Elevated PSA

When results of the PSA or Prostate Specific Antigen blood test are returned with elevated or abnormal PSA levels, men are often referred to an urologist to determine if cancer is present. While PSA levels tend to be elevated in men with prostate cancer, they can also be elevated for other non-cancerous reasons.

The compassionate urologists at Georgia Urology, who treat over 35,000 new patients each year including many with the same concern, will discuss what an elevated PSA level means for you and make recommendations about what further diagnostic testing should be performed.

What is a PSA or Prostate Specific Antigen?

PSA, or prostate-specific antigen, is a protein made only by the prostate gland. Very little PSA escapes from a healthy prostate into the bloodstream, but certain prostatic conditions can cause larger amounts of PSA to leak into the blood. One possible cause of a high PSA level is a benign (non-cancerous) enlargement of the prostate or BPH. Inflammation of the prostate, called prostatitis, is another common cause of PSA elevation, as is recent ejaculation. Prostate cancer is the most serious possible cause of an elevated PSA level.

What is a normal PSA?

Recent data has redefined the way our urologists look at PSA test results and what is considered “normal.” In addition to the PSA value or number, our urologists will review other factors such as your age, the rate at which the PSA number changes over a period of time, and the percentage of free PSA in the blood.

Men with normal levels of PSA may also have prostate cancer.

PSA Evaluation

On the initial exam, the urologist will take a detailed medical history, including family history and risk factors, and perform a physical exam, which includes a digital rectal or DRE.

  1. A DRE is a simple procedure in which a gloved finger is inserted into the rectum to feel the size, texture, and shape of your prostate and to determine the presence of nodules, which can be suggestive of prostate conditions such as BPH or prostate cancer.

Your urologist will discuss your PSA test results relative to your digital rectal exam and may recommend further testing, including:

  1. Urinalysis to detect infection or blood in the urine.
  2. X-ray
  3. Ultrasound examination to look at images of the prostate produced by sound waves.
  4. Prostate biopsy, performed under local anesthetic using ultrasound guidance, is a test in which a tiny needle is used to withdraw small amounts of tissue to be examined in the laboratory. The results of the biopsy will show the nature of the prostate condition.

PSA Recommendations:

Men should consider being screened for prostate cancer with the PSA test and digital rectal exam beginning at age 40, especially if they have risk factors for the disease. Risk factors include:

  1. Age 50 years old or older
  2. Race, African Americans are at greater risk
  3. Family history: have a father, brother, or son who has had prostate cancer.

While some men with prostate cancer exhibit symptoms such as difficulty urinating, frequent urination or blood in the urine or semen, other men with prostate cancer do not exhibit any symptoms at all.

Other testing:
The PSA blood test and digital rectal exam are the recommended first steps in diagnosing prostate cancer. Additional testing has been developed to determine who needs further treatment for the disease.

Prostate CAncer gene 3 (PCA 3) is a new gene-based test carried out on a urine sample after a digital rectal exam (DRE). PCA3 is highly specific to prostate cancer, and unlike PSA, is not increased by conditions such as benign prostatic hypertrophy (BPH) or inflammation of the prostate. It is currently used both to determine when a biopsy is needed and to follow patients who elect to watch and wait as a treatment choice for known prostate cancer.

No PCA3 test has yet been approved by the U.S. Food and Drug Administration (FDA): however, there are currently several U. S. laboratories are certified to perform clinical testing. The PCA3 test is available at Georgia Urology but not covered by insurance.

Schedule an appointment with an experienced urologist in one of our convenient office locations in the Atlanta area.