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Bph psa levels: How should prostate specific antigen be interpreted?

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How should prostate specific antigen be interpreted?

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High PSA, No Prostate Cancer: Understand Your Results

You may have elevated PSA levels due to age or certain health conditions, including an enlarged prostate and certain infections.

Prostate-specific antigen (PSA) is a protein produced by prostate gland cells. Elevated levels may indicate prostate cancer, but PSA levels can also be affected by other things, such as enlarged prostate, a urinary tract infection, or recent ejaculation.

On their own, PSA levels aren’t a good indicator of prostate health. Instead, your doctor will look at your PSA levels alongside other risk factors, like age, digital rectal exam results, and family history. Keep reading to learn more about why your PSA levels may be high.

PSA levels may increase as you get older. This normal rise may be caused by the growth of benign, prostatic tissue. Some men also experience an enlarging of their prostate as they age, which may also elevate PSA levels.

BPH, also known as enlarged prostate, is common in older men. BPH can raise PSA levels and affect the bladder and urinary tract. Men with BPH may have difficulty urinating. If left untreated, it may also interfere with kidney function.

Common symptoms include:

  • difficulty initiating urination
  • weak urine output, which includes dribbling or straining, or stops and starts during urination
  • frequent urination
  • urgent need to urinate
  • Inability to empty bladder completely

The prostate enlarges in many men as they age, possibly as a result of shifting hormonal levels. BPH only requires treatment if symptoms are affecting quality of life or health. Treatments include medications, such as alpha blockers or 5-alpha reductase inhibitors. If your symptoms are severe or do not respond to medication, a minimally-invasive surgical procedure or laser therapy may help to alleviate the problem.

Learn more: Traditional treatment methods for enlarged prostate »

UTIs may spike PSA levels. They are commonly diagnosed through a urine test and treated with antibiotics. Symptoms of a UTI include:

  • a constant urge to urinate, which is not always fully relieved after urination
  • inability to fully relieve the bladder
  • lower back pain, particularly in the flank
  • abdominal pain
  • a burning sensation or pain during urination
  • cloudy, foul smelling, or bloody urine
  • fevers or chills

UTIs become more common as you age. Some men are also at greater risk for UTIs. Risk factors include having:

  • diabetes
  • kidney stones
  • an enlarged prostate
  • a compromised immune system

Talk to your doctor if you think you have a UTI. They are often treated with antibiotics. If you have high PSA levels and a known UTI, you will need to wait until you’ve recovered from your UTI before repeating the PSA test.

A common condition in men under 50, prostatitis is often the result of a bacterial infection. It causes swelling, inflammation, and irritation of the prostate gland. Symptoms are similar to those of a UTI, and may include:

  • lower back or abdominal pain
  • pain or discomfort when urinating
  • difficulty urinating

If bacterial infection is causing your prostatitis, you may also experience flu-like symptoms and be treated with antibiotics. Nerve damage in the urinary tract may also cause prostatitis. This can occur as a result of injury or as a surgical complication. If no infection is found, anti-inflammatory medication or alpha-blockers may be used to reduce discomfort.

Some studies have looked at the effects of ejaculation on PSA levels. One study published in 2016 found that PSA levels rise in some men after ejaculation. They may remain higher than their typical baseline level for up to 24 hours afterward.

More research is needed to fully understand the effects of ejaculation on PSA levels. However, if you have a PSA test scheduled, consider abstaining from sexual activities that may result in ejaculation for 24 hours before the test.

Parathyroid hormone is naturally occurring hormone produced by the body to regulate calcium levels in the blood. It may also promote prostate cancer cell growth, even in men who do not have prostate cancer. For this reason, high levels of parathyroid hormone may escalate PSA levels.

An injury to the groin, caused by a fall, impact, or accident, may spike PSA levels temporarily. Let your doctor know if you suspect an injury may have affected your PSA levels.

Any procedure that causes temporary bruising or trauma to the groin can have an effect on PSA levels. This can include the insertion of any type of instrument, such as a catheter or surgical scope, into the bladder.

Prostate cancer can cause your PSA levels to increase, so your doctor may recommend that you get a PSA blood test in conjunction with other tests, such as a digital rectal exam, to assess your potential risk. Doctors often recommend PSA testing in men 50 and older. Your doctor may recommend testing your levels at an earlier age if you have known risk factors for prostate cancer, like family history of the disease.

If your PSA levels are high and other diagnostic tests also indicate an increased risk for prostate cancer, your doctor will likely recommend a biopsy to confirm a prostate cancer diagnosis. Ask your doctor about all of the risks associated with biopsy. For some men, holding off on a biopsy and taking a watchful approach is a good option because prostate cancer is generally slow growing. Your doctor will go over all of your options and explain the risks associated with each option.

Second opinion

Getting a second medical opinion can help put your mind at ease about your current care or give you a different perspective, which may help you to decide upon your best options for treatment.

If your current doctor recommends PSA testing or further testing or biopsy after a PSA test, make sure to discuss the benefits versus the risks of each procedure being recommended. Take notes or bring someone with you to your appointment to take notes for you. If you feel the need to discuss this information with another doctor, you absolutely should.

It’s important to remember that elevated PSA levels can mean many things. Prostate cancer is one of those things. If it feels medically necessary to have a biopsy or other testing done, make sure to weigh the benefits versus the risks of each test. Prostate cancer, especially when caught early, is treatable. So are many of the other causes of elevated PSA.

A:

Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

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General prostate-specific antigen (General PSA)

General prostate-specific antigen – this is the amount in the blood available for determination of the fractions of the substance that is part of the secretion of the prostate gland – serine protease. Prostate-specific antigen is a laboratory marker of the condition of the prostate tissue.

Synonyms Russian

General prostate specific antigen, prostate cancer marker.

Synonyms English

Prostate-specific antigen total, PSA total.

Test method

Immunochemiluminescent assay.

Detection range: 0.006 – 5000 ng/ml.

Units

Ng/mL (nanograms per milliliter).

What biomaterial can be used for research?

Venous blood.

How to properly prepare for an examination?

  • Eliminate fatty foods for 24 hours before the test.
  • Patients treated with high doses of biotin (> 5 mg/day) should be sampled no sooner than 8 hours after their last dose.
  • Avoid physical and emotional stress for 30 minutes prior to examination.
  • Do not smoke for 30 minutes before the test.
  • Examination should be carried out no earlier than 10 days after prostate massage (obtaining prostate secretion, seminal vesicle massage).

General information about the study

Prostate-specific antigen (PSA) is a protein substance, an enzyme belonging to serine proteases. It is one of the synthesis products of the prostate gland.

The prostate gland consists of muscle tissue and a large number (about 50) of small glands. Muscle tissue is designed to move the fluid that the prostate produces into the internal ducts towards the lumen of the urethra. In addition, intense contractions of the prostate muscles provide the process of ejaculation during intercourse.

The prostate glands produce prostate secretion, which has several functions: it is part of the seminal fluid and serves as an important component of the nutrient medium for spermatozoa. This is a complex composition of biologically active substances that ensure the vital activity of male germ cells. A small part of the secret enters the bloodstream and performs a complex hormonal function – it ensures the normal functioning of the testicles, the functioning of the bladder, regulates sexual desire, affects blood circulation, nervous processes and mental state.

One of the components of prostate secretion is PSA. According to its chemical structure, it is a glycoprotein – a combination of protein and carbohydrates, according to biochemical properties – an enzyme that performs the function of splitting large protein molecules into smaller fragments. Thanks to this ability, it dilutes the seminal fluid. Together with that part of the secretion of the prostate gland that enters the systemic circulation, a small portion of the prostate-specific antigen produced by the prostate also penetrates there. The function of the prostate-specific antigen in the body is unknown, and in laboratory diagnostics it is used to detect diseases of the prostate gland. Some of its fractions have antigenic properties, which makes it possible to identify them using immunochemical laboratory methods. The combination of these properties and determined the name for this substance as “prostate-specific antigen”.

Serum PSA exists in several forms. Two of them are available for determination by immunochemical methods:

1) bound prostate-specific antigen – is in a chemical bond with another compound that blocks its enzymatic function (alpha-1-antichymotrypsin),

2) free prostate-specific antigen – is in free ( unbound) state.

In sum, they reflect the level of the total prostate-specific antigen.

Small fluctuations in total PSA are closely associated with both changes in the functioning of the prostate gland, which are not pathological, and with various diseases of the prostate. For example, PSA levels are influenced by individual differences in prostate mass: a larger prostate produces, correspondingly, more PSA. In addition, the age of patients matters: the amount of PSA gradually increases throughout life. Mechanical effects on the prostate gland, such as massage or cycling, can also cause an increase in this indicator. The same effect has ejaculation.

Total PSA moderately increases with hypertrophy (adenoma) of the prostate, acute and chronic inflammatory diseases of the prostate gland (prostatitis), urinary tract infections, but the main diagnostic value of this analysis is the timely detection of prostate cancer.

Prostate cancer is one of the most common cancers in men. This disease is especially common in men over 50 years of age. In Russia, in almost 70% of patients, it is detected only at the 3-4th stage. Meanwhile, with the timely detection of prostate cancer, the effectiveness of its treatment is very high. But, unfortunately, in the early stages, this disease is asymptomatic. In this regard, during the initial visit to an oncologist, 70% of patients already have tumor spread to surrounding tissues or distant organs. That’s why it’s so important for men to get their PSA checked periodically. The classic methods for detecting prostate cancer – palpation of the prostate gland through the rectal wall in combination with ultrasound – have limited sensitivity and often do not allow timely detection of the tumor, while the PSA test makes it possible to diagnose even early, asymptomatic forms of the disease.

An increase in PSA levels at the beginning of the disease occurs as a result of dysfunction of prostate cells and increased permeability of blood vessels, which stimulates the release of specific substances from prostate cells into the extracellular environment. Tumor cells themselves synthesize prostate-specific antigen in smaller quantities than normal tissues. Thus, this test is highly specific for prostate tissue, but not for prostate tumors. However, with an increase in the total mass of tumor cells, their share in the production of prostate-specific antigen also increases, exerting an increasing influence on the results of laboratory analysis.

The higher the PSA level in the blood, the more certain it is that there is a malignant process in the prostate gland. However, if the total PSA is slightly elevated, the reliability of the diagnosis is doubtful, since the same result can be obtained with other diseases of the prostate, such as benign hypertrophy or prostatitis.

The sensitivity of the PSA indicator increases significantly when simultaneously analyzing the total and free fraction of this substance in the blood and determining the ratio of the results obtained. The proportion of free PSA in the blood serum in prostate cancer is significantly lower compared to its level in any benign process. Due to this, a more accurate distinction between benign and malignant diseases of the prostate is possible with a minimal increase in total PSA.

Early detection of prostate cancer is also carried out through an annual preventive examination. An excessive increase in PSA levels over the year indicates an increased risk of developing the disease.

The total PSA test is also used in the treatment of prostate cancer. This indicator is used to judge the success of therapy: a significant decrease in PSA levels indicates a positive result of therapeutic measures. This analysis is very important for the timely detection of recurrence of the disease after its surgical treatment.

What is research used for?

  • For the early diagnosis of adenoma and inflammatory diseases of the prostate.
  • For the diagnosis of ischemia or infarction of the prostate.
  • For early diagnosis of prostate cancer.
  • For the differential diagnosis of prostate cancer and its benign diseases, as well as infectious and inflammatory processes of the urinary tract.
  • To evaluate the effectiveness of drug therapy for prostate cancer.
  • To monitor the results of surgical treatment of prostate cancer.
  • For the timely diagnosis of recurrence of prostate cancer after surgical treatment.
  • As part of a preventive screening for the early diagnosis of benign diseases and prostate cancer.

When is the test ordered?

  • For prostate symptoms.
  • During examination to confirm or rule out prostate cancer.
  • In monitoring the effectiveness of drug therapy for prostate cancer.
  • When monitoring the patient’s condition after surgery to remove prostate cancer (for the purpose of early detection of a possible recurrence of the disease).
  • For preventive examination of the prostate gland.

What do the results mean?

Reference values: 0 – 4 ng/ml.

The amount of total PSA may moderately increase under some conditions not associated with prostate disease, as well as in a number of pathological conditions. The degree of increase in its level is directly proportional to the severity of prostate disease. A low total PSA indicates a low risk of prostate disease or treatment success.

Reasons for increasing total PSA:

  • relative increase in prostate mass,
  • prostate massage / cycling / ejaculation less than 24 hours before the study,
  • infection / inflammation of the urinary tract,
  • prostate adenoma,
  • prostatitis,
  • ischemia / infarction of the prostate,
  • prostate cancer.

Reasons for low total PSA:

  • low risk of developing prostate disease,
  • successful treatment of prostate disease.

Important notes

Also recommended

  • Cancer embryonic antigen (CEA)

Who orders the examination?

General practitioner, internist, urologist, oncologist, surgeon.

Literature

  1. Andriole GL, Crawford ED, Grubb RL et al. Mortality results from a randomized prostate-cancer screening trial. N Engl J Med 2009;360:1310 – 9.
  2. Schroder FH, Hugosson J, Roobol MJ ​​et al. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med 2009;360:1320-8.
  3. Osterling JE, Jacobsen SJ, Chute CG et al. Serum prostate-specific antigen in a community-based population of healthy men: establishment of age-specific reference ranges. JAMA 1993;270:860-4.
  4. Carter HB, Pearson JD, Metter EJ et al. Longitudinal evaluation of prostate-specific antigen levels in men with and without prostate disease. JAMA 1992;267:2215-20.
  5. Beduschi MC, Osterling JE. Percent free prostate specific antigen: the next frontier in prostate-specific antigen testing. Urology 1998;51(Appendix 5A):98 – 109.
  6. Modi P, Helfand BT, McVary KT. Modifications and surgical interventions for benign prostatic hyperplasia are potential confounders of prostate-specific antigen. Curr Urol Rep 2010;11:224 – 7.
  7. Gleason DF. Histologic grading and staging of prostatic carcinoma. In: Urologic Pathology: The Prostate. Philadelphia, Lea and Febiger 1977, p. 171 – 8.
  8. Oesterling JE. Using PSA to eliminate unnecessary diagnostic tests: significant worldwide economic implications. Urology 1995;46(Appendix 3A):26 – 33.
  9. Mitchell DM, Swindell R, Elliott T, Wylie JP, Taylor CM, Logue JP. Analysis of prostate-specific bounceafter I(125) permanent seed implant for localized prostate cancer. Radiother Oncol 2008;88:102–7.

Should I take a biopsy if my PSA is elevated?

The PSA test is considered the gold standard for diagnosing prostate health. Often, when PSA results are higher than normal, the patient is diagnosed with suspected prostate cancer and sent for a biopsy. However, it is not a fact that a high PSA level is an oncology.

Increased PSA – what to do?

A PSA test, or prostate-specific antigen, makes it possible to suspect the presence of prostate cancer. It must be taken annually by every man after 45 years. In other cases, the analysis is prescribed according to indications: if the results of ultrasound, MRI or CT, digital rectal examination raise doubts about the presence of a tumor.

There is a belief that if PSA is below 4 ng / ml – this is the norm, in fact it is not. It has been proven that PSA levels vary with age. For men under forty, the lower threshold is 2.5 ng / ml, and for the elderly – 4. 5 ng / ml. With age, the prostate enlarges, this is a normal process, and, as a result, the production of PSA increases.

If you have been scheduled for a biopsy, but you want to make sure that the order is correct, you can get a second opinion from the experts at the EMC Urology Clinic.

PHI – diagnosis of prostate cancer without biopsy

When a tumor is suspected, but the total PSA is in the range of 2-10 ng/ml, doctors usually opt for expectant management and regular monitoring, or prescribe a biopsy. The best way to clarify the situation in this case is an additional study – a PHI blood test. If the PHI is low, then the doctor may refuse to take a biopsy and continue monitoring. Studies show that up to 75% of biopsies are performed in vain, that is, they could be replaced by a PHI blood test.

Magnetic resonance imaging (MRI)

MRI of the prostate may also help avoid a biopsy. MRI of the prostate, unlike a biopsy, is a non-invasive diagnostic method that does not injure the body and does not expose it to radiation. MRI allows accurate visualization of pathological foci even at the earliest stages of the development of the disease and confirms or refutes the need for a biopsy.

Fusion biopsy – the most accurate way to diagnose cancer

Prostate biopsy is a method of examining prostate tissue for cancer cells. Using a special needle, rectal or urethral punctures are made in the prostate in order to take suspicious tissue for examination.

EMC is one of the few clinics in Russia that does not perform a classic biopsy, but a fusion biopsy. With a classic biopsy, the doctor acts, one might say, blindly, even if the procedure is performed under ultrasound guidance. Fusion biopsy is a procedure carried out under the combined control of ultrasound and MRI. This technology allows you to take the material exactly from the area that is in doubt.