Should You Panic About Prostate Cancer If You Learn That Your Psa Is Shockingly High
Is it at all possible for a man who does not have prostate cancer to have a VERY high PSA?
Absolutely. Many benign conditions can cause a very elevated PSA, including recent surgeries, trauma or catheterization due to urinary retention, says Michael Herman, MD, director of urologic oncology at South Nassau Communities Hospital in Oceanside, NY.
The most common benign cause of a very high PSA is a urinary tract infection or prostatitis.
Also, some people simply have an elevated PSA without prostate cancer. Just because someone has a high PSA does not mean they have prostate cancer, but it does need to be evaluated very carefully.
PSA stands for prostate specific antigen. High levels are correlated to the likelihood of prostate cancer, but its not 100 percent reliable.
This is why a man can have a PSA in the normal range and still be diagnosed with the disease.
What Is Prostate Intraepithelial Neoplasia Or Atypical Or Suspicious Cells On Biopsy
In about 10% of prostate needle biopsy reports, the pathologist will tell us that the final diagnosis is neither benign nor malignant. They describe this condition as
- High Grade Intraepithelial Neoplasia
- A premalignant condition
- Biopsy should be repeated soon
- 25% risk of cancer on repeat biopsy
- Low Grade Intraepithelial Neoplasia
- Repeat biopsy is not indicated unless there is a rise in PSA
- Atypia
Positive Psa Score Association With Other Conditions
The amount of PSA in your blood test may increase with other prostate conditions such prostatitis, enlarged prostate , or within two days after ejaculation.
Rest assured, even though your results may be high, it doesnt necessarily mean you have prostate cancer. Just a greater risk of developing it.
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How High Is Too High Psa
An elevated PSA test level may indicate prostate cancer or an enlargement or infection of the prostate. Because other conditions can cause a high PSA test level, a prostate biopsy is also needed to confirm if cancer is present. General guidelines show levels above 4 ng/mL require a biopsy to check for cancer.
How Are Researchers Trying To Improve The Psa Test
Scientists are investigating ways to improve the PSA test to give doctors the ability to better distinguish cancerous from benign conditions and slow-growing cancers from fast-growing, potentially lethal cancers. None has been proven to decrease the risk of death from prostate cancer. Some of the methods being studied include:
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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.
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What Does A High Psa Level Mean
High PSA levels could be a sign of prostate cancer or a different condition like prostatitis or an enlarged prostate.
Other things can affect your PSA level:
- Age. Your PSA will normally go up slowly as you get older, even if you have no prostate problems.
- Medications. Some drugs may affect blood PSA levels. Tell your doctor if youâre taking dutasteride or finasteride . These drugs may falsely lower PSA levels by half of what they should be.
If your PSA level is high, your doctor may suggest that you get a prostate biopsy to test for cancer.
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Risk Prostate Cancer And Being 70 To 80 Years Of Age
So a relatively new article in Reviews in Urology caught your Sitemasters eye this morning and worried him because it seemed to be communicating a conclusion of questionable accuracy, which we will explore below. And if we have misinterpreted the data provide in the paper, we are more than willing to be corrected.
The new paper by Shah and Ioffe is based on a retrospective analysis of data from 5,100 patients of between 70 and 80 years, all of whom received radiation therapy of some type for the treatment of prostate cancer over a 10-year period from 2005 to 2015. The authors state that:
Multiple studies in peer-reviewed journals document that men 70 years and older have more prevalence of prostate cancer, more high-grade disease, more metastases, and more prostate cancer-specific deaths compared with men under 70 years.
That they have a higher prevalence of prostate cancer and more prostate cancer-specific deaths than men of < 70 years is probably undisputed, for the simple reason that they are older, incidence of prostate cancer is well understood to be age-related, and many such patients may well have at least micrometastatic disease by the time they are initially diagnosed . Whether they really have more high-grade disease at time of diagnosis, however, is not quite as clear.
So the first thing that worries us about this study is that it appears to include exclusively men who received treatment for prostate cancer. The authors state this very clearly:
What Is A Psa Test
PSA is a protein that is made by all prostate cells, whether they are normal or cancerous. A PSA test measures the level of PSA in a mans blood and generally reflects the volume of prostate tissue in the body.
Since prostate cancer can increase the level of PSA in the blood as it is progressing, a high PSA is associated with higher risk of having the disease. Therefore, many doctors have used the test to help determine whether a man is harboring the disease. Since the test was developed, several professional organizations have recommended that men over age 50 undergo PSA testing, often in addition to a digital rectal exam, to aid in early detection of the disease.
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Sites Of Highest Concentrations
PSA is found primarily in prostate epithelial cells and in the seminal fluid. The exact mechanism by which PSA gains access to the serum is unknown, but a possible mechanism has been suggested.
The lumen of the prostate gland contains the highest concentration of PSA in the body. A number of barriers exist between the glandular lumen and the capillaries, including the basement membrane of the glands, the prostatic stroma, and the capillary endothelial cell. Diseases such as infection, inflammation, and cancer may produce a breakdown in these barriers, allowing more PSA to enter the circulation.
PSA levels can rise dramatically with a prostate infection, but they return to the reference range after the infection has healed. A vigorous prostate massage also can produce a brief elevation of the PSA level.
Low concentrations of PSA have been identified in urethral glands, endometrium, normal breast tissue, breast milk, salivary gland tissue, and the urine of males and females. PSA also is found in the serum of women with breast, lung, or uterine cancer and in some patients with renal cancer.
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.
References
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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.
- Chemotherapy.
You may continue to have PSA level tests during and after prostate cancer treatment. These tests check that the treatment is working.
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 The Psa Test
Prostate-specific antigen, or PSA, is a protein produced by normal, as well as malignant, cells of the prostate gland. The PSA test measures the level of PSA in a mans blood. For this test, a blood sample is sent to a laboratory for analysis. The results are usually reported as nanograms of PSA per milliliter of blood.
The blood level of PSA is often elevated in men with prostate cancer, and the PSA test was originally approved by the US Food and Drug Administration in 1986 to monitor the progression of prostate cancer in men who had already been diagnosed with the disease. In 1994, FDA approved the use of the PSA test in conjunction with a digital rectal exam to test asymptomatic men for prostate cancer. Men who report prostate symptoms often undergo PSA testing to help doctors determine the nature of the problem.
In addition to prostate cancer, a number of benign conditions can cause a mans PSA level to rise. The most frequent benign prostate conditions that cause an elevation in PSA level are prostatitis and benign prostatic hyperplasia . There is no evidence that prostatitis or BPH leads to prostate cancer, but it is possible for a man to have one or both of these conditions and to develop prostate cancer as well.
Repeating The Psa Test
A mans blood PSA level can vary over time , so some doctors recommend repeating the test after a month or so if the initial PSA result is abnormal. This is most likely to be a reasonable option if the PSA level is on the lower end of the borderline range . For higher PSA levels, doctors are more likely to recommend getting other tests, or going straight to a prostate biopsy.
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What Is Screening For Prostate Cancer
Some men get a PSA test to screen for prostate cancer. Talk to your doctor, learn what is involved, and decide if a PSA test is right for you.
Cancer screeningexternal icon means looking for cancer before it causes symptoms. The goal of screening for prostate cancer is to find cancers that may be at high risk for spreading if not treated, and to find them early before they spread.
If you are thinking about being screened, learn about the possible benefits and harms of screening, diagnosis, and treatment, and talk to your doctor about your personal risk factors.
There is no standard test to screen for prostate cancer. Two tests that are commonly used to screen for prostate cancer are described below.
When You Should Screen For Psa Levels
Colloquially, prostate cancer screening is thought to be routinely undertaken by men over the age of 40. The American Urological Association recommends the following:
- Men under 40: No screening – there is no evidence to suggest a benefit of screening under 40
- Men aged between 40 to 54: No screening if youre at average risk. If youre at a high risk , the decision should be made by yourself and your doctor.
- Men aged between 55 to 69: Screening with doctor approval. This is the age group is identified as having the greatest benefit of screening
- Men aged over 70 or less than a 10-15 year life expectancy: Routine screening not recommended unless you are in excellent health where they may be benefit
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When Should I Get A Psa Test
The guidelines below are adapted from the NCCN Clinical Practice Guidelines In Oncology for Prostate Cancer Early Detection. Please use these guidelines to have a discussion with your physician about your personal risk and make a plan for screening.
- If you are between ages 45 and 75:
- Discuss the risks and benefits of prostate cancer screening with your doctor, have a baseline PSA, and consider a baseline DRE
- If your PSA is below 1 ng/mL and your DRE is normal, repeat testing every 2-4 years
- If your PSA is between 1 and 3 ng/mL and your DRE is normal, repeat testing every 1-2 years
- If your PSA is greater than 3 ng/ML or your DRE is very suspicious, your doctor may suggest additional testing or a biopsy
Prostate Cancer Surgery Wont Boost Survival In Men With Early
Men with early-stage prostate cancer often face a difficult choice as to treatment: Do they opt for radiation, surgery or watchful waiting to see if the cancer gets worse.
A new study in the New England Journal of Medicine finds men who opt to surgically remove their prostate gland a procedure called a radical prostatectomy are no less likely to die than men who choose wait and monitor their symptoms to see if the cancer progresses.
The study adds to the ongoing debate surrounding prostate-specific antigen testing and whether the tests pick up cancers that may be too slow-growing to ever cause a problem.
In May, the U.S. Preventive Services Task Force, a panel of advisors on government medical guidelines, reviewed existing research and reported in its final recommendation that healthy men of all ages should not take a PSA test because the potential harms from a positive test outweigh the benefits from catching the cancer early.
The study tracked 731 men with early-stage prostate cancer found through PSA testing, average age of 67, who agreed to be randomized to either receive radical prostatectomy or just observation from a doctor between November 1994 through January 2002. The men were followed-up with by January 2010 to see how they fared.
The National Cancer Institute has more for men on choosing a treatment for early-stage prostate cancer.
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How Is Hormone Therapy Used To Treat Hormone
Hormone therapy may be used in several ways to treat hormone-sensitive prostate cancer, including:
Early-stage prostate cancer with an intermediate or high risk of recurrence. Men with early-stage prostate cancer that has an intermediate or high risk of recurrence often receive hormone therapy before, during, and/or after radiation therapy, or after prostatectomy . Factors that are used to determine the risk of prostate cancer recurrence include the grade of the tumor , the extent to which the tumor has spread into surrounding tissue, and whether tumor cells are found in nearby lymph nodes during surgery.
The use of hormone therapy before prostatectomy has not been shown to be of benefit and is not a standard treatment. More intensive androgen blockade prior to prostatectomy is being studied in clinical trials.
Relapsed/recurrent prostate cancer. Hormone therapy used alone is the standard treatment for men who have a prostate cancer recurrence as documented by CT, MRI, or bone scan after treatment with radiation therapy or prostatectomy.
Hormone therapy is sometimes recommended for men who have a “biochemical” recurrencea rise in prostate-specific antigen level following primary local treatment with surgery or radiationespecially if the PSA level doubles in fewer than 3 months.
When Is A Psa Test Needed
If you are age 50 to 74, you should discuss the PSA test with your doctor. Ask about the possible risks and benefits.
Men under 50 or over 75 rarely need a PSA test, unless they have a high risk for prostate cancer.
- You are more likely to get prostate cancer if you have a family history of prostate cancer, especially in a close relative such as a parent or sibling.
- Your risks are higher if your relative got prostate cancer before age 60 or died from it before age 75. These early cancers are more likely to grow faster.
- If you have these risks, you may want to ask your doctor about getting the PSA test before age 50.
This report is for you to use when talking with your healthcare provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.
04/2014
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