Elevated PSA Levels: Risks and Next Steps in Urology

Q: Elevated PSA Levels: Risks and Next Steps in Urology

BEN： Hello, given your age, the likelihood of cancer is indeed low. <br>However, it cannot be completely ruled out. <br>The F/T PSA ratio is also not very favorable. <br>Additionally, what were the results of the transrectal ultrasound? What were the findings from the digital rec

Elevated PSA levels indicate a potential concern?

Hello, Doctor: Currently, my company’s health check includes a PSA index test.
For the past two years, my results have been above the standard, with values of 4.12 and 4.75.
Recently, I went to the urology department for a follow-up PSA test (three months later, the result was 4.5, with a Free PSA/T PSA Ratio of 19.2%).
The doctor is waiting for another follow-up in three months.
If the index remains elevated, a biopsy is recommended.
I searched online and found that it could also be chronic inflammation, but the doctor mentioned that inflammation wouldn’t last for three months, so no treatment was initiated.
Given my age and these results, what is the likelihood of cancer? If the index is still elevated after three months, can I start medication treatment (considering it as chronic inflammation) before further monitoring?

Ben, 30~39 year old female. Ask Date: 2016/01/13

Dr. Xu Weikai reply Urology

BEN: Hello, given your age, the likelihood of cancer is indeed low.
However, it cannot be completely ruled out.
The F/T PSA ratio is also not very favorable.
Additionally, what were the results of the transrectal ultrasound? What were the findings from the digital rectal examination? These can both be considered when deciding on a biopsy.
Generally, for my patients, I would follow the same approach as your attending physician and wait three months before repeating the blood test.
If the levels continue to rise, then a biopsy would be indicated; if they decrease or remain stable, we would wait another three months.
As for whether you have chronic prostatitis, I cannot be certain.
Typically, prostatitis presents with some bothersome clinical symptoms.
Chronic prostatitis does not have specific medications; it is usually managed symptomatically, such as with pain relief and treatment for urinary frequency.
Whether or not to undergo a biopsy ultimately depends on your personal choice.
You can look up the factors that affect PSA levels online.
You will find that many factors can influence it, including sexual activity, diarrhea, and constipation, among others.
If there are any unclear points, feel free to ask again, and we can discuss and research further.
Online responses should only serve as a reference; if necessary, you should seek medical care at a healthcare facility.
This response is provided by Dr.
Hsu Wei-Kai, Head of Urology, Taitung Hospital, Ministry of Health and Welfare.

Reply Date: 2016/01/13

More Info

Elevated PSA (Prostate-Specific Antigen) levels can be a source of concern for many men, especially when they are consistently above the normal range. In your case, with PSA levels recorded at 4.12, 4.75, and 4.5 over the past two years, it is understandable to feel anxious about the possibility of prostate cancer. However, it is essential to recognize that elevated PSA levels can be influenced by various factors, and not all elevations indicate cancer.

Firstly, it is important to understand that PSA is a protein produced by both normal and malignant cells of the prostate gland. While a PSA level above 4.0 ng/mL is often considered elevated, it is not a definitive indicator of cancer. Many benign conditions can cause an increase in PSA levels, including benign prostatic hyperplasia (BPH), prostatitis (inflammation of the prostate), urinary tract infections, and even recent sexual activity or vigorous exercise, such as cycling.

In your case, the Free PSA to Total PSA ratio of 19.2% is a useful metric. Generally, a lower ratio (below 10%) may suggest a higher risk of prostate cancer, while a higher ratio indicates a lower risk. Your ratio of 19.2% is relatively reassuring, suggesting that the likelihood of cancer may be lower, but it does not eliminate the need for further monitoring.

Regarding your age, being in your 30s, the risk of prostate cancer is significantly lower compared to older men. Most prostate cancers are diagnosed in men over 65. However, it is still essential to remain vigilant, as individual risk factors, including family history and ethnicity, can influence your risk.

Your physician's recommendation to wait three months for another PSA test is a common approach. If the PSA levels remain elevated, a prostate biopsy may be suggested to rule out cancer. It is crucial to follow your doctor's advice and not rush into invasive procedures unless necessary.
As for the possibility of treating elevated PSA levels with medication, it is essential to consult your urologist. While medications can help manage symptoms related to benign conditions, they may not directly lower PSA levels. If chronic inflammation is suspected, your doctor may consider anti-inflammatory medications or other treatments to address the underlying issue.

In summary, while elevated PSA levels can be concerning, they are not definitive for cancer, especially in younger men like yourself. Continuous monitoring, along with a thorough evaluation of your symptoms and medical history, is the best course of action. If your PSA levels remain elevated after the next test, discuss with your doctor the potential for further evaluation, including a biopsy, while also considering the possibility of benign conditions that may be contributing to the elevated levels. Always communicate openly with your healthcare provider about your concerns and any symptoms you may be experiencing, as this will help guide your management plan effectively.

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