Prostatic specific antigen (PSA)

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PSA is a 34KD glycoprotein enzyme produced by the columnar acinar and ductal prostatic epithelial cells. It is a member of the human kallikrein family and its function is to liquefy the ejaculate, enabling fertilization. PSA is present in both benign and malignant cells, although the expression of PSA tends to be reduced in malignant cells and may be absent in poorly differentiated tumours. Large amounts are secreted into the semen, and small quantities are found in the urine and blood.

The function of serum PSA is unclear, although it is known to liberate the insulin-like growth factor type 1 from one of its binding proteins. 75% of circulating PSA is bound to plasma proteins (complexed PSA) and metabolized in the liver, while 25% is free and excreted in the urine. Complexed PSA is stable, bound to alpha-1 antichymotrypsin and alpha-2 macroglobulin. Free PSA is unstable, recently found to consist of two isoforms: pro-PSA is a peripheral zone precursor, apparently elevated in the presence of prostate cancer, and BPSA is the transition zone precur-sor and associated with benign prostatic hyperplasia. The half-life of serum PSA is 2.2 days. The normal range for the serum PSA assay in men is <4.0ng/ml, though this varies with age. 

In the absence of prostate cancer, serum PSA concentrations also vary physiologically, according to race and prostate volume.

Indications for checking serum PSA
  • Patient request, following counselling 
  • Lower urinary tract symptoms
  • Abnormal digital rectal examination
  • Progressive bone pain, especially back pain
  • Unexplained anaemia, anorexia, or weight loss
  • Spontaneous thrombo-embolism or unilateral leg swelling
  • Monitoring of prostate cancer patients
The age-adjusted normal range for PSA
Age range Normal PSA range (ng/ml)
All ages <4.0
40 to 49 <2.5
50 to 59 <3.5
60 to 69 <4.5
>70 <6.5

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