Elevated PSA Levels: Should You Get Retested? - Urology

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Elevated PSA (Prostate-Specific Antigen) levels can be a source of concern for many men, especially when they exceed the standard reference range. Your recent PSA level of 5.520 ng/mL is indeed above the commonly accepted threshold of 4.0 ng/mL, which often prompts further investigation. However, it is essential to understand that PSA levels can be influenced by various factors, and an elevated level does not automatically indicate prostate cancer.

Firstly, it is important to consider your age and overall health. PSA levels tend to increase with age, and what is considered "normal" can vary significantly among different age groups. For instance, men in their 40s may have a lower threshold for concern compared to those in their 60s or 70s. Therefore, your age should be taken into account when interpreting your PSA results.

In addition to age, several benign conditions can cause elevated PSA levels. These include:
1. Prostatitis: Inflammation of the prostate, which can be acute or chronic, often leads to increased PSA levels. If you have experienced any urinary symptoms, such as pain or difficulty urinating, this could be a contributing factor.

2. Benign Prostatic Hyperplasia (BPH): This is a non-cancerous enlargement of the prostate that is common in older men. BPH can lead to elevated PSA levels as well.

3. Recent Sexual Activity: Ejaculation can temporarily raise PSA levels, so it is advisable to avoid sexual activity for 24-48 hours before a PSA test.

4. Medical Procedures: Recent procedures involving the prostate, such as a digital rectal exam (DRE), prostate biopsy, or cystoscopy, can also elevate PSA levels.

Given these factors, it is crucial to have a comprehensive evaluation. Here are some steps you might consider:
1. Retesting PSA Levels: It is often recommended to repeat the PSA test after a few weeks to confirm whether the elevated level persists. This can help determine if the elevation was a temporary fluctuation or a more concerning trend.

2. Free PSA Testing: Alongside total PSA, measuring free PSA can provide additional insights. The ratio of free PSA to total PSA can help differentiate between benign conditions and the potential for prostate cancer. A lower percentage of free PSA may indicate a higher risk of cancer.

3. Digital Rectal Exam (DRE): A DRE performed by a healthcare professional can help assess the prostate's size and texture, providing further information that may guide the next steps.

4. Imaging Studies: If there are persistent concerns, imaging studies such as multiparametric MRI can be useful in evaluating the prostate for any abnormalities.

5. Consultation with a Urologist: If your PSA levels remain elevated or if you have concerning symptoms, consulting a urologist is advisable. They can provide a thorough evaluation and discuss the need for a prostate biopsy if warranted.

In conclusion, while an elevated PSA level can be concerning, it is not an immediate cause for alarm. It is essential to approach this situation with a comprehensive plan that includes retesting and possibly further diagnostic evaluations. Always discuss your concerns and options with your healthcare provider to make informed decisions about your health.