What You Need To Know About An Elevated PSA

As men get older, they should be aware of their PSA, whether it is elevated, and what it means for the PSA to be elevated. PSA stands for prostate-specific antigen, which is a protein that is produced by the prostate gland. The PSA can become elevated in the blood as a result of the prostate cells or gland being disrupted in some way. Because the PSA is not specific for one type of prostate condition, it can be elevated due to a number of different conditions.

A “normal” PSA level is generally between 1.0 and 4.0 ng/mL. Anything above 4.0ng/mL is considered “abnormal” or elevated. The PSA level may differ depending on a man’s age. As men age, the prostate gets larger. A larger prostate produces more PSA. Therefore, younger men generally have lower PSA levels while older men tend to have higher PSA levels. These variations in PSA levels are not always associated with a prostate condition, other than an enlarged prostate. The PSA level may also vary depending on the man’s ethnicity or if they have a family history of prostate cancer.

If you have an elevated PSA, you should see a urologist. A urologist will do a number of tests to determine exactly what is causing the elevated PSA. Additional tests may include another PSA test, a urinalysis test, post-void residual, assessment of medical history and family history, and possibly a prostate biopsy or cystoscopy.

Here are the most common causes of an elevated PSA:

• Prostatitis. Prostatitis also means a prostate infection, which causes inflammation of the prostate gland. Prostatitis is the most common prostate condition in men younger than 50. It can usually be treated with antibiotics.
• Age. As men age, their prostate naturally gets bigger. This happens regardless of any medical condition affecting the prostate gland.
• Benign prostatic hyperplasia (BPH). BPH also means an enlarged prostate gland. This does not mean prostate cancer. BPH is the most common prostate condition men over 50 suffer from. It can often cause urination problems such as frequent urination or difficulty urinating.
• Prostate cancer. An elevated PSA could indicate prostate cancer. If you have an elevated PSA, your doctor will also do a digital rectal exam to see if there are any suspicious lumps present on the prostate gland. If they suspect prostate cancer, a prostate biopsy will be recommended. It’s also important to monitor any changes in the PSA; if the PSA continues to rise, this may mean prostate cancer. If you continue to have an elevated PSA, but your biopsy is negative, your doctor will most likely recommend follow-up PSA tests and a follow-up biopsy within six months.
• Urinary tract infection. A urinary tract infection can cause irritation and inflammation in the prostate gland, which can cause the PSA to go up. If you have a UTI, a doctor will prescribe antibiotics to treat it. The PSA should go back to normal after the infection has gone away so make sure to wait until then to have a PSA test. Men with an enlarged prostate have a higher risk for urinary tract infections.
• Having certain medical procedures or exams. The prostate can sometimes be affected after certain procedures, such as a prostate biopsy or cystoscopy. It can also be affected after having a digital rectal exam. The PSA can elevate after having any of these done because they disturb the prostate gland. It can even rise after having a catheter in place. The PSA should go back to normal within a few days once the prostate has healed.
• After sex. After sex, or ejaculation, the PSA can go up. The PSA usually only goes up very slightly, so it may not even show a difference. The PSA should go back to normal within a few days.

With less serious conditions, the PSA level goes back to normal within a few hours or in the case of an infection, with antibiotics. However, with more serious conditions like BPH or prostate cancer, your urologist will do further testing to determine which of these may be causing the elevated PSA. Further testing includes a digital rectal exam (DRE) and a prostate biopsy.

The PSA test is mainly used to screen for prostate cancer. If a person is diagnosed with prostate cancer, the PSA is an important value throughout your treatment:

• To guide your treatment plan – The PSA is used along with the DRE and tumor stage to determine how advanced or aggressive the prostate cancer is. The results will determine the best option for treatment.
• Prognosis after treatment – After having a radical robotic prostatectomy and/or radiation, the PSA level is monitored to determine how successful the treatment was. After surgery, the PSA level typically goes down to zero. However, a rising PSA after treatment typically indicates prostate cancer cells are present and the cancer has come back. In this case, further treatment would be needed.

Should you have a PSA test?

Knowing the risk factors for prostate cancer can help you understand why it’s important to have your PSA tested and when to start screening.

• Age – After 50, the risk for prostate cancer greatly increases. However, men as young as 40 can get prostate cancer, and it is often more aggressive. Men should begin screening for prostate cancer at age 40.
• Race – African-American men have the highest risk for prostate cancer; they are more likely to have aggressive cancer, be diagnosed at an advanced stage, and die from the disease.
• Family history – Men who have had a brother or father with prostate cancer are twice as likely to be diagnosed with prostate cancer.
• Diet – A diet high in fat or being obese may increase your risk for prostate cancer.

With early detection, lives can be saved. Not only are there are more treatment options available, but a better outcome, less side effects, and less chance of a recurrence. So if you any of these risk factors, or multiple risk factors, be smart – get your PSA checked.

Patients who are newly diagnosed with prostate cancer can contact world renowned prostate cancer surgeon and urologic oncologist, Dr. David Samadi, for a consultation at 212.365.5000.