Prostate‑specific antigen (PSA) is a glycoprotein (molecular weight 30000‑34000 daltons) having a close structural relationship to the glandular kallikreins. It has the function of a serine proteinase.
The proteolytic activity of PSA in blood is inhibited by the irreversible formation of complexes with protease inhibitors such as alpha‑1‑antichymotrypsin, alpha‑2‑macroglobulin, and other acute phase proteins. Beside these complexes, about 30 % of the PSA present in blood occurs in the free form, but is proteolytically inactive.
Elevated concentrations of PSA in serum are generally indicative of a pathologic condition of the prostate (prostatitis, benign hyperplasia or carcinoma).
As PSA is also present in para‑urethral and anal glands, as well as in breast tissue or with breast cancer, low levels of PSA can also be detected in sera from women. PSA may still be detectable even after radical prostatectomy.
The main areas in which PSA determinations are employed are the monitoring of progress and efficiency of therapy in patients with prostate carcinoma or receiving hormonal therapy. The steepness of the rate of fall in PSA down to no‑longer detectable levels following radiotherapy, hormonal therapy or radical surgical removal of the prostate provides information on the success of therapy.
An inflammation or trauma of the prostate (e.g. in cases of urinary retention or following rectal examination, cystoscopy, coloscopy, transurethral biopsy, laser treatment or ergometry) can lead to PSA elevations of varying duration and magnitude.