The panel / Screening and safety

PSA

PSA is the prostate safety check, and the reason it is on this panel is not that testosterone causes prostate cancer. It is that you should know where you started before adding a hormone that drives prostate tissue, and there are specific numbers at which we send you to a urologist rather than wait.

What it measures

Prostate specific antigen is a protein made by the prostate. It rises with prostate cancer, but also with benign enlargement, with inflammation, and with a number of things that have nothing to do with disease at all. It is a screening prompt rather than a diagnosis.

What PSA is

A prostate proteinNot a cancer test

What raises itBenign enlargement and prostatitis as well as cancer

How it is readAs a trend over time as much as a single value

PSA screening itself is a decision to be made with you rather than done to you, generally relevant from 55 to 69, or from 40 if you are at higher risk through family history or ancestry.

Why it is on the panel

Because testosterone therapy without a baseline PSA and a prostate exam is not adequately monitored care. Guidance is to have both before starting and again within the first year. Reassuringly, the TRAVERSE trial, which followed over 5,000 men, found no increased prostate cancer risk with testosterone therapy.

How it is measured

SpecimenSerum

BaselineBefore starting therapy, with a prostate exam

ThenAt 3 to 12 months after starting

ThenBy standard screening intervals for age and risk

Before the drawAvoid ejaculation, cycling and vigorous exercise for 48 hours

TurnaroundTypically 1 to 3 days

Interpretation

Reading the result

These are the thresholds that trigger urology referral. They are worth knowing before you start therapy, not after.

Bands used in practice

Confirmed rise over 1.4 ng/mL in 12 monthsUrology referral.

Confirmed PSA above 4.0 ng/mL at any pointUrology referral.

Nodule or firmness on examinationUrology referral regardless of the PSA.

Substantially worsening urinary symptomsUrology referral.

The 1.4 figure is not arbitrary. It comes from the 90 percent confidence limit for how much PSA varies between repeat tests in the same man, which is exactly why a rise is confirmed on a second sample before anyone acts on it.

What raises PSA without cancer

7 things that move it

Benign prostatic enlargement, which is the most common cause by far.

Prostatitis or any prostate inflammation, which can raise it substantially.

Recent ejaculation, within about 48 hours.

Cycling, and vigorous exercise before the draw.

Recent catheterisation, prostate examination or urinary infection.

Assay variability between laboratories, which is why serial testing should stay with one lab.

Finasteride and dutasteride, which roughly halve PSA and require the result to be interpreted accordingly.

What happens next

Any raised or rising result is confirmed on a repeat sample before referral, because inflammation, benign enlargement and simple assay variation are all more common than cancer.

A baseline above 4.0, or a nodule on examination, means testosterone therapy is not started until the prostate is assessed.

If you take finasteride for hair loss, tell us, because it halves PSA and an uncorrected result reads as falsely reassuring.

Referral happens on the thresholds above rather than on a hunch, and we will tell you which one was met.

Straight answers

The best evidence says no. The TRAVERSE trial randomised over 5,000 men with low testosterone to testosterone or placebo and followed them for a mean of 33 months, with a prostate substudy using prespecified referral criteria, and found no increased prostate cancer risk. That is a considerably stronger answer than was available a decade ago. It does not remove the need for monitoring, because finding an existing cancer earlier still matters.

PSA