Elevated PSA
Prostate Specific Antigen (PSA) is a protein found in your blood thru a simple blood test. It is a screening test to look for prostate cancer. If you have prostate cancer, it is also used to follow the progression of treatment of the cancer or how well your body is responding to treatment. There are 3 main reasons the PSA can be elevated- a large or growing prostate (BPH), inflammation or infection, or prostate cancer. As urologists, we are most worried about prostate cancer. Just because your PSA is high, it doesn’t mean you have cancer… but it does mean you should see your urologist and have a discussion on what to do next.
The results of the blood test are recorded as nanograms of PSA per milliliter (ng/ml) of blood. There is no specific normal or abnormal level, however in someone without prostate cancer a level below 2.5ng/ml is considered normal. Anything over 4.0ng/ml is abnormal and should be discussed with your Urologist.
We use the PSA number as a guide, but we look at other things such as medical conditions, infections, medications, age, and PSA velocity to determine what further workup is needed. PSA velocity is the change from year to year. Any change by more than 0.75ng/ml over 1 year is considered abnormal. There are also considerations of age-related PSA nomograms as well as Free and Total PSA tests to give more statistical information that may determine next steps.
It is important that every man get yearly PSA screenings at age 50. If you are African American or have a male relative that has had prostate cancer, you have a 2x risk of prostate cancer than the general population. For these individuals we usually recommend getting a baseline PSA at 35 and then yearly at age 40. About 1 in 8 men get prostate cancer in the United States, but only about 1 in 40 men die because of prostate cancer. It is the number 2 cancer leading to death in men (behind lung cancer), but it also one of the more treatable cancers if it is caught early.
There are a lot of nuances with PSA as well as a lot of misinformation out there about PSA, so it is important to follow thru with your yearly PSA test and discuss these findings with your Urologist.
For more information please visit: https://www.urologyhealth.org/urology-a-z/all-conditions
