Professor Mark Frydenberg AM discusses the PSA blood test used to detect prostate cancer.
My name is Professor Mark Frydenberg, and I am one of the urologists at Australian Urology Associates. I wanted to briefly discuss with you today a very common topic in urology, namely the PSA blood test, otherwise known as prostate-specific antigen test. This is a very common blood test ordered by general practitioners and urologists as a screening tool for early prostate cancer. It’s been well recognised for at least 30 years that an elevated PSA blood test does signify prostate cancer in a proportion of men, and it does lead to the early diagnosis of prostate cancer, and therefore earlier treatment.
It is however important not to be alarmed if you do have an elevated PSA, because there are other non-cancerous causes that could also cause the PSA to be elevated. Such causes could be just an enlarged benign prostate, or simple things like a urinary infection, or even some activity such as bicycle riding, or if you do a blood test soon after an ejaculation. All of these things can cause a temporary rise in the PSA and as a result of that it’s important to simply repeat the PSA in the first instance to ensure that it is a consistent, elevated reading.
If the PSA is elevated, however, your general practitioner is likely to refer you to urologists such as myself and my colleagues at Australian Urology Associates for investigation. Again, this is nothing to be alarmed about, as in many cases it is not related to prostate cancer. Generally what will happen is that the urologist will examine you to determine if there’s any abnormal finding within the prostate or an abnormal area of firmness or hardness within the gland, and we’ll often send you for an x-ray called the Multiparametric MRI of your prostate. This is a very simple scan, it is non-invasive, it takes about 30 to 45 minutes to complete and will often give very good information about the likelihood of cancer being present.
When you have an MRI performed they will give it a risk score called a PI-RADS score and the PI-RADS score goes from two to five, with a score of two signifying essentially a normal prostate with a very low likelihood of cancer being present up to five where there’s a very high risk of cancer being present. Depending on where you fall on that risk scale, your urologist may recommend a biopsy to further investigate it.