Irving, Texas – The prostate-specific antigen (PSA) test is used to measure the level of PSA in the blood. Men with high PSA levels may have prostate cancer, although PSA levels may be elevated by other conditions affecting the prostate. Factors like age, race, medical procedures, medications, enlarged prostate, prostate infections and more can also change the levels of PSA.

“Because of the many factors that affect the levels of PSA, doctors are the ones qualified to interpret the PSA test results,” explained Dr. Echt. “Some doctors may consider using special types of PSA tests to decide if a patient needs a prostate biopsy, but this should be discussed to determine the risks and the need.”

Below are the various special types of PSA tests that are rarely used and may be recommended by some doctors:

Age-specific PSA ranges – PSA levels are usually high in men who are older than in younger men even without the presence of cancer. A borderline range PSA result in a 50-year old man raises concern more than in an 80-year old. That is why doctors compare PSA results of patients with those of other men of the same age.

Percent-free PSA (fPSA) – PSA may be attached to blood proteins or may circulate freely in the blood. Percent-free PSA is the ratio of how much PSA is circulating freely compared to the overall PSA levels. It is lower in men with prostate cancer than in those who don't have the disease. The test helps to decide if a patient should get a prostate biopsy when PSA results range from 4 – 10. A low percent-free PSA means high chances of developing prostate cancer.

PSA density (PSAD) – Men with large prostate glands have high PSA levels. PSA density is at times used on men who have large prostate glands to adjust for this. High PSA density shows a high likelihood of cancer.

Complexed PSA - It is a test that measures how much PSA is attached to other proteins. The test can give concrete results of the other combined tests done separately. It is still being studied for accuracy.

PSA velocity – It is the measure of the speed of PSA elevation over time. In healthy people, PSA levels rise with age. But if the man has cancer, the levels rise faster.

“If a patient has high PSA level, the doctor may advise them to wait for a while,” continued Dr. Echt. “ The doctor may later decide to repeat the test or get a prostate biopsy to determine if the patient has cancer.”

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