If the patient received chemotherapy or radiation therapy as the main treatment, the PSA decrease is slow. However, with a decrease in the indicator by more than 1 ng / ml, it allows you to build optimistic forecasts, as it indicates a stable remission.
• If the treatment led to an increase in protein concentration, this may indicate its ineffectiveness and exacerbation of cancer.

The procedure for preparing for the delivery of the analysis

To get a reliable result of the analysis, you should carefully prepare for it. It must be taken into account that the protein concentration tends to change under the influence of a number of factors.

• Within two days before passing the analysis, you should refrain from sexual intercourse. And this applies not only to sexual intercourse, but also to masturbation.
• On the eve of the study, it is impossible to massage the prostate gland.
• If it is planned to conduct an ultrasound of the prostate, in which the study is carried out by inserting a sensor into the rectum, the analysis must be taken either before it or a week after it ends.
• If the patient underwent surgery, during which part of the prostate was removed through the urethra, the analysis should be taken only after 6 months.

Before taking the analysis, you need to adjust the diet, as some substances can affect the result of the study. Therefore, the day before it is not recommended to eat fatty and spicy foods. And 8 hours before the scheduled examination, you can not take any drinks, except for pure water. Smoking can also distort the analysis data, so it should be excluded 30 minutes before the analysis.

Like any other blood test, this examination is carried out in the morning on an empty stomach. If the patient is prescribed treatment in the form of taking medications, their use should be excluded before taking the analysis.

Even the complete removal of the affected organ and other tissues cannot guarantee that the cancer will not return. It cannot be ruled out that during the operation the tumor may be damaged, as a result of which the cancer cells, together with the blood, will penetrate into other organs. Therefore, after the removal of the prostate gland, it is necessary to see a doctor and control the PSA level.

It also happens that during the examination, a seal is felt in the prostate gland, and the protein concentration does not exceed the norm. To exclude the possibility of an error, a repeated PSA analysis is taken after 3 months.

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