Rapid Rise In Psa May Signal Prostatitis

What Is The Psa Test

The most common screening tool for prostate cancer is the prostate-specific antigen test. This is a simple blood test that measures the presence of PSA circulating in your bloodstream. This test is usually the first step in any prostate cancer diagnosis. However, the PSA screening by itself cannot tell you if cancer is present.

The PSA test is also used to track the effects of prostate cancer treatment such as surgery, radiation, hormone therapy and chemotherapy. When a man has treatment for prostate cancer, his PSA level will drop significantly. Regular screening with PSA is one of the tools the physician will use to measure if the cancer has returned.

When PSA levels rise to a certain threshold after prostate cancer treatment, this is known as biochemical recurrence. This means that some cancer cells have survived and are producing PSA. If this happens, the doctor will order additional tests and make recommendations for additional treatment.

What Does An Elevated Psa Level Mean If Ive Had Prostate Cancer In The Past

If youve ever had treatment for prostate cancer, youll have regular PSA screenings for the rest of your life. An increasing PSA level may mean the cancer has returned. Your care team may use other tests, including imaging scans and biopsies, to check for signs of cancer. If cancer returns, your team will discuss your treatment options with you.

What Are The Signs And Symptoms Of Prostate Cancer

Early stages may cause no symptoms.

Intermediate stages may cause urinary problems like:

• trouble urinating or a weak urine flow
• frequent urination

Non-cancerous problems may also cause these symptoms.

High-risk stages cause urinary problems and may include:

• Dull pain in the pelvic area
• Blood in the urine
• Pain in hips, lower back or upper thighs
• Loss of appetite and/or weight loss

WHAT ARE THE BENEFITS AND RISKS OF TESTING?

As you talk with your doctor to determine if Prostate Cancer screening is right for you, it is helpful to know the benefits and risks of the testing. It is best to use both the PSA and DRE tests for initial screening.

Possible benefits of prostate cancer testing:

• A normal PSA test may put your mind at ease.
• A PSA and DRE may find prostate cancer early before it has spread.
• Early cancer treatment can slow the spread of the disease.
• Early cancer treatment helps many men live longer.

Possible risks of prostate cancer testing:

• Sometimes PSA test results suggest something is wrong when it is not and lead to worry and an unneeded biopsy.
• A normal PSA result may miss cancer .
• A positive PSA test may detect prostate cancer, but it may be slow-growing and wont cause problems.

POSSIBLE RISKS OF A BIOPSY AND TREATMENT

DISCLAIMER

For more information about prostate cancer, including detection, symptoms, and treatment options, call the Urology Group of Princeton, at 609.924.6487, to schedule an appointment.

Recommended Reading: How Do They Do A Biopsy On Your Prostate

What Is Biopsy And How Is It Done

Once we find an abnormal area in the prostate on ultrasound, we need to remove small pieces of prostate for pathological examination called prostate biopsy.

While the ultrasound probe is in the rectum, a biopsy needle is inserted through the probe and under the ultrasound guidance, biopsies are performed. Six to twelve tine pieces of tissue are taken from the prostate. These pieces of prostate tissue are then sent to a Laboratory where a pathologist who is an expert in prostate cancer examined these pieces under the microscope to determine.

• Whether cancer is present
• Evaluate microscopic features of cancer
• Whether suspicious lesions are present
• Or the biopsy is negative for cancer
• Whether inflammation is present

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 .

Recommended Reading: What Causes Enlarged Prostate Symptoms

Prostatitis: A Common Problem In Men Under 50

“The PSA test is a good screening tool for prostate cancer, but it is not very specific,” says Erik P. Castle, MD, a urologist and researcher at the Mayo Clinic in Phoenix, Arizona. “Common causes of inflammation in the gland, called prostatitis, can cause high PSA levels.”

Prostatitis is the most common prostate problem for men younger than 50.

Prostatitis caused by bacteria can be treated with antibiotics. Another, more common type of prostatitis, called nonbacterial prostatitis, can be harder to treat and may last a long time.

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.

You May Like: Is There Any Cure For Prostate Cancer

What Are Psa Levels

Cells in the prostate gland produce PSA, and levels typically remain below 4 nanograms per milliliter .

Most individuals with prostate cancer have PSA levels above 4 ng/mL. However, some men with prostate cancer have a normal PSA level. Similarly, some men with a higher than average PSA do not have prostate cancer.

These variations mean that a PSA test alone cannot rule out or diagnose prostate cancer. However, the PSA test can identify whether a person has a higher risk of developing the disease.

Initial testing may include both a PSA test and a DRE.

During a DRE examination, a doctor inserts a finger into the rectum to check the prostate for anomalies.

If both of these tests suggest prostate cancer, then the doctor will arrange for a biopsy to confirm the diagnosis.

Recommendations For Psa Testing

According to a 2019 position statement from the European Association of Urology, a baseline PSA test in men aged 45 years at risk of prostate cancer should be used in combination with family history, ethnicity, and other factors to establish individualized screening frequency.

The American Urological Association and the American Cancer Society offer divergent recommendations on prostate-specific antigen screening. The AUA recommends baseline PSA testing, along with digital rectal examination , at age 40 for all men with a life expectancy of 10 years or more, with subsequent testing intervals determined on the basis of the PSA level and DRE results.

The ACS does not specify an age at which to pursue screening in asymptomatic men with a life expectancy of 10 years or more rather, the ACS advises clinicians to provide men with information on the risks and benefits of screening so the patient can make an informed decision. In addition, the ACS recommends that men whose initial PSA level is below 2.5 ng/mL can be screened every 2 years, but men with higher PSA values should be tested annually.

From these findings, the investigators concluded that potentially curable prostate cancer is not compromised when measuring PSA every other year in men with PSA levels of 2 ng/mL or less, as long as the DRE findings are normal.

Recommended Reading: What Are The Symptoms Of Early Stage Prostate Cancer

What Happens To Your Psa Levels After Radiation Therapy

After radiation therapy Radiation therapy doesnt kill all of the cells in the prostate gland, so its not expected to cause the PSA to drop to an undetectable level. The remaining normal prostate cells will still make some PSA. The pattern of the drop in PSA after radiation therapy is also different from after surgery.

Tests Used To Check The Prostate

This first step lets your doctor hear and understand the “story” of your prostate concerns. You’ll be asked whether you have symptoms, how long you’ve had them, and how much they affect your lifestyle. Your personal medical history also includes any risk factors, pain, fever, or trouble passing urine. You may be asked to give a urine sample for testing.

Also Check: What Age To Get Checked For Prostate Cancer

Factors Influencing Psa Levels

For clinical purposes, prostate-specific antigen is considered specific for the prostate gland but not specific for prostate cancer. A major limitation of PSA as a prostate cancer marker is the overlap in values between benign prostatic hyperplasia and prostate cancer. Normal, hyperplastic, and neoplastic epithelial cells all make PSA, but the amount of PSA produced by cancer cells is 10 times higher per gram of tissue than the amount produced by normal or hyperplastic tissue.

Fast Psa Rise Implies Bad Prostate Cancer

Prostate Cancer Death Linked to Speedy Rise in PSA Count

May 25, 2007 — Men whose PSA count goes up 2 ng/mL or more in one year are at high risk of dying of prostate cancer despite treatment.

The finding, by Dana-Farber Cancer Institute researcher Anthony V. D’Amico and colleagues, comes from a study of 948 men who underwent surgery or external-beam radiation therapy for prostate cancer.

At the time of treatment, all of the men had localized prostate cancer — that is, their doctors could not detect cancer outside their prostate glands.

Among the 660 men who chose radical prostatectomy — surgical removal of the prostate — there were 89 deaths within a median 5.4 years. Prostate cancer caused 29 of these deaths. In 44% of these prostate-cancer deaths, the only sign of high-risk disease was a PSA rise of at least 2 ng/mL in the year before treatment.

Among the 288 men who chose external-beam radiation treatment, there were 75 deaths within a median four years. Prostate cancer caused 32 of these deaths. In 28% of these prostate cancer deaths, the only sign of high-risk disease was a PSA rise of at least 2 ng/mL in the year before treatment.

Other clues that a man is at increased risk of dying from prostate cancer are tumors with a score of 7 or more on the Gleason tumor aggressiveness score clinical disease that has advanced to the T2b stage and a PSA level of greater than 10 ng/mL.

Recommended Reading: Prostate Cancer Types And Treatment

Urinary Tract Infection Or Irritation

An infection of the urinary tract, as well as irritation caused by medical procedures involving the urethra or bladder, may irritate the prostate and cause it to produce more PSA. If you have experienced any of these, be sure to let your doctor know. Youll need to give the area some time to heal and calm down before running a PSA test.

Why Are My Psa Levels So High For Prostate Cancer

Prostate cancer makes PSA levels go higher, but a high PSA test result doesnt always mean a man has prostate cancer. Sometimes PSA readings are elevated because of something benign, such as ejaculating within 24 hours of the test, or because of a problem that needs treatment, such as a urinary tract infection, but that isnt cancer.

Read Also: Bladder Recovery After Prostate Surgery

Questions You May Want To Consider Asking Your Doctor Include:

• What type of prostate problem do I have?
• Is more testing needed and what will it tell me?
• If I decide on watchful waiting, what changes in my symptoms should I look for and how often should I be tested?
• What type of treatment do you recommend for my prostate problem?
• For men like me, has this treatment worked?
• How soon would I need to start treatment and how long would it last?
• Do I need medicine and how long would I need to take it before seeing improvement in my symptoms?
• What are the side effects of the medicine?
• Are there other medicines that could interfere with this medication?
• If I need surgery, what are the benefits and risks?
• Would I have any side effects from surgery that could affect my quality of life?
• Are these side effects temporary or permanent?
• How long is recovery time after surgery?
• Will I be able to fully return to normal?
• How will this affect my sex life?
• How often should I visit the doctor to monitor my condition?

Related Resources

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.

Read Also: Treatment Plan For Prostate Cancer

Does An Elevated Psa Mean I Have Cancer

About 3 out of 4 men with a raised PSA level will not have cancer.

A high PSA can be a sign of common prostate problems which are not related to cancer, such as prostatitis, or even a urine infection. Certain sports and medications may also temporarily affect PSA levels. You should avoid sexual activity for 48 hours before a PSA test. This is because ejaculation can temporarily increase your PSA levels.

If you decide to have a PSA test, your GP will talk to you about what you should do before your test to help get an accurate result. It is important that you tell your GP about any medications you are taking, including over the counter remedies and any kind of herbal or natural health supplements.

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.

Recommended Reading: Stage 4 Prostate Cancer Spread To Bones

Is There Rise In Psa After Prostatectomy

While a rise in PSA after prostatectomy signals that the cancer is still present, it does not indicate where the cancer is located.

After radiation therapy Radiation therapy doesnt kill all of the cells in the prostate gland, so its not expected to cause the PSA to drop to an undetectable level. The remaining normal prostate cells will still make some PSA. The pattern of the drop in PSA after radiation therapy is also different from after surgery.

During And After The Test

A laboratory technician or nurse will draw your PSA after receiving an order from your physician.

When you are in the lab or exam room, the technician will cleanse your arm with an antiseptic and perform a venipuncture . After taking the sample, she will hold pressure on the site for a few moments and then cover the site with a bandage.

If you notice any bleeding or bruising, applying light pressure for several minutes is all that is usually needed. There are no restrictions following the blood draw, though it’s usually advised to keep the site clean and covered for a day or two.

Also Check: External Beam Radiation Treatment For Prostate Cancer

Can A Rapid Rise In Psa Indicate Prostatitis

Rapid Rise in PSA May Signal Prostatitis. But men with a PSA velocity of 4.0 ng/mL per year or higher were just as likely to have prostatitis as they were to have prostate cancer, said Dr. Eggener, who performed the study with William J. Catalona, MD, Professor of Urology at Northwestern University Fienberg School of Medicine.

In the group of men who had a PSA velocity below 2.0 ng/mL in the year before biopsy, 30% had prostate cancer on their first biopsy and 5% had prostatitis. In the men with a PSA velocity of 4.0 ng/mL per year or higher, 13% had cancer on their first biopsy and 13% had prostatitis.

In the year following biopsy, the mean PSA velocity among the men with prostatitis fell 1.6 ng/ML in the two years after biopsy, it dropped 0.7 ng/mL.