Elevated PSA: What Next?

The phone rings, and caller identification indicates it is your primary physician’s office. Your husband was expecting the results of his routine yearly bloodwork, so this isn’t a surprise. “I am just calling to tell you that Mr. Smith’s bloodwork all looks good, but his PSA test was elevated above the normal range. I am going to refer you to a Urologist to discuss this.” The call ends. You both are left wondering: PSA? What is that? What does this mean??

What is Elevated PSA?

The goal of this article is to introduce you to the prostate cancer screening blood test called PSA (Prostate Specific Antigen), and what to expect if this test is elevated. Prostate cancer affects 1 in every 8 men in their lifetime, and it is the second leading cause of cancer death in men.

When caught early, prostate cancer is treatable and even curable. A quick and easy screening blood test, the PSA, is available to help your physicians identify if you or a loved one is at risk of harboring prostate cancer now or developing it in the future.

PSA is a protein that circulates in the blood and is produced only by the prostate and only in men. There is no “normal” value for the PSA. What is considered normal depends on your age, medical history, physical exam, family history, and lifestyle.

The American Urological Association has published age-appropriate PSA levels intended to act as a guide for the average American man. If you’re under the age of 50, your PSA should be less than 2. Between age 50-60, a PSA of 3.0 is considered the upper limit of normal. The PSA can rise to as much as 4.0 and be considered normal for a man age 60-69. Above the age of 70, even higher levels of PSA are acceptable.

What Causes Elevated PSA?

Many things can cause a PSA test to be elevated, not just cancer. That is why, upon identification of a newly elevated PSA, the value should always be confirmed with a second test. Common non-cancerous entities that raise the PSA are:

• Urinary Tract Infections
• Prostate Enlargement (BPH)
• Prostate Inflammation (prostatitis)
• Sexual Activity
• Urinary Catheterization
• Straddle Activities (cycling, horseback riding, etc..)
• Trauma

Upon confirmation of an elevated PSA, your doctor will likely refer you to a Urologist. Remember, the PSA is only a screening test, it does not diagnose you with prostate cancer. Your Urologist should be equipped to inform you whether additional studies are needed to determine if you are at high risk of harboring prostate cancer.

Next Steps

Today, the next step for determining if you have prostate cancer after an elevated PSA is to obtain a prostate MRI. MRI exams allow your Urologist to:

1. Put your PSA level into context with the size and shape of your prostate
2. Diagnose potentially cancerous lesions residing in the prostate
3. Diagnose non-cancerous reasons for PSA elevation if no suspicious lesions exist.

If a suspicious lesion is identified on MRI, your Urologist can use the MRI to “target” the location of the cancer during subsequent biopsy procedures.

Importantly, not all MRI machines are created equal. You will need to make sure with your Urologist that they have access to the latest high-quality MRI technology and experienced radiologists that make interpretation of prostate MRI valuable.

In some cases, the MRI is sufficient to reassure you that your risk of prostate cancer is low, and your doctor may recommend observation in that event.

However, if your MRI indicates a high likelihood that cancer exists, then your Urologist may recommend a prostate biopsy. Prostate biopsy is a medical procedure that acquires samples of prostate tissue to be examined by a Pathologist.

Be sure to ask your Urologist if they offer “MRI Fusion Prostate Biopsy” and “Trans-perineal Prostate Biopsy”, both of which enhance the safety and accuracy of prostate biopsy procedures.

Prostate cancer screening is not right for everyone, and the decision to have your PSA level checked should only be undertaken after an informed discussion with your doctor. If your PSA is elevated, don’t hesitate to refer to this guide or to reach out to any of us at Stephenson Cancer Center for more information.

If you have an elevated PSA, talk to your doctor about the next steps or read more about our men's health services and schedule an appointment today.