Elevated PSA
Prostate-specific antigen (PSA) is a protein produced by cells of the prostate gland, and its levels are measured through a blood test.
While PSA testing is primarily used as a screening tool for prostate cancer, an elevated PSA does not always indicate malignancy. Understanding the causes, investigations, and potential management of elevated PSA is crucial for both patients and healthcare providers.
What is PSA?
PSA is produced by both normal and cancerous prostate cells and is present in small amounts in the blood. PSA levels are typically measured in nanograms per millilitre (ng/mL). The PSA test is a valuable tool for:
Screening for prostate cancer.
Monitoring men with a history of prostate cancer.
Evaluating men with symptoms such as urinary issues.
Causes of Elevated PSA
An elevated PSA can be caused by a range of benign and malignant conditions, including:
- Prostate Cancer:
- One of the primary concerns with elevated PSA.
- Often requires further investigation to confirm or rule out malignancy.
- Benign Prostatic Hyperplasia (BPH):
- Non-cancerous enlargement of the prostate.
- Common in older men and can increase PSA levels.
- Prostatitis:
- Inflammation or infection of the prostate.
- Can cause sudden and significant spikes in PSA.
- Recent Prostate Manipulation:
- Activities such as a digital rectal exam (DRE), catheter insertion, or ejaculation can transiently elevate PSA levels.
- Urinary Tract Infection (UTI):
- Infections involving the bladder or urinary tract can also raise PSA levels.
- Age and Ethnicity:
- PSA levels naturally increase with age.
- Certain ethnic groups, such as Black men, are more likely to have higher PSA levels.
- Trauma or Exercise:
- Vigorous physical activity, particularly cycling, can temporarily increase PSA.
Investigations for Elevated PSA
If a PSA test shows elevated levels, the following steps may be recommended:
- Repeat PSA Testing:
- A second PSA test is often performed after a few weeks to confirm the initial result.
- Patients may be advised to avoid activities like cycling or ejaculation before the test.
- Free vs Total PSA Ratio:
- Measuring the ratio of free PSA to total PSA can help differentiate between cancer and benign causes.
- Digital Rectal Exam (DRE):
- A physical examination to assess the size, shape, and texture of the prostate.
- Multiparametric MRI (mpMRI):
- A non-invasive imaging technique to identify suspicious areas in the prostate.
- Prostate Biopsy:
- If cancer is suspected, a biopsy involves sampling prostate tissue for histological analysis.
- Additional Blood Tests:
- Tests such as the Prostate Health Index (PHI) or 4Kscore may provide more information about cancer risk.
- Urine Tests:
- To check for infection or markers like PCA3, which are associated with prostate cancer.
Management of Elevated PSA
The management of elevated PSA depends on the underlying cause:
- Benign Causes:
- Prostatitis: Treated with antibiotics and anti-inflammatory medications.
- BPH: Managed with medications like alpha-blockers, 5-alpha-reductase inhibitors, or minimally invasive procedures.
- Prostate Cancer:
- Active Surveillance: Monitoring low-risk cancer with regular PSA tests, DREs, and imaging.
- Definitive Treatment: Options include robotic prostatectomy, radiotherapy, or focal therapies for higher-risk cancers.
- Lifestyle Adjustments:
- Patients with mild elevations may benefit from dietary changes, exercise, and avoiding activities that can artificially raise PSA.
- Follow-Up:
- Regular monitoring of PSA levels ensures early detection of changes and appropriate intervention.
When to Seek Medical Advice
Men experiencing any of the following symptoms alongside elevated PSA should consult a specialist:
- Difficulty urinating.
- Blood in the urine or semen.
- Persistent pelvic or back pain.
- Unexplained weight loss or fatigue.
Conclusion
An elevated PSA is not a definitive diagnosis of prostate cancer but serves as a critical indicator for further evaluation. Understanding the potential causes and following appropriate investigations can help determine the best course of action. Early detection and treatment, when necessary, can lead to improved outcomes and peace of mind. If you have concerns about your PSA levels, consider consulting a specialist for a personalised assessment.
For more information on PSA testing or to schedule an appointment, feel free to contact us.
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