Prostate Cancer Education Series: The Early Screening Tool - PSA Test

???? Series Highlights at a Glance:

1️⃣ Symptom Self-Check: Increased nighttime urination ≠ aging; it could be a cancer signal

2️⃣ Treatment Options: Will surgery cause incontinence? What are the advantages of robotic surgery?

3️⃣ Recurrence Monitoring: Essential salvage strategies after PSA rebound

…… (11 in-depth analyses)

Why Focus on PSA Screening First?

Early-stage prostate cancer is often “silent,” and the PSA test is the first line of defense to uncover hidden risks—but this test is surrounded by many misconceptions and anxieties:

▸ Does an elevated level definitely mean cancer? It could just be from intense cycling!

▸ How is the free PSA ratio calculated? Is 10% the critical threshold?

▸ Who must be screened annually? For whom might screening be harmful?

Today, we start with the most critical PSA screening.

With increased health awareness, more men are paying attention to prostate health. Among the various tests, Prostate-Specific Antigen (PSA) is one of the most commonly used and sensitive screening methods for prostate cancer. Although PSA is not the “sole standard for diagnosing prostate cancer,” it is a crucial first step in detecting potential malignancy. This article will provide a comprehensive understanding of the principles, types, interpretation methods, and screening significance of the PSA test.

What is PSA? How is it Related to Prostate Cancer?

PSA (Prostate-Specific Antigen) is a protein secreted by the prostate gland, with small amounts released into the bloodstream. Healthy men typically have low PSA levels. When prostate diseases occur—whether prostate cancer, benign prostatic hyperplasia, or inflammation—PSA levels in the blood may rise.

This is why PSA is widely used for early prostate cancer screening: many patients with early-stage cancer, who are asymptomatic, can already have abnormal findings detected through a PSA test.

Total PSA, Free PSA, and Ratio: Don't Be Misled by a Single Number

Clinical PSA testing involves more than just one “value”; it includes:

• Total PSA (tPSA): The sum of all forms of PSA in the blood, the most basic and commonly used indicator.

• Free PSA (fPSA): PSA in its “free state,” not bound to other proteins in the blood.

• fPSA/tPSA Ratio: The ratio of free PSA to total PSA, helpful in distinguishing prostate cancer from benign prostate diseases.
  

When total PSA is >10 ng/mL, the likelihood of prostate cancer is relatively high. When total PSA is <4 ng/mL, the likelihood of benign prostate disease is relatively high. However, when the total PSA value falls within the “gray zone” (4~10 ng/mL), total PSA alone cannot distinguish between benign and malignant conditions. In this case, the ratio of free PSA to total PSA (fPSA/tPSA) becomes particularly critical. Studies have found that the lower the fPSA/tPSA ratio, the higher the likelihood of prostate cancer.

The following is a simplified reference for differentiation:

• fPSA/tPSA Ratio >25%: Mostly indicative of benign disease;

• fPSA/tPSA Ratio 10%~25%: Moderate suspicion of cancer;

• fPSA/tPSA Ratio <10%: High suspicion of prostate cancer.
  

Who Should Undergo PSA Screening? When Should It Be Done?

Not all men need a PSA test, but the following groups are key candidates for screening:

• Healthy men aged 50 and above: Annual PSA testing is recommended;

• Individuals with a family history of prostate cancer (e.g., father, brother): Screening can start from age 45;

• Individuals experiencing symptoms such as abnormal urination, hematuria, hematospermia, or bone pain: Should seek medical evaluation promptly;

• Individuals previously diagnosed with prostate cancer: Require regular PSA monitoring after treatment to detect recurrence.
  

Non-Cancer Factors Affecting PSA Levels

It is important to note that an elevated PSA does not equal cancer. Certain lifestyle factors or benign conditions can also cause a temporary rise in PSA. For example:

• Prostatitis, urinary tract infection;

• Benign prostatic hyperplasia;

• Ejaculation (recommended to avoid 24 hours before blood draw);

• Strenuous exercise, cycling;

• Prostate massage or catheterization procedures.

Therefore, before undergoing a PSA test, inform your doctor of any recent exposure to the above factors to ensure accurate results.

What to Do After an Abnormal PSA Finding?

When PSA is elevated, the doctor will make a comprehensive assessment based on your age, family history, digital rectal exam results, and other clinical manifestations. Some patients may require further evaluation with the following tests:

• Prostate MRI (Magnetic Resonance Imaging): To assess for suspicious cancerous lesions;

• Needle Biopsy: To obtain prostate tissue for pathological diagnosis;

• Repeat PSA Testing: To rule out transient elevations.

Do not become overly anxious over a “single elevated reading,” nor become complacent because the “indicator is normal.” PSA is a trend indicator; dynamic observation is more meaningful than a single data point.

The Significance of PSA in Long-Term Management for Prostate Cancer Patients

Beyond early screening, PSA serves as a “barometer” after prostate cancer treatment. Whether a patient has undergone surgery, radiotherapy, or hormone therapy, post-treatment PSA changes are a core indicator for determining recurrence.

• After surgical removal, PSA should drop to near 0;

• After radiotherapy, PSA declines more slowly and requires continuous monitoring;

• If PSA shows a “sustained rise” or “re-elevation,” it may indicate recurrence.

Therefore, even after completing treatment, prostate cancer patients still need long-term, regular follow-up, closely monitoring PSA trends.

HeYou Reminder

PSA is a sensitive, simple, and repeatable screening tool. Although it cannot be used alone to diagnose cancer, it plays an irreplaceable role in the early screening and long-term management of prostate cancer. The expert teams from the Department of Urology and the Department of Oncology at HeYou Hospital, with extensive experience and supported by advanced imaging and pathological examinations, can provide scientific evaluation and subsequent diagnostic and treatment recommendations for individuals with abnormal PSA levels.

Paying attention to PSA is the starting point for focusing on men's health. If you or a family member wish to learn more about prostate cancer screening, you are welcome to visit the [HeYou Comprehensive Cancer Center] for a professional assessment.

Prostate Cancer Education Series

This series is jointly developed by experts from the Department of Urology and the Comprehensive Cancer Center at HeYou Hospital, covering core decision points across the entire process from screening to treatment and rehabilitation.

1. The Sharp Tool for Early Prostate Cancer Screening: An In-depth Look at the PSA Test

2. Understanding Prostate Cancer: From Symptoms and Screening to Diagnosis

3. Staging and Grading of Prostate Cancer: How Does Risk Stratification Affect Treatment Decisions?

4. What Are the Surgical Treatment Options for Prostate Cancer?

5. Follow-up and Quality of Life Management After Prostate Cancer Treatment

6. Systemic Therapy for Advanced Prostate Cancer: What Are the New Advances in Chemotherapy, Targeted Therapy, and Immunotherapy?

7. How Should Elderly Individuals Face Prostate Cancer? Balancing Comorbidity Management and Treatment Choices

8. Family History and Genetics: Who Is More Likely to Get Prostate Cancer? Do I Need Genetic Testing?

9. Multidisciplinary Diagnosis and Treatment of Prostate Cancer: Precision Treatment and Individualized Care

10. Combating Prostate Cancer “Flare” and Metastasis: Clinical Strategies for Salvage Therapy and Systemic Management

11. Hormone Therapy: The Cornerstone Treatment for Advanced Prostate Cancer—New Advances in Combination Therapy and Individualized Management

12. The New Era of Radiotherapy for Prostate Cancer—Clinical Applications of Intensity-Modulated Radiotherapy, Proton Therapy, and Stereotactic Body Radiotherapy
    
    

About HeYou Comprehensive Cancer Center

The HeYou Comprehensive Cancer Center (Heyou Cancer Center of Excellence) is a key specialty department established by HeYou International Hospital Group. As a newly established, high-level, modern cancer center in the Greater Bay Area, the center is dedicated to providing cancer diagnosis and treatment services that are globally synchronized, technologically advanced, and comprehensive for both Chinese and international patients. Guided by the core philosophy of “International Standards, Precision Medicine,” the center integrates the latest scientific research achievements with international collaboration platforms, committed to providing precise and internationalized cancer care, blending cutting-edge technology with humanistic care to safeguard every hope for life.

Author of this article>>>Tan Zhibo (Deputy Chief Physician, Comprehensive Cancer Center)

(Due to individual patient differences, treatment outcomes may vary. Please consult a professional physician for specific advice.)

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