Contrary to what most think, having an elevated prostate-specific antigen (PSA) test does not necessarily mean one has cancer and needs to go under the knife immediately for a biopsy. Urologist and Chief of Robotic Surgery at Lenox Hill Hospital in New York City, Dr. David B. Samadi, explains that while undergoing a PSA blood test is the first step in screening for prostate cancer, a digital rectal exam (DRE) should also be completed before deducing a probability of cancer.
An elevated PSA test result cannot be used as a stand-alone diagnostic sign for prostate cancer, as it can also be observed in Benign Prostatic Hyperplasia (BPH), prostatitis (enlarged prostate), or a urinary tract infection. “The PSA level may differ depending on many factors such as age, race and family history of prostate diseases such as prostatitis. An elevated PSA doesn’t always mean Prostate Cancer, that’s why it is critical for every patient to receive an individualized approach,” said Dr. Samadi.
Despite its name, PSA levels are not actually prostate cancer-specific and can be caused by other conditions of the prostate, thereby underscoring the additional need for a thorough patient assessment and interview. Information on their medical and family history, and PSA trend and change velocity are only some of the things vital to physicians’ sound decision making in prescribing further diagnostic tests and, if necessary, treatment.
“The PSA test is not a prostate cancer test, but it is a vital first step in identifying the potential presence of the disease. I am a firm believer in routine PSA screenings. In my experience, an elevated PSA is how many of my patients were diagnosed, combined with knowing their risk factors like family history. In the end, when we look back, that test saved their lives,” noted Dr. Samadi.
Dr. Samadi listed the many other factors that can cause PSA levels to rise:
- Age: PSA levels can increase gradually as you age
- Prostatitis: Inflammation of the prostate gland, due to infection or some unknown cause
- Benign prostatic hyperplasia (BPH): This condition refers to an enlarged prostate. More prostate means more cells making prostate specific antigen, increasing the potential for an elevated PSA.
- Urinary tract infection: can irritate and inflame prostate cells and cause PSA to go up
- Medications: Some medications like Proscar, Avodart, or Propecia can falsely lower your PSA. This too is important to remember. If you are on any of these medications, talk to your doctor. The general rule of thumb is to double your PSA for an accurate score.
- Sex/ejaculation: This can cause a mild elevation in the PSA, but should return to normal after a few days.
- Prostate trauma: Anything that causes direct trauma to the prostate such as riding a bike, having a catheter in, a prostate biopsy, or a bladder exam can significantly increase the PSA temporarily.
“At the Dr. Samadi Prostate Cancer Center, our key approach is measuring the trend and velocity of the PSA over time. PSA mapping by a prostate cancer expert is the best way to determine if elevations are a cause for concern. A PSA level of 4.0 ng/mL is normal, while changes of more than 2.0 ng/mL over the course of a year could be an indicator of the presence of Prostate Cancer. But an elevated PSA must be weighed against specific Prostate Cancer risk factors such as age, family history and lifestyle habits,” stressed Dr. Samadi.
Once an elevated PSA result is received, and the physician has noted risk factors in the patient’s assessment and history and has examined the trend in PSA changes, a biopsy would be recommended to help confirm a cancer diagnosis.