What is PSA?

Prostate Specific Antigen is a molecule produced by the prostate. Its function is to liquefy semen. PSA levels in the blood are abnormally high in >95% of prostate cancers, especially large aggressive cancers. Those rare cancers with normal PSA are detected by rectal examination (DRE).

Who should be offered a PSA?

Aged between 55 to 75 years and in good health OR

Aged 45 to 55 with a family history of prostate cancer OR

A strong history of breast cancer in the family OR

A suspicious lump on rectal examination

What level of PSA is abnormal?

There is no exact ‘cut-off’ below which no one has cancer or above which all men have cancer

The likelihood of cancer goes up with the PSA level

· For a PSA of 1, the likelihood of cancer is 1 in 1,000

· For a PSA of 2.5, the likelihood of cancer is 1 in 100

· For a PSA of 4, the likelihood of cancer is 1 in 4

· For a PSA of 10, the likelihood of cancer is 1 in 2

· For a PSA of 100, the likelihood is 100%

If PSA is abnormal, what next?

· Do a DRE

· Ensure PSA was not immediately after riding a bike, ejaculation, DRE, catheter insertion or other procedure

· Exclude UTI / prostatitis, give antibiotics if symptoms

· Repeat the PSA after 4 weeks

· Add a Free / total PSA ratio

· Calculate the PSA density and velocity

If Normal, when should spa be repeated?

If PSA < 1 at age 40, repeat at age 50

· For 50 – 75 years, repeat every 2 years

· If borderline, repeat at 4 weeks then at 6 months

Prostate Cancer Risk Calculator Tool (Thompson et al, BJUI , 2017)

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Initial Consult:                                                  $240.00 with a Medicare Rebate of $76.15
Follow- up Consult:                                         $160.00 with a Medicare Rebate of $38.25

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