Posted: August 1st, 2023

Assessment Tool/Diagnostic tool : The prostate-specific antigen (PSA)

Assessment Tool/Diagnostic tool : PSA

The prostate-specific antigen (PSA) diagnostic tool for prostate cancer:
Introduction
Prostate cancer is the second most commonly diagnosed cancer in men worldwide, with an estimated 1.4 million new cases diagnosed globally in 2020 (Ferlay et al., 2020). While prostate cancer often grows slowly and may not cause health issues, some prostate cancers are aggressive and can spread quickly (National Cancer Institute, 2022). Early detection through screening and diagnostic testing is important for improving outcomes, as treatment is most effective when prostate cancer is diagnosed and treated early before it spreads (American Cancer Society, 2022).
One of the most widely used screening and diagnostic tests for prostate cancer is the prostate-specific antigen (PSA) blood test. PSA is a protein produced by the prostate gland, and elevated levels can indicate the presence of prostate cancer (National Cancer Institute, 2022). While controversial due to the risk of overdiagnosis and overtreatment, the PSA test remains an important tool in prostate cancer screening and diagnosis when used appropriately (Ilic et al., 2018). This paper will examine the PSA test as a diagnostic tool for prostate cancer, including how it works, its benefits and limitations, and recommendations for its use in screening and diagnosis.
How the PSA Test Works
The PSA test measures the level of PSA in a man’s blood. PSA is a protein produced by the prostate gland, both benign and cancerous cells (National Cancer Institute, 2022). Higher-than-normal PSA levels can indicate prostate abnormalities such as cancer, but PSA levels may also be elevated for other noncancerous reasons like benign prostatic hyperplasia (BPH) or prostatitis (American Cancer Society, 2022).
A man’s PSA level is considered normal if it is 4 ng/mL or less. Levels between 4-10 ng/mL are considered elevated but not clearly indicative of cancer. Levels higher than 10 ng/mL significantly increase the likelihood of prostate cancer, though cancer can still be present with lower levels (National Cancer Institute, 2022). If a man has an elevated PSA level, his doctor will likely recommend a digital rectal exam (DRE) and possibly a prostate biopsy to determine if cancer is present (American Cancer Society, 2022).
Benefits of PSA Testing
When used appropriately along with other diagnostic tests, the PSA test can help detect prostate cancer early. Early detection allows for potentially curative treatment options like surgery or radiation therapy that may not be possible if the cancer has spread (American Cancer Society, 2022). Studies show PSA testing combined with DRE increases the likelihood of detecting organ-confined prostate cancers that have not yet spread, improving survival rates (Ilic et al., 2018).
The test is also noninvasive, inexpensive, and widely available (National Cancer Institute, 2022). This accessibility allows for large-scale population screening programs that have reduced prostate cancer mortality rates in some countries (Ilic et al., 2018). PSA testing also helps monitor response to treatment and detect cancer recurrence after initial treatment (American Cancer Society, 2022).
Limitations of PSA Testing
While the PSA test has benefits, it also has important limitations. A significant concern is overdiagnosis – detecting cancers that would never become clinically significant or cause health problems if left undetected and untreated (Ilic et al., 2018). This can lead to overtreatment through unnecessary procedures like surgery or radiation that carry risks of impotence and incontinence without clear benefits (American Cancer Society, 2022).
PSA levels can also be elevated for reasons other than cancer, such as BPH or prostatitis. This reduces the specificity of the test and increases the likelihood of false positives requiring unnecessary biopsies (National Cancer Institute, 2022). PSA screening also does not distinguish between aggressive cancers requiring treatment and indolent cancers that may not require intervention (American Cancer Society, 2022).
Recommendations for PSA Testing
Given these limitations, medical organizations have differing recommendations on PSA screening. The U.S. Preventive Services Task Force (2016) recommends against PSA-based screening for most men, concluding the potential harms outweigh the benefits. However, the American Cancer Society (2022) states that men should receive information on benefits and limitations to make an informed decision with their doctor about screening starting at age 50 for those with at least a 10-year life expectancy.
For diagnostic purposes once symptoms are present, the PSA test remains an important tool. If levels are elevated, follow-up with DRE and biopsy is recommended to determine if cancer is present (National Cancer Institute, 2022). Ongoing research aims to improve the accuracy and specificity of PSA testing through new biomarkers or testing strategies to better distinguish indolent from aggressive cancers (Ilic et al., 2018). In conclusion, the PSA test is a valuable but imperfect diagnostic tool that requires careful consideration of risks and benefits for each individual when used for prostate cancer screening.
Conclusion
In summary, the PSA blood test is a widely used screening and diagnostic tool for prostate cancer. While noninvasive and able to detect some cancers early, it also faces limitations including overdiagnosis and false positives. Medical organizations differ in their screening recommendations but agree the PSA test remains important for diagnosis once symptoms arise. Continued research seeks to improve PSA testing and develop complementary tests that better predict cancer aggressiveness. When used appropriately and combined with other diagnostic evaluations, the PSA test provides valuable information for prostate cancer detection and management.
References
American Cancer Society. (2022). Prostate Cancer Early Detection. https://www.cancer.org/cancer/prostate-cancer/detection-diagnosis-staging/detection.html
Ferlay, J., Ervik, M., Lam, F., Colombet, M., Mery, L., Piñeros, M., Znaor, A., Soerjomataram, I., & Bray, F. (2020). Global Cancer Observatory: Cancer Today. International Agency for Research on Cancer. https://gco.iarc.fr/today
Ilic, D., Neuberger, M. M., Djulbegovic, M., & Dahm, P. (2013). Screening for prostate cancer. Cochrane Database of Systematic Reviews, 2013(1), CD004720. https://doi.org/10.1002/14651858.CD004720.pub3
National Cancer Institute. (2022). Prostate Cancer Screening (PDQ®)–Health Professional Version. https://www.cancer.gov/types/prostate/hp/prostate-screening-pdq
U.S. Preventive Services Task Force. (2016). Prostate Cancer: Screening. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/prostate-cancer-screening

Adult Assessment Tools or Diagnostic Tests:

Assessment Tool/Diagnostic tool : PSA

Include the following:

A description of how the assessment tools or diagnostic tests you were assigned is used in healthcare.
What is its purpose?
How is it conducted?
What information does it gather?
What information does it gather?
Based on your research, evaluate the test or the tool’s validity and reliability, and explain any issues with sensitivity, reliability, and predictive values.
Include references in appropriate Help write my thesis – APA formatting.

Prostatic secretion play a key function in providing spermatozoa’s the ability to move independently using metabolic energy (motility). The secretion is usually acidic with a pH of about 6.4, the acidity of the secretion is useful in balancing the vaginal alkalinity. The PSA (which is part of the secretion) works to liquidize the semen and dissolve cervical mucus (Arneth, 2009). PSA is a serine protease enzyme synthesised by the columnar epithelium which is a part of the prostatic tissue. It enters the system circulation and is additionally used to prevent seminal coagulation by breaking down semenogelin and fibronectin proteins which are of thick and gel-like consistency (David and Leslie, 2021). PSA allows for impregnation of the female.
PSA test is a blood test that measures the amount of prostate-specific antigen in an individual’s blood. PSA is a protein produced by tissues in the prostate (both cancerous and non-cancerous tissues). The PSA is a screening exam that is mostly advised for asymptomatic and healthy looking male. The PSA is mostly found in the semen and small amount if the PSA usually circulate within the male’s blood. It is in low concentration across the body, but it may increase with prostate irritation, infection and benign prostatic hyperplasia (BPH) which is a normal condition of aging (Arneth, 2009). PSA test can be used to identify any amount of prostate-specific antigen in the blood system. High amounts of PSA in the blood system may indicate presence of prostate cancer. But this is not always the case.
As men grow older, their sperm count, relative to sperm production starts to decrease. While spermatozoa production decreases, PSA production does not decrease, but it does the opposite and increases. David and Leslie (2021) identify that the increase in PSA production is explained as an evolutionary adaptation that allows genetic fitness in other males as opposed to others. This consequently increases BPH across the male general population. Inflammation irritation and increased BPH, all work to increase serum PSA levels.
The PSA test on the other hand employs the use the blood withdrawn. The test is 91% more effective in cancer rates detection from a sample as small as 4 ng/mL, as compared to digital rectal examination or DRE (51%) and transrectal prostatic ultrasonography (David and Leslie, 2021). The PSA tests is necessarily not effective in reducing prostate cancer morbidity and mortality rates. REcent research identify that it often leads to prevention 3 out of 1000 men from dying of prostate cancer, while also misdiagnosis of 60 out of 1000 men, which often ends up in increased and unnecessary cancer treatments (Informed Health Organization, 2020). Other researchers identify that the PSA monitoring are often ambiguous and lead to greater uncertainty in both patients and physicians as there remains to be limited interpretation especially when using variable PSA quotient given (Arneth, 2009).
While PSA screening are on the increase, researchers identify that there is limited significance in the test. David and Leslie (2021) identify that PSA sensitivity sully varies between 9% and 33% relative to age of the patient and the PSA cut-off levels used. Majority of people who are diagnosed with prostate cancer usually have normal PSA levels (Ilic et al., 2018). Benign conditions, that are not risky to individual health but a part of aging, may play a role in increasing PSA levels. While their blood levels may indicate a higher value of PSA through the PSA test, this does not necessarily imply presence of prostate cancer. Effectively the test becomes less important in significantly reducing morbidity and mortality rates. Ilic et al (2018) identify that overall, in an empirical research conducted over 10 year period, scientist discovered that PSA test led to small reduction in disease-specific mortality but in the long run they did not affect mortality trends across the world.
While the test is more effective than DRE and transrectal prostatic ultrasonography, it has proven unreliable on a variety of fronts. Summarily, the PSA test is not reliable and it has not been able to achieve significant changes in diagnosis and treatment of cancer. A high PSA level does not guarantee the existent of prostate cancer. Also a variety of men, who may be diagnosed with prostate cancer usually have normal PSA levels.

References
Arneth, B. (2009). Clinical Significance of Measuring Prostate-Specific Antigen. Laboratory Medicine, 40(8), 487-491. doi: 10.1309/lmeggglz2edwrxuk
David, M., & Leslie, S. (2021). Prostate Specific Antigen. Retrieved 14 June 2021, from https://www.ncbi.nlm.nih.gov/books/NBK557495/
Ilic, D., Djulbegovic, M., Jung, J., Hwang, E., Zhou, Q., & Cleves, A. et al. (2018). Prostate cancer screening with prostate-specific antigen (PSA) test: a systematic review and meta-analysis. BMJ, k3519. doi: 10.1136/bmj.k3519
Informed Health Organization. (2020). Localized prostate cancer: PSA tests for prostate cancer screening. Retrieved 14 June 2021, from https://www.ncbi.nlm.nih.gov/books/NBK284938/

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