Rapid PSA Level Increase: Causes and Next Steps

Q: Rapid PSA Level Increase: Causes and Next Steps

Hello： Your urine test shows 40-50 white blood cells per high power field, which may indicate a significant chance of inflammation. <br>However, a re-evaluation by the urology department at the hospital is necessary. <br>Please pay attention to your lifestyle： stay hydrated, limi

PSA levels have significantly increased over the past five years?

Hello, I am 47 years old.
I previously had my PSA levels tested in 2015 and 2016, with results of 1.33 and 1.01, respectively.
I did not have any further tests for several years until last month, when my PSA level was unexpectedly high at 24.9.
Additionally, I have some abnormal urine test results: 1.
Positive for occult blood, 2.
Red blood cells 3-5, 3.
White blood cells 40-50.
The laboratory personnel mentioned that this could indicate prostatitis or prostate cancer, and I need to consult a urologist for diagnosis.
I would like to ask the doctor, if it is a more aggressive form of prostate cancer, is it possible for the PSA level to rise from just over 1 to 24.9 within five years? Or could other conditions like prostatitis or benign prostatic hyperplasia also cause the PSA level to spike to 24.9 in that time frame? I am currently planning to have a more accurate PHI test one month after my last blood draw.
What is your opinion on this? Thank you for your response!

Niming, 40~49 year old female. Ask Date: 2021/09/06

Dr. Du Shixi reply Urology

Hello: Your urine test shows 40-50 white blood cells per high power field, which may indicate a significant chance of inflammation.
However, a re-evaluation by the urology department at the hospital is necessary.
Please pay attention to your lifestyle: stay hydrated, limit spicy foods, engage in moderate exercise daily, and practice safe sex.
If inflammation is present, the PSA levels should gradually decrease after treatment, and follow-up will be needed over a period of time.
Wishing you good health.

Reply Date: 2021/09/06

More Info

The rapid increase in PSA (Prostate-Specific Antigen) levels, as you've described, is indeed concerning and warrants further investigation. 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 prostate cancer, benign prostatic hyperplasia (BPH), and prostatitis (inflammation of the prostate).
In your case, the significant jump from previous PSA levels of around 1.33 and 1.01 to a current level of 24.9 is alarming. Such a drastic increase over a span of five years could suggest a few possibilities. While prostate cancer is a potential cause, especially aggressive forms, it is also important to consider other conditions that could lead to elevated PSA levels. For instance, prostatitis or BPH can cause significant increases in PSA, sometimes even more than what is typically seen in prostate cancer.
The presence of hematuria (blood in urine), elevated white blood cell count, and the potential for urinary tract infection could indicate an inflammatory process, which might also contribute to the elevated PSA levels. Inflammation can lead to increased vascular permeability and release of PSA into the bloodstream, thus elevating the levels detected in blood tests.
Regarding your question about whether prostate cancer could escalate from a low PSA to 24.9 in five years, it is possible, but it is not the only explanation. Prostate cancer can be indolent (slow-growing) or aggressive, and the rate of increase in PSA can vary significantly among individuals. Some aggressive forms of prostate cancer can indeed cause rapid increases in PSA, but other benign conditions can also lead to similar elevations.

As for your plan to undergo a PHI (Prostate Health Index) test, this is a reasonable next step. The PHI test combines total PSA, free PSA, and [-2]proPSA to provide a more nuanced assessment of prostate cancer risk. It can help differentiate between benign and malignant conditions more effectively than PSA alone.
In the meantime, it is crucial to consult with a urologist who can perform a thorough evaluation, including a digital rectal exam (DRE), imaging studies if necessary, and possibly a prostate biopsy to determine the underlying cause of the elevated PSA.
In summary, while the rapid increase in your PSA levels is concerning and could indicate prostate cancer, it is essential to consider other potential causes, including prostatitis and BPH. The PHI test and further evaluation by a urologist will be critical in determining the appropriate next steps and management. It is important to stay proactive about your health and follow through with the recommended evaluations.

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