High PSA = Prostate Cancer? Maybe, maybe not

A man goes to the doctor for his regular checkup.  Everything comes back fine except for one thing – he is told his prostate specific antigen (PSA) level is elevated.  Does this automatically mean he has prostate cancer?

The simple answer to this is no.  An elevated PSA number does not always indicate a man has prostate cancer.  The PSA test is a blood test used to measure a substance in the blood called prostate specific antigen.  It is often the first step in screening for prostate cancer along with the second screening test which is a digital rectal exam (DRE). 

Just like a woman may discover a lump in her breast, does not always signify it is breast cancer as lumps in the breast can be benign or noncancerous.  The same thing is true of an elevated PSA. A man’s PSA level can vary depending on many factors which include his age, race, and family history of prostate diseases such as prostatitis.

How is PSA determined to be within a normal range?

In a man without prostate cancer, the PSA level should be 4.0 ng/mL or less.  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 when a man presents with an elevated PSA number, it needs to be assessed along with other risk factors that can elevate the PSA levels which include the following:

·      Age – the older a man is the greater the risk for developing prostate cancer.

·      Family history – certain genes a man inherits from his parents may affect his risk for prostate cancer.

·      Race – prostate cancer is more common in African American men.

·      Diet – a diet high in saturated fat along with obesity can increase prostate cancer.

·      High testosterone levels – men who use testosterone therapy are more likely to develop prostate cancer as an increase in testosterone stimulates the growth of the prostate gland.

·      Prostatic intraepithelial neoplasia (PIN) – this is a condition in which prostate gland cells look abnormal when examined with a microscope.

·      Medications – some medications like Proscar, Avodart, or Propecia can falsely lower a man’s PSA level. 

·      Ejaculation – A man should refrain from sex or ejaculating for at least 24-48 hours before a PSA test as sex can cause a mild increase in the PSA number.

·      Avoid drawing blood for a PSA test after a digital rectal exam.  This can raise the PSA level temporarily to it is important to have blood drawn before the DRE.

·      Benign prostatic hyperplasia (BPH) – BPH is when a man has an enlarged prostate. A larger prostate means more cells making prostate specific antigen increasing the potential for an elevated PSA. 

·      Trauma to the prostate gland – any kind of direct trauma to the prostate such as riding a bicycle, insertion of a catheter in the prostate, a prostate biopsy, or a bladder exam can significantly increase PSA levels temporarily.

What happens if the PSA level is elevated?

Due to the fact there are numerous things that can raise a man’s PSA level besides prostate cancer, it is important to treat each man individually.  A biopsy of the prostate gland is not always necessary when a man has an elevated PSA.  A man with an elevated PSA however does warrant further investigation into a potential problem. 

Whether a man has a biopsy or not, depends on how high the PSA is and how much it has changed from previous readings.  When a urologist reviews a man’s health history and physical, then is when he may be able to identify the cause of an elevated PSA.  It is at this point when a physician can recommend a biopsy to rule out cancer.  Otherwise, if an elevated PSA is high due to an infection, then antibiotics will be given or a scope procedure may be done to evaluate the size of the prostate. 

In summary

The most important message for men is to have regular yearly checkups with their physician along with a PSA blood test and DRE starting at age 40.  Do not assume right away that a high PSA is automatically prostate cancer.  There are many different causes for an elevated PSA.  Sorting out what exactly is the cause needs to be determined before assuming it is prostate cancer.  Even if it is, when a man receives regular medical care and follows healthy lifestyle habits, he will be in a better position to beat back the cancer and get on with his life.