Elevated PSA Levels and Prostate Health Concerns

Q: Elevated PSA Levels and Prostate Health Concerns

PSA： Generally, PSA levels stabilize after about three months. <br>Therefore, drawing blood too early typically does not result in significant changes. <br>Additionally, elevated PSA levels can be caused by various factors, including ejaculation, constipation, diarrhea, prostate

Elevated PSA levels and prostate issues?

Hello Doctor, I am 31 years old.
During a health check-up in April this year at New Taipei City Keelung Hospital, my PSA level was found to be 6.0.
However, I did not have any discomfort, except for an incident a few months ago where I noticed blood in my semen, and I experienced a persistent urge to urinate after ejaculation on two occasions, but I haven't had any abnormal symptoms since then.

Two weeks later, I had another test at Far Eastern Clinic, and the result was 7.68.
The combined test of semen and urine showed bacteria at 1+ and elevated white blood cell count.
The doctor performed a digital rectal exam and noted some warmth and enlargement, initially diagnosing me with prostatitis and prescribed antibiotics.
After taking them for two to three days, a simple urine test seemed normal.
I then went to Wan Fang Hospital for further evaluation, where a prostate ultrasound was performed.
The doctor mentioned that there were some calcifications in my prostate, likely due to previous inflammation, but the ultrasound did not indicate any malignant tumors.
Therefore, the diagnosis remained prostatitis, and I was prescribed more antibiotics.
After a total of over eight weeks of antibiotics, my urine test returned to normal, but my PSA level was still 6.53.
The doctor mentioned that for some individuals, PSA levels may not decrease quickly and advised me to return for follow-up in three months.
Is this situation considered normal? After taking antibiotics for such a long time, is it expected that the PSA level has not decreased, and will it really take more time to lower? Or could there be other possibilities? If the prostate ultrasound did not show any signs of malignancy, does that truly indicate that it is not prostate cancer? How accurate is the prostate ultrasound? Should I undergo any additional tests for confirmation? Thank you!

People troubled by high PSA levels, 30~39 year old female. Ask Date: 2010/09/20

Dr. Xu Weikai reply Urology

PSA: Generally, PSA levels stabilize after about three months.
Therefore, drawing blood too early typically does not result in significant changes.
Additionally, elevated PSA levels can be caused by various factors, including ejaculation, constipation, diarrhea, prostate cancer, and prostatitis.
For confirmation, a transrectal ultrasound can be performed, and if necessary, a prostate biopsy may be added.
Furthermore, a digital rectal examination is also an essential assessment; an experienced physician can provide a clear diagnosis through this method.
If there are any unclear points, feel free to ask again for further discussion and research.
Ministry of Health and Welfare, Taitung Hospital, cares about you.
Response by Dr.
Hsu Wei-Kai, Chief of Urology.

Reply Date: 2010/09/20

More Info

Elevated PSA (Prostate-Specific Antigen) levels can be a source of concern for many men, especially when they are accompanied by symptoms such as blood in the semen or urinary urgency. In your case, at 31 years old, a PSA level of 6.0, which later increased to 7.68, warrants careful evaluation, particularly since you have experienced symptoms indicative of potential prostate issues.

Firstly, it is essential to understand that PSA is a protein produced by both normal and malignant cells of the prostate gland. While elevated PSA levels can indicate prostate cancer, they can also be influenced by a variety of non-cancerous conditions. In your situation, the presence of bacteria and elevated white blood cell counts in your urine suggests a possible urinary tract infection or prostatitis (inflammation of the prostate), which can indeed cause PSA levels to rise. The fact that your physician diagnosed you with prostatitis and prescribed antibiotics is a standard approach, as treating the underlying infection often leads to a decrease in PSA levels.

The persistence of elevated PSA levels despite prolonged antibiotic treatment can be concerning, but it is not uncommon. Some men may experience a delayed response in PSA reduction after resolving an infection or inflammation. The prostate can remain inflamed for some time, and it may take several weeks or even months for PSA levels to normalize after the inflammation subsides. Therefore, your doctor’s recommendation to monitor your PSA levels over the next three months is prudent.

Regarding the ultrasound findings, the presence of calcifications in the prostate can be a result of previous inflammation and does not necessarily indicate cancer. Prostate ultrasounds are generally reliable for assessing the size and structure of the prostate, but they are not definitive for diagnosing cancer. If there are no suspicious masses or lesions seen on ultrasound, it is a good sign, but it does not completely rule out the possibility of cancer.
If your PSA levels remain elevated after the follow-up period, further evaluation may be warranted. This could include a repeat PSA test, possibly a free PSA test (which can help differentiate between benign conditions and cancer), or even a prostate biopsy if there are still concerns about malignancy.
In addition to medical evaluations, lifestyle factors can also play a role in prostate health. Maintaining a healthy diet, regular exercise, and managing stress can contribute positively to overall prostate health. It is also advisable to avoid activities that may irritate the prostate, such as prolonged cycling or excessive alcohol consumption.

In summary, while elevated PSA levels can be alarming, they are not solely indicative of prostate cancer, especially in the context of prostatitis. Continued monitoring and follow-up with your healthcare provider are essential. If you have ongoing concerns or if your symptoms change, do not hesitate to seek further evaluation. Communication with your healthcare team is crucial in managing your prostate health effectively.

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