Significance Of A Rising Psa
Many doctors use PSA levels to determine the diagnosis and treatment of prostate problems. Unfortunately, some urologists subscribe to the theory that almost any rise in a mans PSA value should be followed up with a prostate biopsy.
Men are also led to believe that PSA levels are all-important for diagnosing prostate cancer both by their peers and by the media. However, many situations can significantly rise in PSA that does not indicate cancer or require significant treatment.
Other conditions that can cause increased PSA levels include an enlarged prostate or an inflamed or infected prostate . In addition, PSA values can be temporarily increased by external stress on the prostate, such as bicycle or motorcycle riding as well as sexual activity, especially intense sexual or physical activity.
For older men, the general upper limit that is considered normal is 4.0 ng/mL. However, normal prostates emit a higher level of PSA as a man ages. The PSA level also tends to increase with the size of the prostate, especially with BPH. A CAT scan or an MRI can determine the size of a mans prostate, but such tests may not always be warranted.
Some doctors use rising PSA as a major factor in determining if a man needs a biopsy or further treatment, especially when the PSA rise is showing a steep slope.
The Relationship Between Constipation And The Prostate Is Kind Of Like The Old Chicken And Egg Conundrum
The egg: Constipation, aka the build-up of feces in the intestine , can put pressure on the bladder and the prostate, which can cause symptoms resembling those associated with an enlarged prostate. The chicken: an enlarged prostate can put pressure on the rectum and cause constipation. But wait, theres more
How Does Bph Occur
The prostate goes through two main periods of growth. In early puberty, the prostate doubles in size. Then, around age 25, the prostate begins to grow again and continues to grow throughout most of a mans life.
The continuing enlargement of the prostate does not usually cause problems until later in life. However, the second period of growth may, many years later, result in BPH. According to the National Institute of Diabetes and Digestive and Kidney Diseases:
BPH rarely causes symptoms before age 40.
More than half of men in their 60s have some symptoms of BPH.
As many as 90 percent of men in their 70s and 80s have some symptoms of BPH.
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When To See A Doctor
Some of the first symptoms of patients who have an elevated PSA level is difficult or painful urination, pain in the abdomen or pelvic area, and a frequent urge to urinate. These symptoms can be signs of BPH, prostatitis, prostate cancer, and kidney stonesall of which require different treatment. If you are experiencing any of these symptoms, it is important to talk with your doctor. Your doctor will be able to help determine the cause of your problems and provide an individualized treatment plan.
If I Have Elevated Psa Levels What Should I Ask My Healthcare Provider
If you have any symptoms of prostate cancer, or if it runs in your family, ask your provider:
- Should I have regular tests to check my PSA level?
- What can I do to lower my risk for prostate cancer?
- What other tests or monitoring do I need?
- What are my treatment options if I get prostate cancer?
- What other signs or symptoms should I look out for?
A note from Cleveland Clinic
An elevated PSA level can be a sign of prostate cancer, but it doesnt always mean you have cancer. Your healthcare provider will watch you and do more tests to arrive at a diagnosis. Prostate cancer is often slow-growing and may never become life-threatening. If you have symptoms of prostate problems, such as difficulty urinating, don’t hesitate to let your provider know.
Last reviewed by a Cleveland Clinic medical professional on 04/06/2021.
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Causes Of High Psa Levels Without Prostate Cancer
PSA or prostatic specific antigen is a special protein that is secreted by prostate cells. The PSA test determines the serum levels of this protein in the blood. It has been observed that high PSA levels are usually suggestive of prostate disease but high levels of PSA doesnt always mean that the person is suffering from prostate cancer. High PSA levels that are caused by benign conditions returns to normal levels if inciting source is removed.
Medical Procedures Can Cause Psa To Rise
“Anything that traumatically interferes with the architecture around the prostate gland can make PSA go up,” says Dr. Milner. “One of the most common causes of significantly high PSA from this type of trauma is the placing of a catheter into the bladder.”
Another cause is a prostate or bladder exam that involves passing a scope or taking a biopsy.
“Since it takes about two to three days for PSA to go down by half, you should wait two to three weeks after this type of trauma to do a PSA test,” Milner says.
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What Is A Psa Test
The PSA, which stands for prostate-specific antigen, is a specific enzyme produced by prostate cells in men. A PSA blood test measures the level of prostate-specific antigen in the patients blood at that given moment and is a valuable screening tool for the early detection of prostate cancer. Because the PSA can go up and down in response to a number of factors and conditions, it is important to monitor your level with regular PSA tests over time.
A Dozen Things That Can Raise Your Psa That Arent Cancer
Elevated PSA levels dont always spell cancer!
This month was Prostate Cancer Awareness Month. So you went to your doctor for an exam and a Prostate Specific Antigen blood test. If your came Prostate Specific Antigen back 1.0 ng/ml or less, congratulations on a perfectly healthy prostate! However, if you are one of the many men whos Prostate Specific Antigen level is slightly to moderately elevated , not to worry, it doesnt necessarily mean cancer!
There are many things that can contribute to an elevated Prostate Specific Antigen level beside having cancer. Think of PSA as a barometer of overall prostate health. If levels start to rise then its time to take action as something is going awry.
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What Is The Test To See If I Have Elevated Psa
Healthcare providers use a blood test to measure PSA levels.
You may have a digital rectal exam together with a PSA test to check for signs of prostate cancer. During a DRE, your provider inserts a gloved finger into the rectum to check for bumps or other irregularities.
Depending on the results of your initial test, your provider may want you to repeat the test. PSA levels can change. A second test gives your provider more details about your prostate health.
What Factors Can Falsely Elevate Your Psa Level
There are other factors that can affect the PSA level besides prostate cancer. The following conditions can lead to increased PSA levels:
Benign prostate hyperplasia , a condition that commonly develops as those assigned male at birth age and causes the prostate to grow in size
Inflammation or infection of the prostate, like prostatitis or a urinary tract infection
Hormone medications, like testosterone
Ejaculation, which can raise the PSA level for a short period of time
Riding a bike, or anything that puts pressure on the area near the prostate
Trauma to an area near the prostate, for example from having a catheter placed
Inaccurate test results
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Diagnostic Examination For Elevated Psa Despite A Lack Of Symptoms
Most men find it difficult to understand why they need to have a prostate examination if theyre experiencing no symptoms. Indeed, more than 90% of our patients indicate that they feel quite healthy. While age-related prostate enlargement is more likely to cause symptoms than prostate cancer, it is prostate cancer that men fear most when their PSA level is elevated.
We are able to determine the cause of an elevated PSA level by carrying out an MRI scan of the prostate.
What Can Cause A High Psa Other Than Prostate Cancer
While prostate cancer is certainly a consideration when a patients PSA comes back high, it is not the only possible explanation. Besides prostate cancer, potential causes for an elevated PSA include:
- Infection: Prostatitis, urinary tract infection , and other infections involving the genitourinary tract can cause PSA elevations.
- Rectal exam: Because a digital rectal exam can cause a temporary PSA elevation, it is usually performed after the PSA has been drawn.
- Recent ejaculation: In some cases, ejaculating within 24 hours of a PSA test can cause the PSA to be elevated.
- BPH: Benign prostatic hyperplasia refers to an enlargement of the prostate gland. This condition is not cancerous or precancerous, though it can cause a number of signs and symptoms, including obstructed voiding and an elevated PSA.
- Trauma or surgery: Injury or manipulation of structures near the prostate and rectum, including surgical procedures, can cause the PSA to become elevated.
- Labile PSA: In some men, the PSA naturally rises and falls without an obvious inciting factor.
- Age: Most mens PSA levels rise gradually over time.
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Causes Of An Elevated Psa Level
Prostate cancer typically leads to an elevated PSA level. Given that early-stage prostate cancer is generally limited to asymptomatic malignant changes at the cellular level, men have no way of knowing that something is wrong. This is why prostate cancer screening in the form of PSA testing is the best method of early detection. Please refer to the PSA Table for help in interpreting your PSA scores.
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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.
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How Is Prostate Cancer Treated
Treatment options for prostate cancer include:
- Surgery to remove the prostate .
- High intensity focused ultrasound .
- Cryotherapy .
- Hormone treatment, also called androgen suppression therapy.
You may continue to have PSA level tests during and after prostate cancer treatment. These tests check that the treatment is working.
Can Kidney Stones Affect Your Psa Count
Typically, no. While kidney infections or UTIs can cause an elevated PSA count, kidney stones generally do not. Kidney stones are formed in the kidneys and pass through the bladder and urethra. PSA is produced in the prostate. If you had a kidney stone that got caught in your urethra at the prostate, and caused further inflammation of the prostate, it could result in a spike in your PSA level.
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Mri/ultrasound Fusion Guided Biopsy: Working Together For Your Health
At UVA Health, we are proud to offer a new prostate cancer detection option: MRI/ultrasound fusion guided biopsy. Through a unique partnership between the UVA Radiology and Urology departments, we are able to use MRI imaging to help guide a biopsy in real time. This makes the biopsy much more accurate. It also reduces the risk of false negative or false positive results, and decreases the odds that you may have to repeat a biopsy.
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.
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What Is It Used For
A PSA test is used to screen for prostate cancer. Screening is a test that looks for a disease, such as cancer, in its early stages, when itâs most treatable. Leading health organizations, such as the American Cancer Society and the Centers for Disease Control and Prevention , disagree on recommendations for using the PSA test for cancer screening. Reasons for disagreement include:
- Most types of prostate cancer grow very slowly. It can take decades before any symptoms show up.
- Treatment of slow-growing prostate cancer is often unnecessary. Many men with the disease live long, healthy lives without ever knowing they had cancer.
- Treatment can cause major side effects, including erectile dysfunction and urinary incontinence.
- Fast-growing prostate cancer is less common, but more serious and often life-threatening. Age, family history, and other factors can put you at higher risk. But the PSA test alone canât tell the difference between slow- and fast-growing prostate cancer.
To find out if PSA testing is right for you, talk to your health care provider.
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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.
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When Is Bph Treatment Necessary
The course of BPH in any individual is not predictable. Symptoms, as well as objective measurements of urethral obstruction, can remain stable for many years and may even improve over time for as many as one-third of men, according to some studies. In a study from the Mayo Clinic, urinary symptoms did not worsen over a 3.5-year period in 73% of men with mild BPH. A progressive decrease in the size and force of the urinary stream and the feeling of incomplete bladder emptying are the symptoms most correlated with the eventual need for treatment. Although nocturia is one of the most annoying BPH symptoms, it does not predict the need for future intervention.
If worsening urethral obstruction is left untreated, possible complications are a thickened, irritable bladder with reduced capacity for urine infected residual urine or bladder stones and a backup of pressure that damages the kidneys.
- Inadequate bladder emptying resulting in damage to the kidneys
- Complete inability to urinate after acute urinary retention
- Incontinence due to overfilling or increased sensitivity of the bladder
- Bladder stones
- Symptoms that trouble the patient enough to diminish his quality of life
Find a Location
Currently, the main options to address BPH are:
- Watchful waiting
What Factors Can Affect Your Psa Levels
Since prostate-specific antigen is an enzyme made by healthy prostate cells, it is normal to find some in every mans bloodstream. However, PSA levels vary from person to person, as there are several factors that can increase them.
Thus, a high PSA level does not necessarily indicate the presence of prostate cancer. There are other things to consider, such as your physical characteristics, lifestyle, health, or recent medical procedures.
Your age is an important factor. PSA levels over 2.5 ng/mL would be cause for concern for men under 50. For men over 60 years of age, however, PSA levels under 4.5 ng/mL are considered normal. The amount of naturally occurring PSA in your blood gets higher as you age. Furthermore, people of certain ethnic groups may have naturally higher PSA levels.
Way of life
Certain activities are not recommended before taking a PSA test. If you exercise vigorously less than 48 hours before your PSA test, you could experience elevated PSA levels. This is especially common in people who ride bicycles for extended periods of time.
Anal sex or prostate stimulation within a week of a PSA test could lead to a high PSA number. Moreover, although not proven, ejaculation in the 48 hours before a PSA test could lead to a false positive test.
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