Elevated PSA Levels: Is Prostate Cancer Always the Cause?

Regarding prostate cancer?

Hello Dr.
Pan, my father is 64 years old.
During a routine health check, his PSA level was found to be 16.6.
He went to a municipal hospital for further examination, where the doctor noted a dark spot on the ultrasound.
A repeat PSA test showed a level of 20, and a biopsy was performed but did not reveal any cancer cells.
Is it possible for the PSA to be as high as 20 without indicating cancer? Would you recommend performing another biopsy, and how long should we wait before doing so? Currently, my father only experiences some difficulty urinating and urgency at night.

Danxin, 40~49 year old female. Ask Date: 2005/12/15

Dr. Pan Zhenqin reply Urology

A PSA level of 16.6 is significantly above the normal range; however, the ultrasound-guided biopsy did not confirm the presence of cancer cells.
Therefore, it is advisable to continue monitoring.
Clinically, chronic prostatitis or an enlarged prostate, especially when calcification is present, can also lead to elevated PSA levels.
Prostate cancer remains a concern, so regular follow-up is necessary.
Additionally, alpha-blockers can be prescribed to manage prostate symptoms.
PSA should be monitored approximately every three months; if levels do not continue to rise, the frequency can be changed to every six months after one year.
If the increase is slow, another biopsy may be considered in six months or even a year.

Reply Date: 2005/12/15

More Info

Elevated PSA levels can indeed be concerning, especially when they reach numbers like 16.6 or 20, as seen in your father's case. However, it is crucial to understand that elevated PSA (Prostate-Specific Antigen) levels do not automatically indicate prostate cancer. There are several benign conditions that can cause an increase in PSA levels, including benign prostatic hyperplasia (BPH), prostatitis (inflammation of the prostate), and even recent sexual activity or certain medical procedures.

In your father's situation, the fact that a biopsy was performed and no cancer cells were found is significant. This suggests that while the PSA levels are elevated, the underlying cause may not be cancer. The presence of a "black spot" on ultrasound could indicate a variety of conditions, including benign changes in the prostate, and does not definitively point to cancer.
It is essential to consider the context of the PSA levels. For instance, PSA levels can fluctuate due to various factors, including inflammation or infection. In cases of prostatitis, PSA levels can rise significantly, and once the inflammation is treated, PSA levels may return to normal. Given that your father is experiencing urinary difficulties, it may be worth exploring whether he has any underlying inflammation or infection that could be contributing to the elevated PSA.

Regarding the timing of a follow-up biopsy, it is generally recommended to wait a few months after an initial biopsy, especially if it was negative, before considering another one. This allows time for any potential inflammation to subside and for the PSA levels to stabilize. Typically, a follow-up PSA test can be done in about 3 to 6 months, depending on the physician's recommendation and the patient's overall health status.

In addition to monitoring PSA levels, it may be beneficial for your father to undergo further evaluation of his urinary symptoms. This could include a urodynamic study or a referral to a urologist specializing in urinary disorders. Treatment options for urinary symptoms due to BPH can range from lifestyle changes and medications to more invasive procedures, depending on the severity of the symptoms and the patient's overall health.

In summary, while elevated PSA levels can be alarming, they do not always indicate prostate cancer. The absence of cancer in the biopsy is a positive sign, and it may be prudent to monitor PSA levels over time while also addressing any urinary symptoms. Regular follow-ups with a healthcare provider are essential to ensure that any changes in PSA levels or urinary symptoms are appropriately managed. It is always advisable to have an open dialogue with the healthcare team to understand the best course of action tailored to your father's specific situation.

Similar Q&A

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.

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 Sudden PSA Level Increase: Causes and Concerns

Hello Doctor, I had my annual health check-up on May 17th this year. Since 2013, I have been monitoring my PSA levels, which were consistently between 2 and 2.1 until 2018. However, this year, the level suddenly increased to 8. Before the check-up, I didn't have any specific...

Dr. Xu Wencang reply Urology
Prostatitis can also cause an increase in PSA levels. The incidence of prostate cancer in a 39-year-old is very low, so close monitoring is recommended.