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serine protease enzyme produced by normal and malignant prostate epithelial cells
tumour marker but controversy regarding usefulness for screening  

screening reduces death but over diagnosis and Rx was high - men to make informed choice (1/1000 deaths avoided with 37 more treated)

''upper limits for PSA ...''
|Age	|PSA level (ng/ml)|
|50-59 years	|3.0|
|60-69 years	|4.0|
|> 70 years	|5.0|

''Poor specificity and sensitivity''
33% of men with PSA 4-10 ng/ml will be found to have prostate cancer
PSA 10-20 ng/ml 60% men will have ca
20% with prostate cancer have normal PSA
tried to improve results with age adjusted limits and change in level - none great

''“Major evidence-based guidelines recommend against PSA testing for the following reasons'': (BMJ 2013;346:f325):
The test is unlikely to prevent you from dying from prostate cancer over 10–15y or to help you to live longer. (70% of those who die over 70yr for any cause also have prostate ca)
Elevated PSA values are common and lead to tests that have harms.
PSA tests find many cancers that will never cause health problems.
Once we find a cancer, it is difficult not to treat it.
Treatments have harms which can be serious and may persist and yet have very little if any benefits.
If you choose not to have a PSA test, you can live a similar length life, have little or no difference in dying from prostate cancer
and avoid the harms associated with tests, procedures and treatment”.

''PSA levels may be raised'' by ...
benign prostatic hyperplasia (BPH)
prostatitis and urinary tract infection (NICE recommend postpone test for >1/12 post Rx)
ejaculation (ideally not in the previous 48 hours)
vigorous exercise (ideally not in the previous 48 hours)
urinary retention
instrumentation of the urinary tract
??digital exam ??