What Happens If My Psa Level Is Elevated
If you have a high PSA level, you will need ongoing PSA tests and DREs so your provider can look for any changes. If the PSA level continues to increase or if your healthcare provider finds a lump during a DRE, you may need other tests, including:
- Transrectal ultrasound and prostate biopsies.
- Prostate MRI.
- Iso PSA or 4Kscore® .
A biopsy can tell you definitively if you have prostate cancer. The biopsy results also affect your treatment. For example, if the biopsy shows a lot of cancer cells, you might need more aggressive treatment.
What Else Can Cause An Elevated Psa Besides Prostate Cancer
If you are a man in your 50s or older, you likely have a PSA drawn with your routine annual blood work. For men who receive an elevated PSA result, prostate cancer may be an immediate concern. However, prostate cancer is not the only condition that can cause the PSA to become elevated. Board-certified urologists Drs. Ahmad and Ali Kasraeian and the expert team at Kasraeian Urology in Jacksonville, FL have a deep understanding of the complex behavior of the PSA and carefully monitor patients PSA levels to identify any cause for concern. Learn more about PSA elevations here, including why other than prostate cancer your PSA may be high.
What If My Biopsy Results Are Positive
Following a positive biopsy result, the next step is to determine the cancers staging the extent to which cancer has developed by growing and possibly spreading. You will undergo a bone scan, an MRI of the pelvis, or a CT scan. In the near future, PET scanning specifically for prostate cancer will be widely available. Ruckle says you and your physician should customize your prostate cancer care based on your desires, fears, age, current health status, motivation, and lifestyle.
There is a wide spectrum of treatments, Ruckle says. It is really important that patients understand that it is not a one-size-fits-all treatment by any means. Different prostate cancer treatments bear various side effects from close observation with deferred treatment if necessary, focal therapy to radiation therapies to robotic surgical removal.
We have a lot of resources and options to help men get through this and not have it adversely affect their life or their lifestyle, Ruckle says.
Learn more about prostate cancer screening and treatment options online. Loma Linda University Health is committed to your health and safety. Visit MyChart to schedule a telehealth visit or in-person appointment, or call .
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What Can Cause Psa To Rise Quickly
Sudden elevated PSA can be caused by prostatitis. Prostatitis is inflammation of the prostate. When the prostate is inflamed, it can be difficult or painful to urinate. If you have prostatitis, you may experience a persistent urge to urinate, wake up at night to urinate, or feel like you need to make frequent trips to the restroom. You may also have pain in the testicles or anorectal region or general pelvic discomfort. Chronic prostatitis is usually caused by autoimmune diseases, stress, and pelvic floor spasms. Urinary tract infections, bladder infections, urinary retention, and prostate stones usually cause bacterial prostatitis. Prostatitis is usually treated with antibiotics.
Why It Is Done
The prostate-specific antigen test is done to:
- Screen men for prostate cancer. Since other common medical conditions, such as benign prostatic hyperplasia and prostatitis, can cause high PSA levels, a prostate biopsy may be done if your doctor is concerned about signs of prostate cancer.
- Check if cancer may be present when results from other tests, such as a digital rectal exam, are not normal. A PSA test does not diagnose cancer, but it can be used along with other tests to determine if cancer is present.
- Watch prostate cancer during active surveillance or other treatment. If PSA levels increase, the cancer may be growing or spreading. PSA is usually not present in a man who has had his prostate gland removed. A PSA level that rises after prostate removal may mean the cancer has returned or has spread.
What If A Screening Test Shows An Elevated Psa Level
If a man who has no symptoms of prostate cancer chooses to undergo prostate cancer screening and is found to have an elevated PSA level, the doctor may recommend another PSA test to confirm the original finding. If the PSA level is still high, the doctor may recommend that the man continue with PSA tests and DREs at regular intervals to watch for any changes over time.
If a mans PSA level continues to rise or if a suspicious lump is detected during a DRE, the doctor may recommend additional tests to determine the nature of the problem. A urine test may be recommended to check for a urinary tract infection. The doctor may also recommend imaging tests, such as a transrectal ultrasound, x-rays, or cystoscopy.
If prostate cancer is suspected, the doctor will recommend a prostate biopsy. During this procedure, multiple samples of prostate tissue are collected by inserting hollow needles into the prostate and then withdrawing them. Most often, the needles are inserted through the wall of the rectum . A pathologist then examines the collected tissue under a microscope. The doctor may use ultrasound to view the prostate during the biopsy, but ultrasound cannot be used alone to diagnose prostate cancer.
What Are Some Of The Limitations And Potential Harms Of The Psa Test For Prostate Cancer Screening
Detecting prostate cancer early may not reduce the chance of dying from prostate cancer. When used in screening, the PSA test can help detect small tumors that do not cause symptoms. Finding a small tumor, however, may not necessarily reduce a mans chance of dying from prostate cancer. Many tumors found through PSA testing grow so slowly that they are unlikely to threaten a mans life. Detecting tumors that are not life-threatening
that requires treatment.
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My Psa Is Elevated What Could It Mean
First, realize that having an elevated PSA does not necessarily mean you have cancer in your prostate. Other causes for an elevated PSA include:
- infection, instrumentation of the urinary tract, disruption, trauma, or manipulation of the prostate
- certain conditions like prostatitis or enlarged prostate
You and your doctor will work together to identify any of these possible contributing factors to your higher PSA through measures like checking for urine infection, reviewing for history of instrumentation, inflammation and discussing family health history. You and your doctor may identify such a cause, address it with treatment, and re-test PSA to see whether the level has appropriately decreased.
If you and your doctor do not rule out any other causes, you will likely need to undergo another PSA test and a digital rectal exam. During this exam, a physician inserts a lubricated, gloved finger into the rectum to reach the prostate and feel for any lumps or hard areas. Continued abnormal results from the PSA test or rectal exam call for further investigation to identify clinically significant prostate cancer.
Is The Psa Test Recommended For Prostate Cancer Screening
Until about 2008, some doctors and professional organizations encouraged yearly PSA screening for men beginning at age 50. Some organizations recommended that men who are at higher risk of prostate cancer, including African-American men and men whose father or brother had prostate cancer, begin screening at age 40 or 45. However, as more was learned about both the benefits and harms of prostate cancer screening, a number of organizations began to caution against routine population screening. Most organizations recommend that men who are considering PSA screening first discuss the risks and benefits with their doctors.
Currently, Medicare provides coverage for an annual PSA test for all Medicare-eligible men age 50 and older. Many private insurers cover PSA screening as well.
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Noncancerous Prostatic Disease And Urologic Manipulation
The serum PSA level can also be altered by noncancerous prostatic disease and urologic manipulations. Elevation of PSA levels has been demonstrated in acute prostatitis, subclinical or chronic prostatitis, and urinary retention. Nadler et al reported that serum PSA levels higher than 4.0 ng/mL in 148 men with subclinical prostatitis could be attributed to their disease because all these men had negative findings from biopsies repeated on multiple occasions.
No significant change occurs in the PSA level after a digital rectal examination , but a vigorous prostate massage can produce a short-term 2-fold increase. Cystoscopy, urethral catheterization, and transrectal ultrasonography of the prostate do not tend to elevate the PSA level. Needle biopsy of the prostate raises the PSA level by a median of 7.9 ng/mL within 5 minutes after the biopsy, and this level persists for 24 hours.
The time it takes for PSA to return to baseline levels depends on the precipitating event and the half-life . After a biopsy, 2 to 4 weeks may elapse before the PSA returns to its original level. If an infection occurs as a result of the biopsy, the return to baseline levels may take longer. After ejaculation, PSA levels have been reported to return to their original levels within 48 hours, whereas fPSA returns to baseline at 6 hours because of its shorter half-life .
There Are Risks To Getting Prostate Cancer Tests And Treatments
If your PSA is not normal, you will probably have a biopsy. The doctor puts a needle through the wall of the rectum and into the prostate to take a few samples. Biopsies can be painful and cause bleeding. Men can get serious infections from biopsies, and they may need hospital care.
Surgery or radiation are the usual treatments for prostate cancer. They can do more harm than good. Treatment can cause serious complications, such as heart attacks, blood clots in the legs or lungs, or even death. In addition, 40 men out of 1,000 will become impotent or incontinent from treatment.
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Does My Psa Level Determine Whether I Have Prostate Cancer
Your provider looks at two factors related to your PSA:
- Your PSA level: A higher level means a higher risk of prostate cancer.
- A continuous rise: PSA levels that continue to rise after two or more tests may mean you have cancer.
But the PSA level alone doesnt determine if you have cancer or not. Two men can even have the same PSA levels but different risks of prostate cancer. And a high PSA level may reflect prostate problems that arent cancer.
Psa Score: A Mans First Encounter With His Prostate
Many menâs first encounter with their prostate gland is an elevated PSA score. This is because the prostate gland is well hidden in the body and is usually not a source of any sensory experience. Most men also have no idea what its function is.
This state of blissful ignorance can change all of a sudden when their doctors inform them that their PSA levels are elevated. This is usually the moment when those affected begin to concern themselves with their prostate.
In the case of younger men, the cause of an elevated PSA level often turns out to be an acute condition such as an infection that leads to inflammation. For middle-aged men, the list of typical causes will also include age-related prostate enlargement and prostate cancer.
It is important to bear in mind that if your PSA level is elevated, it is important to determine the specific cause of the elevation, no matter what your age bracket is. And an MRI scan of the prostate represents an optimal means of determining the cause.
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Using The Psa Blood Test After Prostate Cancer Diagnosis
Although the PSA test is used mainly to check for prostate cancer, it can also help your doctor:
- Choose a treatment. Along with an exam and tumor stage, the PSA test can help determine how advanced a prostate cancer is. This may affect treatment options.
- Check treatment success. After surgery or radiation, the doctor can watch your PSA level to see if the treatment worked. PSA levels normally fall if all of the cancer cells were removed or destroyed. A rising PSA level can mean that prostate cancer cells are present and your cancer has returned.
If you choose a watchful waiting approach to treatment, your PSA level can tell your doctor if the disease is progressing. If so, youâll need to think about active treatment.
During hormone therapy, the PSA level can show how well the treatment is working and when itâs time to try another treatment.
What Is The Treatment For Bph
Specific treatment for BPH will be determined by your doctor based on:
Your age, overall health, and medical history
Extent of the disease
Your tolerance for specific medications, procedures, or therapies
Expectations for the course of the disease
Your opinion or preference
Eventually, BPH symptoms usually require some kind of treatment. When the gland is just mildly enlarged, treatment may not be needed. In fact, research has shown that, in some mild cases, some of the symptoms of BPH clear up without treatment. This determination can only be made by your doctor after careful evaluation of your individual condition. Regular checkups are important, however, to watch for developing problems.
Treatment for BPH may include:
Laser surgery. Using laser instruments to cut away obstructing prostate tissue.
Open surgery. Surgery that requires an external incision often performed when the gland is very enlarged, when there are complicating factors, or when the bladder has been damaged and needs to be repaired.
Nonsurgical treatments may include:
Balloon urethroplasty. A thin tube with a balloon is inserted into the opening of the penis and guided to the narrowed portion of the urethra. The balloon is inflated to widen the urethra and ease the flow of urine.
Transurethral microwave thermotherapy. A device called a Prostatron uses microwaves to heat and destroy excess prostate tissue to reduce urinary frequency and urgency.
Lifestyle management for BPH may include:
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What Secondary Tests Are Available To Me
Various secondary testing methods are at your disposal should you need more information before engaging in shared decision-making with your physician about further prostate cancer screening. It could also be helpful if your PSA test or rectal exam results place you in a “gray area” of risk for prostate cancer.
- PSA free-to-total-ratio, or prostate health index : can help improve the accuracy of the standard PSA test by discerning whether your risk of having prostate cancer is as low as 10% or as high as 50%.
- PSA velocity: If you’ve had previous PSA tests, your physician will look at them to determine how quickly your PSA levels have changed over time. A steep PSA level increase over a short period often correlates with a prostate cancer diagnosis, Ruckle says.
- Urine tests: One of which detects PCA3, a noncoding RNA gene that is only in your prostate. Too many copies of PCA3 in the urine indicate a greater chance of having prostate cancer.
- MRI of the prostate to image for biopsy targets.
Based on any of these results, the doctor will recommend a prostate biopsy if they suspect cancer.
Problems With The Psa Test
There are reasons doctors donât agree on whether you need this test:
- Finding prostate cancer early doesnât always protect you. The PSA test often finds small, slow-growing tumors that arenât life-threatening. Treating them anyway, whether itâs with surgery or radiation, can expose you to harmful side effects and complications. Also, finding cancer early may not help if you have an aggressive tumor or if it spread to distant body parts before you found it.
- The results arenât always accurate. If you have a high level but you donât have cancer, the test results can create a lot of worry and lead to medical procedures you donât need. A negative result if you really do have cancer can prevent you from getting treatment you do need.
Who Should Have Regular Screening Tests For High Psa
The PSA test was first developed to observe prostate changes in men who had a history of prostate cancer. Then it became more widely used in the general population as a way to detect and prevent prostate cancer before symptoms developed. But routine screening can find prostate cancers that grow slowly and do not need treatment. Talk to your healthcare provider to see if you should have regular PSA tests.
What Happens If My Psa Comes Back High
Should your PSA level return higher than expected or above the normal physiologic range based on your age, the first step will likely be to draw a follow-up PSA. If the repeat PSA is lower, the initial elevation may have been temporary and associated with something other than prostate cancer. If the repeat PSA remains high, Dr. Kasraeian may recommend further studies, including an MRI, prostate biopsy, or another advanced diagnostic test to rule out prostate cancer. While all patients are monitored closely, patients who receive an elevated PSA result can expect to have PSAs drawn more frequently for a period of time.
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How Fusion Guided Biopsy Works
First, a patient will have a prostate MRI. The MRI will image the prostate and any abnormalities in much greater detail than the ultrasound used for traditional biopsies. This allows the radiologist to better distinguish between abnormal and regular tissue.
Next, the patient will have an ultrasound-guided biopsy. A special machine attaches to the ultrasound probe and overlays the MRI image onto the ultrasound image. So when the doctor moves the ultrasound probe, the detailed MRI image moves with it in real time.
The doctor then biopsies the prostate with fine needles, using the MRI image to guide the needles directly to the areas with tumors or abnormal tissue. Because the MRI images are so detailed, doctors can more precisely target exactly where they need to biopsy. This means that far fewer clinically significant tumors are missed. This strategy also helps reduce the number of biopsies a patient might need by giving the doctor better information the first time.