Elevated PSA Levels: Causes and Next Steps for Diagnosis

The PSA levels are abnormally high, but the cause has not been identified?

Hello Doctor: I am very concerned about my father, so I am inquiring on his behalf.
My father is 58 years old and a few years ago, his PSA level was found to be as high as 80.
However, after a prostate biopsy, no cancer cells were detected.
Despite this, his PSA level continued to rise, and he underwent a second biopsy, which also did not reveal any cancer cells.
Recently, his PSA skyrocketed to over 200.
Blood tests and ultrasound examinations were conducted; the blood tests showed no signs of inflammation, and the ultrasound did not reveal any tumors, but it did show unilateral prostate enlargement.
A digital rectal exam also showed no abnormalities.
The doctor prescribed anti-inflammatory medication to see if it could lower the PSA level, but it continues to rise.
The doctor has not been able to determine the cause and has suggested another biopsy.
I understand that biopsies may not always detect cancer cells, but a PSA level over 200 is significantly elevated.
Is it possible that an ultrasound could still miss a malignant tumor? I would like to ask the doctor if there could be other reasons for the PSA level being over 200, and if there are any other recommended diagnostic or treatment options.
I hope to identify the cause as soon as possible for early treatment.
Thank you very much for your help, and I hope to receive some advice.

Tom, 20~29 year old female. Ask Date: 2018/09/10

Dr. Fu Shizhang reply Urology

To confirm a diagnosis of prostate cancer, biopsy is currently the only definitive method.
However, there is a possibility that the biopsy may miss the tumor.
In terms of imaging, MRI provides the clearest results.
If cancer has not been diagnosed and the ultrasound imaging appears normal, health insurance will not cover the costs, so it is recommended to consider paying for the examination out of pocket.

Reply Date: 2018/09/10

More Info

Elevated PSA (Prostate-Specific Antigen) levels can be a source of significant concern, particularly when they reach alarming figures such as 200. Your father's case, where multiple biopsies have not revealed cancer despite high PSA levels, is not uncommon. There are several factors to consider when interpreting elevated PSA levels and determining the next steps for diagnosis and management.

Firstly, it's essential to understand that PSA is a protein produced by both normal and malignant cells of the prostate gland. Elevated PSA levels can be attributed to various conditions, including benign prostatic hyperplasia (BPH), prostatitis (inflammation of the prostate), and prostate cancer. In your father's case, the absence of cancer cells in biopsies suggests that the high PSA levels may not be due to malignancy but could be related to other prostate conditions.

Given that your father has had a history of elevated PSA levels, it is crucial to consider the following:
1. Benign Prostatic Hyperplasia (BPH): This is a common condition in older men and can lead to increased PSA levels. The enlargement of the prostate can cause elevated PSA levels without the presence of cancer.

2. Prostatitis: Inflammation of the prostate can also lead to elevated PSA levels. Even if recent blood tests did not show signs of inflammation, chronic prostatitis can sometimes cause persistent elevations in PSA.

3. Prostate Cancer: While your father's biopsies have not shown cancer, it is important to note that biopsies can miss cancerous cells, especially if the cancer is localized or if the sampling does not capture the affected area.
4. Other Factors: Activities such as recent ejaculation, vigorous exercise, or even certain medical procedures can temporarily elevate PSA levels. It is generally recommended to avoid ejaculation for 2-3 days before a PSA test to minimize these effects.

Given the complexity of interpreting high PSA levels, further diagnostic steps may be warranted. Here are some recommendations:
- Repeat Biopsy: If there is still a high suspicion of cancer despite previous negative biopsies, a repeat biopsy may be necessary. Advanced techniques such as MRI-guided biopsies can improve the chances of detecting cancer if it is present.

- Multi-Parametric MRI: This imaging technique can provide detailed information about the prostate and help identify areas of concern that may warrant biopsy. It can be particularly useful in cases where previous biopsies have been inconclusive.

- Genomic Testing: There are tests available that analyze the genetic makeup of prostate tissue to assess the likelihood of cancer being present. These tests can help guide treatment decisions.

- Monitoring: If the PSA levels continue to rise without any definitive diagnosis, a strategy of active surveillance may be appropriate. This involves regular monitoring of PSA levels and prostate health without immediate invasive procedures.

- Consultation with a Specialist: Given the complexity of your father's case, it may be beneficial to seek a second opinion from a urologist or an oncologist who specializes in prostate health. They can provide insights into the latest diagnostic and treatment options.

In conclusion, while elevated PSA levels can be alarming, they do not always indicate cancer. A comprehensive evaluation considering all potential causes is essential. Continued monitoring and appropriate diagnostic testing will be crucial in determining the underlying cause of your father's elevated PSA levels and guiding further management. It is important to maintain open communication with healthcare providers and to discuss any concerns or questions regarding the diagnostic process and treatment options.

Similar Q&A

Understanding Elevated PSA Levels: Is It Prostate Cancer?

Recently, I visited a urologist due to urinary issues. In addition to a digital rectal exam, my PSA level was measured and found to be in the sixties. The doctor prescribed antibiotics, and after taking them, my urinary flow improved. The doctor recommended a follow-up appointmen...

Dr. Fu Shizhang reply Urology
There are many reasons for elevated PSA levels, with cancer, inflammation, and benign prostatic hyperplasia being common causes. A definitive diagnosis requires a prostate biopsy. Generally, if PSA levels are high but digital rectal examination and ultrasound imaging show no abno...

Understanding Elevated PSA Levels: Causes, Concerns, and Next Steps

Hello, Doctor: Q1. In April of this year, I had a health check-up, and my PSA level was 7.96. In May, I went to the hospital for further testing, and my PSA level was 7.92. Initially, the doctor only performed a blood test, but later I researched online and found that (1) acute ...

Dr. Xu Weikai reply Urology
Hello, 1. Elevated PSA levels can have many causes. However, your levels are quite high, and further examination is necessary, such as a prostate ultrasound and prostate biopsy. 2. Turbidity, leukocytes, nitrite, WBC, and RBC levels are all normal, which indicates no evidence...

Understanding Elevated PSA Levels: Causes and Concerns

My prostate-specific antigen (PSA) levels have been steadily increasing over the years, and last week it reached 30. I have undergone four biopsies at Asia University Hospital, all of which were normal. However, the continuous rise in this index is concerning. The doctor mentione...

Dr. Li Minghui reply Urology
Hello: A rise to 30 can be primarily attributed to inflammation or cancer. If you are open to it, I recommend seeking a second opinion at a medical center, as some physicians are more specialized in this area. Wishing you good health.

Understanding Elevated PSA Levels: Infection vs. Prostate Cancer Risks

Hello Dr. Hsu: The serum prostate-specific antigen (PSA) level is 10.1, which usually indicates a high possibility of prostate cancer. Could an infection also cause the above level to be elevated?

Dr. Xu Wencang reply Urology
Hello: In response to your question, yes, an infection can also cause elevated levels. It is recommended that you continue to monitor the situation, and if the levels remain high, a prostate biopsy may be necessary.