Elevated PSA Levels: Is It Prostate Cancer?

Elevated PSA levels?

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 appointment in a month for another PSA test and a urinalysis.
Could this indicate prostate cancer? Are there any additional tests that should be performed?

Niming, 50~59 year old female. Ask Date: 2018/10/09

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 abnormalities, the physician will choose to monitor the index and observe its changes to determine the subsequent management approach.

Reply Date: 2018/10/09

More Info

Elevated PSA (Prostate-Specific Antigen) levels can indeed raise concerns about prostate cancer, but it's important to understand that a high PSA level does not definitively indicate cancer. PSA is a protein produced by both normal and malignant cells of the prostate gland, and its levels can be influenced by various factors, including benign conditions such as benign prostatic hyperplasia (BPH) and prostatitis (inflammation of the prostate).

In your case, with a PSA level in the sixties and urinary issues, it is crucial to follow the doctor's advice regarding further testing. The initial step of administering antibiotics suggests that your physician is considering the possibility of prostatitis, which can cause elevated PSA levels. If the PSA levels decrease after treatment with antibiotics, it may indicate that the elevated levels were due to inflammation rather than cancer.

After a month, when you return for follow-up tests, the doctor will likely check the PSA levels again and may also perform a urinalysis to assess for any signs of infection or other abnormalities. If the PSA levels remain high or continue to rise, further evaluations may be warranted. These could include:
1. Repeat PSA Testing: It's common practice to repeat the PSA test after a few weeks to confirm whether the elevated levels persist.

2. Free PSA Test: This test measures the proportion of free PSA (not bound to proteins) in the blood. A lower percentage of free PSA can be associated with a higher risk of prostate cancer.

3. Digital Rectal Exam (DRE): Although you mentioned that a DRE was performed, it may be repeated to check for any abnormalities in the prostate.

4. Transrectal Ultrasound (TRUS): This imaging test can help visualize the prostate and guide any necessary biopsies.

5. Prostate Biopsy: If the PSA levels remain elevated or if there are concerning findings from other tests, a biopsy may be recommended to obtain tissue samples from the prostate to check for cancer cells.

6. MRI of the Prostate: In some cases, an MRI may be used to get a more detailed view of the prostate and surrounding tissues.

It's essential to maintain open communication with your healthcare provider regarding your concerns and the next steps in the diagnostic process. They will consider your overall health, age, family history, and any symptoms you may be experiencing when determining the best course of action.

In summary, while elevated PSA levels can be a sign of prostate cancer, they can also be due to benign conditions. The follow-up tests and evaluations will provide more clarity regarding the situation. It's also worth noting that anxiety and stress can accompany such health concerns, so discussing these feelings with your doctor may also be beneficial. They can provide support or refer you to a mental health professional if needed.

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