Elevated PSA

Prostate specific antigen (PSA) is made by prostate cells. PSA’s function is to liquify semen. Both noncancerous and cancerous prostate cells make PSA, but cancerous cells tend to produce a larger amount and leak more into the bloodstream. As a result, men with prostate cancer usually have high PSA levels, which the PSA blood test measures.

High levels of PSA do not always mean cancer, and normal PSA levels do not guarantee cancer is not present. High levels of PSA may also result from an enlarged prostate (BPH), prostatitis (prostate infection), a urinating issue, or a bladder infection. Certain activities such as prostate or bladder procedures, recent ejaculation or aggressive extended bike riding can also temporarily increase PSA levels.

If your PSA increases by more than 0.75 in 1 year, it could be prostate cancer, and it’s essential to see a urologist. Your PSA number is important, and so is the rate at which it changes. There are men with a PSA of 20 who don’t have prostate cancer and men with a PSA of 2 who do because their PSA level increased quickly within a year.

A PSA test, along with a digital rectal exam (doctor inserts a lubricated, gloved finger into the rectum) remains the best way to screen for prostate cancer.

If prostate cancer is detected, PSA testing also can help determine the best treatments and prognosis.

Often there are no symptoms associated with an elevated PSA; however, symptoms can include:

• Sudden change in urinary habits
• Symptoms like that of a urinary tract infection (i.e., burning with urination, urinary frequency or urgency, lower abdominal discomfort, or pelvic pain)
• An increase in your PSA score of 0.75 or more in one year.

While there are many different causes for an elevated PSA, it is most commonly due to one of the following: prostate cancer, enlarged prostate (BPH), urinary tract infection, inflammation, or trouble with urination.

Finding and treating prostate cancer early, when treatment might be more effective, may save lives. It is recommended that beginning at age 50, men should have a PSA test and digital rectal exam every year. Men at high risk, including African American men and men who have a father or brother with prostate cancer, should begin screening at age 40 to 45.

During your visit to Spokane Urology, your doctor will ask you questions regarding your medical history and will perform an exam with focused attention to the abdomen and genitalia. Additionally, a digital rectal examination may be needed to thoroughly examine the prostate. Information regarding PSA history, personal and family cancer history, and urination complaints will also be discussed.

Tests that may be performed during or after your visit:

• Urinalysis: This test evaluates for blood in the urine or signs of infection.
• Post-void residual: Your physician may ask you to void (urinate) and then check to make sure you are emptying your bladder.
• Imaging may be performed: An MRI of the prostate involves an MRI of the pelvis and prostate. It may include contrast material and may involve placement of a probe into the rectum to aid in taking pictures of the prostate (but not always). The procedure typically lasts 30-45 minutes.
• Bloodwork: Additional blood work will often be needed. Biomarker tests can provide additional information to help decide what men need to proceed with a prostate biopsy.

A prostate needle biopsy is used to rule out or diagnose prostate cancer, especially when a man has and elevated PSA.

• Transrectal prostate biopsy: This involves placement of an ultrasound probe into the rectum. We then measure the size of the prostate, provide local anesthetic, and perform biopsies of the prostate (typically 12 biopsies, but occasionally more). The procedure lasts approximately five minutes.
• Transperineal prostate biopsy: This also involves placement of an ultrasound probe in the rectum. However, instead of taking biopsies through the rectum, biopsies are taken through the skin located between the scrotum and the rectum (typically more than 12 biopsies are taken, but the number depends on the prostate size and technique used). The procedure lasts approximately 10-15 minutes.