Elevated PSA (Prostate Specific Antigen)

Prostate cancer is the most commonly diagnosed non skin cancer in American men. It is estimated that around 300,000 patients will be diagnosed with prostate cancer this years and and 30-40,000 men will die of the disease. Significant advances have been made in early detection, especially with the increasing availability and usage of biomarkers as well as mpMRI, but the PSA blood test remains the first-line screening test of choice based on randomized trials of PSA-based screening showing reductions in metastasis and prostate cancer death.

Prostate cancer screening is an important health consideration for men, particularly as they age. The PSA is a blood test. The test measures the level of PSA concentration in the blood, Elevated PSA levels can indicate the presence of prostate cancer but they may also result from benign conditions such as prostatitis (infection or inflammation) or benign prostatic hyperplasia (BPH or enlarged prostate).

Prostate-specific antigen (PSA) is a protein produced by cells of the prostate gland. It is primarily found in semen where it functions to liquefy the semen to help fertilization. Small amounts of PSA circulate in the blood as a result of blood flowing through the prostate. The PSA does not have a function in the bloodstream. A high level is not harmful to you, it is simply an indication you may have prostate cancer.

Recommendations for PSA Screening

The decision to undergo PSA screening should be based on individual factors, including age, family history of prostate cancer, and overall health. The general guidelines recommend:

  • Men aged 50 and older: Discuss the benefits and risks of PSA screening with a healthcare provider.

  • Men at higher risk (e.g., African American men or those with a family history of prostate cancer): Consider screening starting at age 45.

  • Men with a significantly higher risk: For those with multiple family members affected by prostate cancer, starting screening as early as age 40 may be advisable.

Interpreting PSA Test Results

A PSA below 1.5 ng/ml means a man’s risk of prostate cancer is very low. As the number rises above 1.5 the risk of having prostate cancer also increases. As men age the average PSA levels also increase because our prostates grow and tend to leak more PSA into the bloodstream. Historically a cutoff PSA level below 4.0 ng/mL was typically considered normal, but this threshold can vary based on age and other factors. We tend to use age-specific PSA criteria to help assess a man’s risk of prostate cancer.

Here are some of the generally accepted age-specific PSA thresholds:

  • Ages 40-49: A PSA level of 0 to 2.5 ng/mL is considered normal. Levels above 2.5 ng/mL may warrant further investigation, given the lower baseline levels in this age group.

  • Ages 50-59: Normal PSA levels are typically between 0 and 3.5 ng/mL. Levels above this range may indicate a higher risk of prostate pathology.

  • Ages 60-69: PSA levels should generally be between 0 and 4.5 ng/mL. Elevated levels require further evaluation due to an increased risk of prostate cancer.

  • Ages 70 and older: A normal PSA level may range from 0 to 6.5 ng/mL. Higher levels may suggest an increased probability of prostate issues, including cancer.

These criteria are not absolute; individual factors such as family history, race, and previous prostate conditions also play significant roles in the interpretation of PSA results.

What happens when the PSA is elevated?

An elevated prostate-specific antigen (PSA) level can be a concern for many individuals, as it may indicate potential prostate issues, including prostatitis, benign prostatic hyperplasia (BPH), or prostate cancer.

Next Steps After an Elevated PSA:

  1. Repeat Testing: A repeat PSA test may be recommended to confirm that the elevation is consistent.

  2. Digital Rectal Exam (DRE): A DRE can help assess the prostate's size, shape, and texture to identify any abnormalities.

  3. Imaging Tests: Depending on the situation, ultrasound or MRI might be utilized to visualize the prostate and identify potential problems.

  4. Other Blood or Urine Tests: Other tests can help determine overall cancer risk. Tests such as an iso-PSA or 4K score can help determine if a prostate biopsy should be done.

  5. Biopsy: If there is a sustained elevation or other concerning signs, a prostate biopsy may be necessary to determine the presence of cancer.

Prostate MRI

A prostate MRI (Magnetic Resonance Imaging) is a non-invasive imaging technique used to obtain detailed images of the prostate gland and surrounding tissues. This procedure is particularly valuable for diagnosing prostate conditions, including prostate cancer, benign prostatic hyperplasia (BPH), and prostatitis.

During the MRI, the patient lies on a table that slides into a cylindrical machine. The MRI machine uses strong magnetic fields and radio waves to create detailed images without the use of ionizing radiation. The entire procedure typically lasts between 30 to 60 minutes.

Before the MRI, patients may be asked to avoid certain foods or medications and to inform their healthcare provider about any metal implants, pacemakers, or claustrophobia. In some cases, an intravenous contrast agent may be administered to enhance the images of the prostate.

The results of the prostate MRI can provide valuable information for guiding diagnosis A prostate MRI (Magnetic Resonance Imaging) is a non-invasive imaging technique used to obtain detailed images of the prostate gland and surrounding tissues. This procedure is particularly valuable for diagnosing prostate conditions, including prostate cancer, benign prostatic hyperplasia (BPH), and prostatitis.

During the MRI, the patient lies on a table that slides into a cylindrical machine. The MRI machine uses strong magnetic fields and radio waves to create detailed images without the use of ionizing radiation. The entire procedure typically lasts between 30 to 60 minutes.

Before the MRI, patients may be asked to avoid certain foods or medications and to inform their healthcare provider about any metal implants, pacemakers, or claustrophobia. In some cases, an intravenous contrast agent may be administered to enhance the images of the prostate.

The results of the prostate MRI can provide valuable information for guiding diagnosis and treatment decisions. The images can help identify the size, shape, and specific characteristics of any abnormalities, aiding in determining the need for further evaluation or intervention. Following the MRI, a radiologist will analyze the images and generate a report for the patient’s healthcare provider, who will discuss the findings and recommend next steps.and treatment decisions. The images can help identify the size, shape, and specific characteristics of any abnormalities, aiding in determining the need for further evaluation or intervention. Following the MRI, a radiologist will analyze

Prostate Biopsy

During the biopsy, small tissue samples are taken from the prostate gland for laboratory analysis.

The procedure is typically performed in our outpatient clinic. There are several methods for conducting a prostate biopsy, the most common of which is transrectal ultrasound-guided biopsy. A small ultrasound probe is inserted into the rectum to allow the physician to visualize the prostate and guide a needle to collect samples from specific areas.

Other techniques include transperineal biopsy, where samples are taken through the skin between the scrotum and rectum, and saturation biopsy, which involves taking more samples than standard methods to ensure thorough examination.

Patients may experience some discomfort or minor pain during and after the procedure. Serious complications of infection and bleeding can occur after the procedure but are uncommon.

The biopsy results help determine whether cancer is present, the aggressiveness of the disease, and guide treatment decisions if necessary.