1030. Total Prostate-Specific Antigen (PSA)

Prostate-specific antigen (PSA) is a protein produced by prostate cells. Elevated levels may indicate inflammation, hyperplasia, or prostate cancer. It is used for early diagnosis, treatment monitoring, and recurrence detection.

Prostate-specific antigen (PSA) is a protein, an enzyme from the serine protease group, produced by prostate epithelial cells. PSA's primary physiological function is to thin the ejaculate, but when the barriers between the prostate and the vascular system are compromised, it enters the bloodstream.

PSA circulates in serum in two forms:

• free (unbound PSA) – not bound to blood proteins;
• bound (in a complex with alpha-1-antichymotrypsin).

Total PSA is the sum of the free and bound fractions. Elevated total PSA levels can be observed in both benign conditions (prostatic hyperplasia, prostatitis, trauma, and after instrumental interventions such as cystoscopy and biopsy) and malignant neoplasms, particularly prostate cancer. A sharp or sustained increase in PSA levels may prompt further investigation, including prostate ultrasound, MRI, or biopsy.

Given the low specificity of the test alone, it is recommended to combine it with free PSA levels (determining the free-to-total ratio), prostate-specific acid phosphatase (PAP), tissue polypeptide antigen (TPA), and other markers. This combination improves diagnostic accuracy and allows for a better assessment of cancer risk, treatment effectiveness, and the risk of recurrence.

PSA is also widely used in routine screening programs for men aged 45+, especially those with a strong family history of prostate cancer.

Who is recommended to have a PSA test and when:

• for the early diagnosis of benign prostate hyperplasia (BPH);
• if inflammatory diseases of the prostate gland (prostatitis) are suspected;
• if there are clinical or ultrasound signs of prostate ischemia or infarction;
• for prostate cancer screening, especially in men over 45 years of age or with a strong family history;
• for the differential diagnosis of prostate cancer, benign changes, and urinary tract infections and inflammations;
• to assess the effectiveness of prostate cancer treatment (chemotherapy, hormone therapy, radiation therapy);
• for post-surgical monitoring to detect recurrences early;
• as part of a preventive examination of men over 45 years of age.

• Venous blood

In order to exclude factors that may affect the test results, we recommend to follow the preparation rules: