elevated PSA

prostate specific antigen (PSA)

Prostate specific antigen (PSA) is a protein produced by the prostate gland and released into the bloodstream. The primary role of PSA is to liquefy the semen, allowing it to swim freely.

PSA testing is commonly used as a screening tool for prostate cancer. Elevated PSA levels may indicate the presence of prostate abnormalities, prompting further investigation, such as a prostate biopsy. However, an elevated PSA level doesn't conclusively indicate cancer and additional diagnostic steps are determined based on a combination of PSA levels, clinical findings, and individual risk factors.

causes of elevated PSA

facts about PSA testing

Prostate Specific Antigen (PSA) testing, when conducted appropriately, is a valuable tool for early prostate cancer diagnosis.

• Increased PSA levels may indicate the presence of cancerous prostate cells, prompting further diagnostic investigations.

• PSA testing has been proven to prevent death from prostate cancer by enabling early detection and intervention.

• However, it is not foolproof, as around a third of men with elevated PSA levels do not have prostate cancer.

• Causes of increased PSA beyond cancer encompass conditions like Benign Prostate Hyperplasia (BPH), urine infection, prostatitis, and urethral catheter use.

• While PSA testing can lead to early cancer diagnosis, it may also result in unnecessary anxiety and invasive follow-up procedures due to false positives.

• False negatives can occur, potentially delaying or missing a prostate cancer diagnosis.

• Decisions regarding PSA testing should involve informed discussions between individuals and their healthcare providers to balance potential benefits and pitfalls.

PSA related questions

What level of PSA is considered abnormal?

There is no specific cut-off for an abnormal PSA, as levels naturally increase with age and benign prostate enlargement. Generally, a PSA > 2 ng/ml is considered abnormal in a man in his 50s, while a PSA > 3.0 ng/ml is abnormal in his 60s.

What does an elevated PSA mean?

An increased PSA can result from a variety of conditions, including prostate cancer, benign prostate enlargement, or prostate infection. Transient PSA elevation is a common occurrence and may occur due to factors like non-specific prostatic inflammation, urinary infection, sexual activity, or direct prostate pressure. A second PSA test is recommended for confirmation, and a PSA level between 4.0 – 10.0 ng/ml carries a roughly 30% chance of prostate cancer. The PSA test is highly sensitive and detects about 90% of prostate cancers. However, some aggressive cancers may not produce PSA, warranting a digital rectal exam (DRE) to feel for prostate abnormalities along with the PSA test.

Is there evidence for mass population PSA screening?

Studies investigating PSA screening have produced varied results, with notable trials such as the European Randomised Study of Screening for Prostate Cancer (ERSPC), the Prostate, Lung, Colorectal, and Ovary (PLCO) screening trial, and the Göteborg trial.

• ERSPC (European Randomised Study of Screening for Prostate Cancer):

  • The ERSPC trial indicated a 20% reduction in prostate cancer mortality in the screening group.

  • The study showed a median follow-up of 9 years, demonstrating the potential benefit of PSA screening in reducing mortality rates.

• PLCO (Prostate, Lung, Colorectal, and Ovary) Screening Trial:

  • In contrast, the PLCO trial did not show a significant difference in prostate cancer mortality.

  • The trial results, with data complete up to 7 years follow-up, suggested no clear advantage of PSA screening in reducing prostate cancer deaths.

• Göteborg Trial:

  • The Göteborg trial contributed to the evidence landscape, demonstrating a significant reduction in prostate cancer mortality with PSA screening.

  • This trial provided insights into the potential benefits of screening in specific populations and contexts.

Is there any harm with having a PSA test?

PSA testing, while valuable for prostate cancer detection, can pose potential harm. False positives may lead to unnecessary anxiety and invasive procedures like biopsies. Overdiagnosis may result in treating slow-growing cancers that may never cause harm. Additionally, treatment-related complications, such as erectile dysfunction or urinary incontinence, can impact quality of life. To mitigate harm, informed decision-making is crucial, involving discussions with healthcare providers, considering individual risk factors, and choosing active surveillance for low-risk cases. Balanced information and personalized approaches help navigate the potential drawbacks of PSA testing.

Does A/prof zargar recommend psa testing?

PSA testing is an effective tool for early detection of prostate cancer. When monitored and interpreted in conjunction with clinical factors, PSA levels provide valuable insights. Early identification allows for timely intervention, improving treatment outcomes. A/Prof Zargar emphasizes informed decision-making, weighing the benefits and potential harms. Regular PSA testing, particularly for individuals with risk factors, aligns with a proactive approach to managing prostate health.
PSA screening decisions should be tailored based on individual factors such as age, comorbidities, and family history. Associate Professor Zargar emphasizes the importance of considering a patient's life expectancy to determine the appropriateness of screening. This personalized approach ensures that screening recommendations align with each patient's unique health profile.

What happens after referral

After you get your referral, our practice nurse will triage your case, and you'll be immediately contacted for a brief overview of your condition. After your visit, you can go over several diagnostic tests, including repeat PSA, urine analysis, ultrasound, CT urogram, are arranged to enhance the evaluation. At your appointment, A/Prof Homi Zargar will be able to engage with you, conduct a thorough assessment, and review the gathered information. A personalized care plan addressing your symptoms will be devised, ensuring all your questions are addressed. Further assessment may include the following:

• Digital rectal examination

• MRI of the prostate

  • MRI of the prostate plays a crucial role in prostate cancer detection by providing detailed images of the prostate gland. This imaging technique aids in identifying suspicious areas and guiding targeted biopsies for accurate diagnosis. It is especially valuable for detecting clinically significant cancers and can help plan treatment. Integrating MRI into the diagnostic process enhances the precision of prostate cancer assessment. MRI will detect up to 85% of significant prostate cancers.

• Prostate biopsy

  • Following an abnormal MRI indicating potential prostate abnormalities, a biopsy is often recommended to confirm the diagnosis. The biopsy involves extracting tissue samples from the identified suspicious areas in the prostate for detailed examination. This procedure helps determine the nature and severity of detected abnormalities, guiding subsequent treatment decisions.

  • Read more on prostate biopsy