PSA indicators for adenoma and prostate cancer
Prostate adenoma - a benign formation of the prostate gland - is a common disease among men over 40-45 years old.
Since the presence of modifications of the prostate is considered a significant risk factor for the development of oncology, such patients are required to calculate PSA and prostate adenoma, which allows to assess the degree of risk, determine further treatment tactics, and give a correct prognosis.
Read more about prostate adenoma and PSA in the article.
The abbreviation PSA implies a prostatic specific polypeptide antigen characterizing the degree of violation of the organic structure of the prostate. Normally, a certain amount of the polypeptide is produced by healthy cells of the prostate glands, and with age, a regular increase in antigen production is observed.
Exceeding the reference value of the marker, taking into account the age category of men, suggests the presence of prostatic pathological cells producing a specific polypeptide.
A significant deviation of indicators or the observation of a dynamic growth of antigen sharply increases the risk of the presence of oncologically active prostate cells.
Analysis Delivery Scheme
The analysis for a specific marker is carried out by taking a venous blood sample. Of particular importance is the preparation for the procedure, since any stimulation of the prostate gland will lead to an increase in the amount of antigen.
Therefore, it is not recommended to submit an analysis if there was:
- sexual intercourse less than 3 days before taking the sample,
- various manipulations on the prostate gland earlier than 7 days ago (any transrectal examination, massage, biopsy, laser irradiation),
- eating less than 8 hours ago
- stress the day before.
Blood is processed by the immunochemiluminescent method, and usually the interpretation is ready in 2-3 days.
Optionally, a general or free antigen can be tested. International organizations recommend evaluating both species, but the general prostatic polypeptide is of great diagnostic value.
PSA norm in men of 70 years with prostate adenoma
It is strongly discouraged to interpret the result of the analysis carried out without taking into account the recommendations for preparation.
PSA for prostate adenoma - the norm:
- 25-40 years old - 0.5-2.5 ng / ml - 15-70%,
- 40-49 years old - 0.5-2.5 ng / ml - 15-70%,
- 50-59 years - 0.6-3.5 ng / ml - 15-70%,
- 60-69 years - 0.9-4.5 ng / ml - 15-70%,
- more than 70 years -0.9-6.5 ng / ml - 15-70%.
What does PSA matter for prostate adenoma? The total PSA of a healthy man varies from 0.1 to 2.5 ng / ml. PSA standards for prostate adenoma: more than 4 ng / ml is considered an indication for observation by repeated analysis after a while with a strong recommendation to exclude physical, emotional stress, as well as stimulation of the prostate gland in any way (sexual intercourse, massage, examination).
Free PSA should be a certain amount from the total, its complete absence or a decrease in the amount below 10-15% is considered pathological. A value in excess of 70% does not exclude non-compliance with the rules of preparation, the presence of inflammation or hyperplasia of the prostate.
The role of the number of PSA
Adenoma acts as a benign formation of the prostate gland. It is treated with conservative methods and is subject to surgical removal only after diagnosis of large sizes or a significant deterioration in the quality of life of a man. PSA levels in BPH will always be elevated, even with minor hyperplasia.
During adenoma therapy, the doctor will evaluate the effectiveness of the treatment based on the concentration of PSA in the plasma. But for the correct presentation of the result, you must also adhere to the basic rules for passing a blood test for PSA with prostate adenoma.
Malignant activity of the formation can be discussed with a more pronounced deviation of the polypeptide level from the norm, with a dynamic increase in the indicator.
Also, with the confirmation of cancer by additional diagnostic methods, the leader among which is the erythrocyte sedimentation rate in the plasma of more than 30 units.
Diagnosis of a specific marker is recommended for all men with adenoma or for suspected neoplasm of the prostate gland. The numerical values of the antigen with the condition of proper preparation for the procedure will allow us to differentiate the malignant formation from the more favorable prognosis and choose a more effective treatment in this case.
PSA formation mechanism
The prostate gland of a man is an organ formed by muscle and glandular tissue structures penetrated by a large number of nerve fibers.
Muscular structures provide transport of fluid produced by the glandular structures through the ducts connecting them to the urethra.
The glandular structures produce fluid, which is a complex combination of biologically active components. It is part of the seminal fluid and provides nutrition to sperm. A certain amount of this secretion penetrates the bloodstream, where it acts as a hormone that supports the production of germ cells and the formation of sperm in the testes, the regulator of blood pressure and neuropsychic processes associated with sexual desire and the functioning of the bladder.
The composition of this fluid contains a prostate-specific antigen, which acts as an enzyme-disintegrator of protein molecules. It destroys heavy protein molecules, turning them into small ones, which leads to liquefaction of seminal fluid. This extends the life of sperm and gives them greater activity. A more detailed idea of the significance of this antigen in biochemical reactions occurring in the male body has not yet been formed.
The chemical structure of a prostate-specific antigen is formed by a glycoprotein related to serine proteases, which are a combination of protein and carbohydrates. The immune system of the body perceives such molecules as foreign formations, which led to the classification of this vital product of the prostate as an antigen.
Together with part of the secretion entering the blood supply system, a specific antigen produced by the prostate also penetrates into the blood plasma. As a result of biochemical reactions with blood plasma components, part of the antigen goes into a bound state, forming associations with macroglobulin from the composition of the blood transport protein, and chymotrypsin, which blocks the enzymatic function of PSA. Part remains in a free state.
An immunochemical blood test allows you to determine the concentration of PSA bound by chymotrypsin and in a free state. In total, they give the level of total prostate-specific antigen.
When to do an analysis
If a man does not have problems with the prostate gland, PSA is in her tissues and is not found in the blood. However, with some pathologies, this tumor marker enters the bloodstream and can be detected even when the man has no specific complaints. Therefore, a direction for such a study can be obtained in the following cases:
- as part of a clinical examination program, if a man is older than 45 years,
- detection of pain in the prostate with a digital examination,
- the presence of ultrasound patches of echogenicity similar to a tumor,
- quality control of treatment for prostate cancer or prostate adenoma,
- with contraindications for puncture biopsy of the prostate.
An increase in PSA does not always indicate cancer or adenoma. In some cases, for example, in the inflammatory process or urological catheterization, this indicator will be higher than normal. Therefore, a correct interpretation is possible only taking into account the results of other studies.
What PSA blood tests are talking about
The total concentration of PSA in the blood plasma of a man depends on a number of factors determined by the nature of the functioning of the prostate gland. Small variations of this indicator are due to:
- the mass of the prostate associated with individual anthropometric parameters (the larger the mass of the prostate, the greater the amount of antigen it produces),
- age, since with its increase the process of enlargement (hypertrophy) of the prostate is inevitable,
- mechanical effects on the prostate, causing an increase in antigen production (massage or palpation of the prostate, horse riding, cycling, etc.),
More significant variations are observed with pathological changes in the prostate gland:
- urinary tract infection (chlamydia, staphylococcus, gonococcus, trichomonads),
- benign inflammatory processes (acute or chronic prostatitis),
- hyperplasia, i.e. adenoma, prostate,
- oncological neoplasms in the organ.
However, differential identification of the disease by PSA level with prostate adenoma or with the manifestation of other inflammatory processes is impossible without additional studies.
The table shows the indicators of the total concentration of PSA, which are the norm for different age groups.
|Total PSA concentration||The ratio of the concentration levels of PSA free / total (lower limit)|
|Age Group (years)||The average value of the norm (ng / ml)||The upper limit of the norm (ng / ml)||Gray zone (ng / ml)|
A number of researchers are inclined to revise these values. In their opinion, the upper limit of the PSA concentration norm should be set equal to 4 ng / ml, and values greater than this value are due to an increase in PSA with prostate adenoma or prostatitis.
The last column of the table contains the lower limit of the acceptable ratio of the concentration of free antigens contained in blood plasma to the total concentration of PSA due to benign prostate tumors. Values below this parameter indicate an oncological etiology of neoplasms.
An indicator of total prostate-specific antigen, equal to or greater than 10 ng / ml, with a high degree of probability can be considered as an indicator of PSA in prostate cancer in the stage of an active inflammatory process. Thus, in the sequence of possible values of the overall PSA there is an interval, called the "gray zone". This interval covers the range of values corresponding to the PSA norm for prostate adenoma, acute and chronic prostatitis, as well as the initial phase of prostate cancer.
The appearance of malignant formations in the tissues of the prostate gland causes a protective reaction of the body - an increase in the production of chymotrypsin and, consequently, an increase in the concentration of bound antigen. This causes a decrease in the relative level of free and bound PSA, the norm of the lower limit of which is given in the last column of the table.
Immunochemical methods for studying the patient's blood serum allow us to determine the concentration of prostate-specific antigen that has interacted with chymotrypsin molecules and calculate its value in relation to the total amount of PSA in a unit volume. The obtained parameter is used as a criterion in the diagnosis of oncological etiology of the disease, even if the results of the analysis fall into the gray zone, that is, at the stage of nucleation of the cancerous tumor.
Proper preparation for analysis
Sometimes men who suspect prostate adenoma violate the rules of preparation for blood donation, resulting in an inaccurate result. Some factors contribute to the distortion of the picture, so you can not shy away from the doctor's recommendations.
Preparation begins 14 days before the appointed date and consists of the following steps:
- Discontinuation of hormonal drugs and drugs that enhance erection 2 weeks before analysis.
- Cessation of prostate massage, prohibition of TRUS and rectal palpation in 2 weeks.
- A special diet is the exclusion from the diet of fried and spicy foods, as well as alcohol and coffee, a ban on smoked meats and canned food 2 days before the study.
- Termination of sexual activity 48 hours before the date of blood sampling. This includes masturbation.
- Limit exercise the day before analysis, and quit nicotine.
If a man smokes for many years and cannot "hold on" for a day, it is permissible not to smoke 2 hours before blood sampling.
In the preparatory period, it is important to minimize any burden on the prostate gland. A man is recommended not to engage in cycling, horse riding. These factors are also able to change blood test data for PSA.
When you need a blood test for PSA
One of the common oncological diseases of men belonging to the older age groups is prostate cancer. This is facilitated, on the one hand, by its asymptomatic course at the early stage of the manifestation of pathological changes, and, on the other hand, by a low awareness of the population about modern methods of diagnosis and treatment of cancer of the prostate. As a result, patients with an inoperable form of the disease come to the doctors when metastases that hit the prostate begin a victorious procession throughout the patient’s body.
Early detection of prostate cancer can prevent the development of the disease even with medical methods, without bringing the situation to surgery. A blood test for PSA has been widely used in urological practice as a tumor marker of prostate disease. Every man over the age of 40, if he cares about his health, must undergo an annual preventive examination.
When visiting a urologist, you should require a referral for analysis to determine the general PSA, since standard methods (palpation of the prostate or ultrasound methods of investigation) do not provide sufficient reliability for detecting prostate cancer on its early stage. Statistics of annual PSA studies, in the case of abnormal antigen growth in patient analyzes, may also be useful in determining when a disease occurs.
For blood tests for PSA, you should use the services of any one laboratory. Due to the specifics of the analysis technologies in various laboratories, it is possible to obtain results with a large instrumental spread, which do not provide smooth "stitching" with each other.
The results of the analysis, falling into the gray zone or exceeding its upper limit, are a reason for the doctor to refer the patient to conduct a secondary extended analysis of PSA, including determining the level of free antigens. In the event that repeated studies of PSA have obtained results indicating the likelihood of developing prostate cancer, the patient is sent for a biopsy. This analysis provides histological verification of the diagnosis and allows you to choose the appropriate method of treatment for the patient.
To monitor the patient's condition, both in the case of medical and surgical treatment, a cyclic repetition of blood tests for PSA is used. With medical treatment, the schedule for blood sampling for PSA is determined by the nature and frequency of the use of drugs. The frequency of PSA analysis after radical prostatectomy is 3 months.The PSA rate after removal of prostate cancer usually ranges from 0.1-0.4 ng / ml. The preservation of these values throughout the year indicates a complete remission of the disease.
How do PSA analysis
To find out which PSA in prostate adenoma, blood is taken from a vein. Such an analysis can be passed at any medical institution specializing in laboratory diagnostics. As a rule, you will need to bring a 5 ml syringe and direction.
Due to changes in PSA levels during the day, blood is taken in the morning. The last meal should be on the evening before, you can’t eat on the day of the study. Most often, blood is taken when a man is sitting, but in some cases, taking biological material is possible in a lying position - this moment will not affect the final result of a PSA study.
PSA and abnormalities
With age, the processes of hyperplasia develop in the male prostate gland. They are not an adenoma, but also affect PSA levels. Therefore, the younger the man, the lower this value will be. In the middle sex, under the age of 40 years, the PSA indicator is normally 2.5 ng / ml, but the picture is different at an older age.
|Age||PSA level (normal)|
|For young men||2.5 ng / ml|
|For older people (50 and above)||3.5 - 4.5 ng / ml|
|In men over 70||up to 6.5 ng / ml|
An increase in PSA relative to normal indicates the development of prostate adenoma, as well as the occurrence of inflammatory processes in the prostate gland, the presence of cancer, heart attack or ischemia.
There are a number of exceptions when elevated PSA levels can be considered normal:
- when installing a catheter in the bladder,
- palpation, biopsy or massage of the prostate was performed,
- taking a medication that boosts testosterone levels,
- ejaculation occurred before examination.
Video: "Analysis of PSA in prostate diseases"
Other types of tests for prostatitis
For a more accurate diagnosis, a number of tests should be taken, the complex of which will determine the presence of an inflammatory process:
- Analysis of urine,
- PCR (presence of bacteria),
- study of the secretion of the prostate, urethral juice, ejaculate,
- general blood analysis,
- computed tomography of the pelvic organs,
- Ultrasound of the bladder,
A more serious analysis requires an advanced form of prostatitis, called chronic. In this case, you will need to do:
- general urine analysis, including the study of the average portion according to Nechiporenko,
- Ultrasound of the prostate.
Sometimes a doctor may ask you to give a triple portion of urine.
Treatment for deviations in rates
Patients who have been diagnosed with prostate adenoma should adhere to the following recommendations:
- avoid excessive hypothermia,
- long sitting
- spicy foods and alcohol
- restriction of fluid intake, especially at night.
Forms of activity such as:
- walk in the fresh air,
- physiotherapy exercises, providing a special load on the muscles and organs of the pelvic floor and hips.
Patients should continue their sexual life, maintaining its rhythm.
Your doctor may also prescribe medications, such as androgens: Testosterone propionate, methyltestosterone, Sustanon, etc. In addition, Roveron, Robberon, Proscar can be prescribed.
The details and details needed to complete the analysis are usually told by the doctor who observes the patient. Normal Values PSA is 0-4 ng / ml. It is necessary to follow the recommendations exactly and undergo a comprehensive examination. It is important to remember that this disease poses a serious threat to health, however, detected in the early stages can be completely cured.
What is the purpose of PSA analysis for prostate adenoma?
The importance of PSA in benign hyperplasia will help to refute or confirm the presence of changes in the pathological nature in the structure of the gland. Based on the results of diagnostic studies, the doctor differentiates:
- A neoplasm of a benign or malignant nature.
- The presence or absence of inflammation.
PSA analysis is carried out in the following cases:
- The specialist during palpation found an increase in the volume of the gland above normal values or a seal in the organ.
- During the diagnosis using ultrasound revealed proliferation of glandular tissue.
- In preventive measures, a study on the prostatic antigen is recommended to be regularly performed for men over forty.
- If it is not possible to take a puncture for subsequent histological examination.
- Bad results of a general blood test, accompanied by proliferation of glandular tissues.
The course of prescribed therapy depends on the results of the tests.
As indicated by high PSA levels in the blood
In a healthy man, a specific antigen is produced in small quantities. With an adenoma, the gland tissues grow rapidly, preserving the cellular structure of the prostate. The volume of antigen produced increases as organ volumes increase.
An elevated PSA level for adenoma indicates serious problems.
Cases that are an exception:
- Catheterization - the volume of the antigen level increases the installation of drainage for urine diversion.
- Prostate massage - PSA levels increase significantly immediately after palpation of the organ for therapeutic or diagnostic purposes.
- Taking hormonal drugs to increase testosterone levels.
- The study is carried out immediately after intercourse.
If the high level of antigen is not the result of extraneous reasons that could distort the results of the study, then this indicates the presence of the following problems:
- Suspicion of oncology causes a PSA level of 13 to 14, the study must be repeated. When confirming the result, a tissue biopsy is prescribed.
- They diagnose prostate cancer with an increase in antigen level to 27. Be sure to conduct a study on the bound and free antigen.
- The presence of metastases is indicated by a PSA result of up to 40. In this case, therapy is ineffective.
All men aged 40 to 65 are at risk of developing prostate adenoma and oncology, so they are required to be examined by a urologist annually and take tests for PSA.
How is the procedure
Blood sampling is performed in the morning, usually before 11 a.m. Material is not taken immediately after the patient arrives at a medical facility. The patient should be given at least half an hour of physical and emotional rest before blood sampling.
Blood for research is taken from a vein. The results of the study will be ready throughout the day, after which they are sent to the attending doctor.
A study for free and general PSA is prescribed only if oncology is suspected. The doctor recommends re-examination with an increased level of antigen content. In this case, to the diagnosis of the total antigen, add the definition of free protein. Based on the results, two indicators are calculated in percentage terms.
In case of non-compliance with the recommendations of a specialist, there is a likelihood of overstatement before blood sampling. The accuracy of the result is influenced by intimate relationships, medication and rectal massage.
PSA norm for adenoma
PSA rate from 0-4 ng per ml of blood - the norm in the absence of benign hyperplasia and other pathologies. This indicator depends on the age of the patient, so for men under 45 years old, indicators no higher than 2.5 ng / ml are considered normal, after 50 years, the PSA level can be in the range of 3.5-4.
Determining the norms, the specialist draws attention to the level of free PSA, which does not exceed the indicators of 0.0 4 - 0.05.
With benign hyperplasia, the antigen level varies from 4 to 9, and in some cases it exceeds 10. Based on the results of the diagnosis, the specialist prescribes an effective method of therapy.
If with prostate adenoma, the PSA indicator significantly exceeds the mark of 10 ng / ml, suggest the development of an oncological process. To confirm or refute prostate oncology, an additional examination is prescribed.
Cases where a high concentration of PSA is considered normal
An elevated protein level in adenoma is determined within the normal range in the following cases:
- The presence of a catheter in the bladder.
- After examination or massage of the prostate in a rectal manner.
- Biopsy study.
- Sexual contact on the eve of the test.
- Taking certain drugs that increase testosterone levels.
The exact determination of the antigen value for adenoma depends on the following rules:
- The exclusion of sexual intercourse three days before the delivery of the material.
- Weeks after catheterization.
- Two months after the end of the course of therapy with antitumor and hormonal drugs.
- Blood sampling is performed on an empty stomach.
Treatment for elevated PSA concentrations
The doctor prescribes a course of therapy aimed at lowering protein levels in benign hyperplasia. Activities that can reduce the level of antigen:
- Drug treatment. The method is selected, taking into account the severity of the pathology and the volume of the prostatic protein.
- Physiotherapeutic methods. It is used to improve blood circulation in the prostate.
- Surgical methods to remove adenomatous tissue (the most popular method is transurethral resection).
During therapy, the antigen level is determined in order to control the effectiveness of the methods used. A decrease in antigen indicates a correctly selected method of treatment. If positive dynamics is not observed, the attending physician adjusts the scheme used to treat pathology.
What will help reduce PSA at home
Benign hyperplasia requires an integrated approach in therapy. In addition to drug treatment, the patient should pay special attention to the products that are included in his diet, and the lifestyle that he leads.
The first step is to stop eating foods that increase PSA levels:
- Fish and meat of fatty grades.
- Butter (especially with a high percentage of fat content).
- Milk products.
- Smoked and salty dishes.
- Canned foods.
Products whose use will reduce protein levels in prostate adenoma:
- nails and vegetables: tomatoes and pomegranates (or freshly squeezed juices from them) are especially useful,
- turkey fillet, chicken,
- fresh berries (especially grapes of different varieties),
- low-fat marine fish.
Proper nutrition involves cooking in a double boiler or oven, which will reduce the level of PSA. Fried foods contribute to the deterioration of the patient's condition and provoke an increase in the level of prostatic protein.
PSA reduction in traditional medicine recipes
Folk remedies help productively fight high protein levels. But it is worth remembering that traditional medicine is used only in combination with the main therapy. Healing infusions in the treatment of pathological disorders will significantly enhance the achieved effect.
Folk remedies used for this:
- Herbs with a relaxing effect on smooth muscles, as well as anti-inflammatory effects. The most popular are calendula and celandine,
- Beekeeping products - propolis and honey,
- Nuts and flax seeds. They strengthen blood vessels, help tissues become more elastic.
It is possible to reduce the level of antigen in the patient’s blood by taking:
- Pumpkin seeds (as they are rich in zinc).
- Infusions of parsley and yarrow with elderberry, shell and peel of chestnuts.
It is undesirable to self-medicate with the help of traditional medicine without consulting a specialist. One and the same remedy can be beneficial for some patients, and cause irreparable harm to others.
Deviations and PSA standards for prostate adenoma
The doctor, studying the results of the examination, must take into account the age of the patient, since at each stage of life there are their own patterns of development of the body and its vital functions.
Normal PSA for prostate adenoma:
- From 25 to 40 years old - 0.5 - 2.5 ng / ml,
- From 40-50 years old - 0.5 - 2.5 ng / ml,
- From 50-60 years old - 0.6 - 3.5 ng / ml,
- From 60-69 years old - 0.9 - 4.5 ng / ml,
- More than 70 years old - 0.9 - 6.5 ng / ml,
If the SPA is exceeded to 4 ng / ml, the patient is monitored. He is recommended not to engage in physical activity, not to stimulate the prostate, exclude sexual intercourse, and then pass a second analysis after a while. In some countries, 4 ng / ml is a clear sign of adenoma. In 15% of cases, this figure is also observed with oncological pathology.
Pathology can also be suspected if the protein concentration is exceeded up to ten percent. With prostate adenoma, indicators often increase to seventy percent. But sometimes this suggests that the rules for preparing for the test were not followed. Usually, it is not difficult for men to prepare well for the test.
Oncology development can be judged by a significant deviation of PSA from the norm, as well as an increase in its dynamics. Diagnosis using this technique is always carried out with suspected tumor development in the gland. The test allows you to distinguish between benign and malignant neoplasms, since in the early stages of their symptoms they are no different. It also allows you to develop an effective course of therapy.
With increased antibody values, do not immediately panic, as one test does not judge pathology. The diagnosis is made after a comprehensive examination.
How to take a blood test?
Conduct a test in any laboratory. In some institutions, usually of a private nature, such a service is paid. But the rules are the same everywhere:
- Five days exclude sexual acts,
- Ten often before analysis, you can’t eat fried, fatty and spicy,
- The analysis can be taken only after two weeks after massage of the prostate and TRUS. This also applies to those men who undergo therapy using a catheter, as well as undergo rectal examination. All of these procedures should be done two weeks before the PSA test.
- Two days before the examination, alcohol is prohibited. And it’s best to abandon it much earlier,
- One day before the test, you can not perform physical activity and play sports.
You can do the test at any time, but some laboratories work only until lunchtime. If a person has any disease, the doctor should be warned in advance.
Typically, the results of the study will be ready in one day. In some clinics, the patient can receive them in a few hours. Such results are considered false positive that indicate an adenoma, not cancer. In any case, additional diagnosis is required.
As a result of effective therapy, further indicators of a specific protein will decrease, and then completely equal to zero.
Such a test according to the recommendations of urologists should be carried out every year together with urine and blood tests. This is especially true for those members of the stronger sex who are at risk, who have relatives with cancer.
PSA is increased, what is the reason?
Prostate adenoma is characterized by the formation of a benign neoplasm already from altered glandular cells. Therefore, such a tumor is rejected by the male body.Immunity does not allow the development of pathology, therefore, it begins to produce special protein antigens that synthesize abnormal cells.
When the prostate is removed, the value of the dog antigen should be equal to zero. If it starts to increase. Which may indicate the development of relapse of cancer. One of the most informative diagnostic methods to date is PSMA PET CT. But an increase in PSA can be associated with such phenomena:
- sexual intercourse before giving blood,
- prostate massage
- power loads performed over a long period of time,
- heart attack or ischemia of the prostate gland,
- acute urine retention.
But all these situations provoke a slight increase in PSA. And in seventy-year-old men, usually all of the above phenomena are excluded. Nevertheless, the results are evaluated taking into account all factors. Other diagnostic methods are also used to make an accurate diagnosis. Diagnosis is based on the results of all examinations.
Also, when detecting PAS, the size of the prostate should be considered. After all, this body changes its volume with age.