Elevated prostate-specific antigen (PSA) levels may indicate prostate cancer, enlargement, or inflammation. PSA is a protein produced by the prostate gland and is measured with a blood test. Elevated levels of PSA are caused by a problem with the prostate.
Elevated PSA
There isn’t a clear line between normal and elevated PSA levels. Physicians typically assess PSA test results alongside a prostate biopsy. The patient’s age, overall health, family history, and medical history are also factored into a diagnosis.
The physician will look at:
- The PSA level. A higher level indicates a higher risk of prostate cancer.
- Multiple test results. If the patient’s PSA levels continue to rise after two or more tests, they may have prostate cancer. However, PSA levels alone won’t tell whether a patient has cancer or not.
The risk of prostate cancer according to PSA level:
- Below 4: 15% chance
- 4-10: 25% chance
- Higher than 10: 50% chance
PSA Level Test Limitations
PSA test results may be influenced by PSA-raising factors, such as an enlarged, inflamed, or infected prostate. It’s also normal to have PSA levels naturally rise with age.
PSA test results may be lowered by medication used to treat benign prostatic hyperplasia (BPH) or urinary conditions. Large doses of certain chemotherapy drugs and obesity can also lower PSA levels.
It’s also possible for PSA tests to show misleading results. Elevated PSA doesn’t necessarily indicate cancer, and it’s possible to have normal PSA levels with prostate cancer.
Patients who undergo PSA tests that reveal prostate cancer don’t always exhibit symptoms. Symptom-free cancers are considered overdiagnoses, or cancer that is unlikely to cause poor health or pose a life-threatening risk.
Risk Factors
Patients may be at increased risk of prostate cancer if they:
- Are older than 50
- Are are of African-American or Caribbean descent
- Have a family history of prostate cancer
- Have certain genetic changes that increase the likelihood of prostate cancer
Causes of Elevated PSA
Though prostate cancer is the main cause of elevated PSA, higher levels may also occur due to:
- Prostate enlargement and inflammation (prostatitis)
- Urinary tract infection
- Urinary catheter (tube) placement
- Medications
Symptoms of Elevated PSA Levels
Though an elevated PSA may not cause any symptoms, patients with the following signs may need to do a PSA test:
- Frequent urination
- Slow urine stream
- Urinary incontinence
- Difficulty urinating
Treatment for Elevated PSA Levels
Patients with a high PSA level will need to take ongoing PSA tests and digital rectal exams (DREs) to identify changes. If the patient’s PSA level continues to increase or if the physician feels a lump during a DRE, they may need additional testing:
- Prostate MRI
- Transrectal ultrasound and prostate biopsies
- Isa PSA or 4Kscore®
A biopsy will determine whether a patient has prostate cancer or not, and also influence the course of treatment. A significant presence of cancer cells indicates the patient needs aggressive treatment.
Treatment options for prostate cancer include:
- Chemotherapy
- Radiation therapy
- Surgery to remove the prostate
- Brachytherapy
- High intensity focused ultrasound (HIFU)
- Cryotherapy
- Hormone treatment
Patients may undergo multiple PSA level tests during and after prostate cancer treatment to check the effectiveness of treatment.
