ELEVATED PSA

There can be many reasons for an elevated PSA. But it is usually due to one of the following:

• Prostate cancer
• Enlarged prostate (BPH)
• Urinary tract infection
• Inflammation
• Trouble with urination

The sooner prostate cancer is detected, the sooner treatment can begin. Treatment is most effective in the cancer’s earliest stages.

The American Cancer Society recommends PSA testing at age 50 for men at average risk. Because family history is a risk factor, men whose father or brother were diagnosed with prostate cancer before age 65 are recommended to begin testing at age 45. Black men also should begin testing at age 45 as they have been found to have a higher risk of developing prostate cancer. Men whose father and brother were diagnosed with prostate cancer before age 65 are recommended to begin testing at age 40.

You can have an elevated PSA and have no symptoms. Those who do have symptoms report:

• Sudden change in urinary habits
• Symptoms that are similar to a urinary tract infection (i.e., burning with urination, urinary frequency or urgency, lower abdominal discomfort, pelvic pain)

Your risk of developing prostate cancer is higher if:

1. You’re 50 or older. Prostate cancer is rare in men younger than 40, but the chances increase rapidly after age 50. About 6 in 10 prostate cancers are found in men older than 65. 
2. Prostate cancer develops more often in Black men and in Caribbean men of African ancestry than in men of other races. And when it does develop in these men, they tend to be younger. Prostate cancer occurs less often in Asian American, Hispanic, and Latino men than in non-Hispanic white men.
3. Although most prostate cancer occurs in men without a family history of it, prostate cancer seems to run in some families, which suggests that in some instances there may be an inherited or genetic factor. Having a father or brother with prostate cancer more than doubles a man’s risk of developing this disease. (The risk is higher for men who have a brother with the disease than for those who have a father with it.) The risk is much higher for men with several affected relatives, particularly if their relatives were young when the cancer was found.

If your PSA level is elevated, your doctor will likely want to perform one of the following:

• Re-check your PSA or other special blood tests to evaluate risk of prostate cancer
• Prostate MRI to evaluate for abnormal nodules and assess size
• Prostate biopsy (can be done in one of multiple ways):

• • Transrectal biopsy: Your doctor places an ultrasound probe into your rectum. The size of your prostate will be determined, then medication will be applied to numb your prostate. Once numb, tissue samples (biopsies) of your prostate will be taken. Typically 12 biopsies are taken, sometimes more. This entire procedure only takes about five minutes. 
  • Transperineal biopsy: This test also involves placement of an ultrasound probe into your rectum. However, instead of passing a needle through your rectum to take tissue samples, your urologist passes the biopsy needle through the perineal skin (between the anus and the scrotum) and into the prostate. Typically 12 biopsies are taken, but occasionally more. This procedure takes about 10-15 minutes. 
  • MRI guided fusion biopsy: This is generally done in an ambulatory surgery center or the operating room under sedation. Images from a previously completed MRI are “fused” with real time ultrasound images to more accurately take biopsies of abnormal areas seen on a prostate MRI. This is done through a probe in the rectum and needle biopsies, similar to the other mentioned biopsy techniques.

Once biopsy results are received, your urologist will recommend a follow-up treatment plan. Your customized treatment plan will be thoroughly discussed with you depending on your situation.