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What is Prostatic Specific Antigen?
Prostate Specific Antigen is a protein produced by glands of the prostate. A PSA blood test is ordered by physicians once yearly to screen for prostate cancer. PSA screening usually starts at age 50 and ends at age 70.
Earlier PSA screening, starting at age 45, is recommended for those at higher risk, such as for African American men or those with family history of a primary relative that also has prostate cancer (father or brother). It is reasonable for PSA screening to continue after age 70 if a patient is relatively healthy and has a life expectancy over 10-15 years.
How Do You Know If You Have an Elevated PSA?
To perform a PSA test, a small amount of blood is drawn from the arm, and the level of PSA in the blood is measured. The results are recorded as nanograms of PSA per milliliter (ng/mL) of blood.
In order to confirm if you have an elevated PSA, you may undergo a repeat PSA test after abstaining from sex for more than 48 hours. Physicians may also have you complete a round of antibiotics prior to PSA repeat testing if they suspect infection or inflammation as the culprit for an elevated result.
There is no standard normal level of PSA in the blood, but most doctors consider PSA levels of less than 4 to be normal. It bears mentioning that younger men should have relatively lower PSA values. For example, a PSA above 2.5 ng/mL is considered elevated in patients who are younger than 60, even though it is under the 4.0 threshold. Alternatively, a man over 70 is likely to have higher PSA levels that are within normal range for his age. As a general rule, higher PSAs that are within normal limits are seen as men age.
Why Is It Important to Know If You Have an Elevated PSA?
An elevated PSA could mean you may have prostate cancer. Approximately 30 percent of men with a PSA between 2.5 and 10 will be diagnosed with prostate cancer. It is important to detect prostate cancer at an early stage because if found early it can be treated and cured.
Additionally, prostate cancer in early stages rarely manifest with any warning symptoms – only the PSA blood test can screen for a possible cancer risk. Once prostate cancer spreads outside the prostate or grows large enough to start causing local symptoms, it can no longer be fully treated.
What Are the Factors That Can Lead to a Falsely Elevated PSA Result?
You may get a falsely elevated PSA in cases of prostate inflammation (prostatitis), urinary tract infection (UTI), or in patients with an enlarged prostate. Sometimes, PSA can also be falsely elevated if the lab test is drawn within 48 hours of sexual intercourse or in someone who is an avid cyclist.
I Have an Elevated PSA, What are the Next Steps?
If your PSA test yields an abnormal result, consult with Dr. Dhir immediately. A digital rectal exam will be needed to detect any asymmetry or nodules that can indicate a higher risk of prostate cancer. The process involves the insertion of a lubricated and gloved finger into the rectum to palpate the prostate gland and takes only seconds.
If there is valid suspicion for prostate cancer, Dr. Dhir will schedule an in-office prostate biopsy to identify tumor cells. This is a procedure that utilizes a needle to collect tissue from the prostate. A ultrasound probe in the rectum will guide Dr. Dhir as he extracts tissue samples from 12 areas of the prostate gland. The entire procedure takes about 10 minutes. A Local nerve block is performed to minimize pain, and ProNox (Nitrous Oxide or laughing gas) is a great sedation option available to those with a low pain tolerance or anxiety.
What are the Alternatives to a Prostate Biopsy?
A prostate biopsy is a necessary test to confirm the diagnosis of prostate cancer. It carries a very low risk of bleeding or infection (< 0.1%). It does not spread prostate cancer. If there is suspicion that an elevated PSA may be due to non-cancerous causes, there are alternative tests that can be done to improve confidence that a biopsy is necessary. An MRI of the prostate can be performed to identify any suspicious cancer lesions prior to biopsy; this is often not covered by insurance, however. Other tests are now on the market that can improve the accuracy of a PSA blood test, such as 4K Score, Prostate Health Index (PHI), ExoDx Prostate Test, and several others. If you are unsure of whether to proceed with a prostate biopsy, discuss these alternatives with Dr. Dhir who can help guide you through a sometimes complex decision.
Schedule your consultation today with Dr. Robert Dhir to learn more about our treatment and diagnostic options for men with an elevated PSA.