7 Reasons Your PSA Level May Be High — Besides Cancer

But in 2017 the USPSTF released new draft guidelines that encourage doctors to discuss the potential benefits and harms of using the PSA test to screen for cancer in men ages 55 to 69. The final recommendation statement is now being developed.

In the meantime, here are seven reasons, besides prostate cancer, your PSA level could be above normal.

1. Aging Affects PSA Levels

Even without any prostate problems, your PSA level can go up gradually as you age. “At age 40, a PSA of 2.5 is the normal limit,” says John Milner, MD, a urologist in the Chicago area. “By age 60, the limit is up to 4.5; by age 70, a PSA of 6.5 could be considered normal.”

2. Prostatitis: A Common Problem in Men Under 50

“The PSA test is a good screening tool for prostate cancer, but it is not very specific,” says Erik P. Castle, MD, a urologist and researcher at the Mayo Clinic in Phoenix, Arizona. “Common causes of inflammation in the gland, called prostatitis, can cause high PSA levels. “

Prostatitis is the most common prostate problem for men younger than 50.

Prostatitis caused by bacteria can be treated with antibiotics. Another, more common type of prostatitis, called nonbacterial prostatitis, can be harder to treat and may last a long time.

3. Medical Procedures Can Cause PSA to Rise

“Anything that traumatically interferes with the architecture around the prostate gland can make PSA go up,” says Dr. Milner. “One of the most common causes of significantly high PSA from this type of trauma is the placing of a catheter into the bladder.”

Another cause is a prostate or bladder exam that involves passing a scope or taking a biopsy.

“Since it takes about two to three days for PSA to go down by half, you should wait two to three weeks after this type of trauma to do a PSA test,” Milner says.

4. In Men Over 50: BPH May Be the Cause of High PSA

Benign prostatic hyperplasia (BPH) is an enlargement of the prostate gland, but it’s not prostate cancer. “BPH means more cells, so that means more cells making PSA,” explains Dr. Castle.

BPH is the most common prostate problem in men over age 50. It may not need to be treated unless it’s causing frequent or difficult urination.

Your primary care doctor may be able to tell the difference between BPH and prostate cancer by doing a digital rectal exam, but commonly this will require evaluation by a urologist and further testing, such as a biopsy or imaging studies.

5. High PSA Levels From a Urinary Tract Infection

“Any infection near the prostate gland, including a urinary tract infection, can irritate and inflame prostate cells and cause PSA to go up,” says Milner.

If you’ve been diagnosed with a urinary tract infection, be sure to wait until after the infection has cleared up before you get a PSA test. In men, most urinary tract infections are caused by bacteria and respond well to antibiotics.

Having BPH increases your risk for a urinary tract infection.

6. Ejaculation Is a Potential Cause of Mildly Elevated PSA

“Ejaculation can cause a mild elevation of your PSA level, and so can having a digital rectal exam,” says Milner. “These types of PSA elevations are usually not enough to make a significant difference unless your PSA is borderline. PSA should return to normal in two to three days.”

To avoid this type of elevation, doctors will usually draw blood for a person’s PSA level before doing a rectal exam. Ask your doctor if you should avoid ejaculation for a few days before a PSA test.

7. Can Riding Your Bike Raise Your PSA Level?

There have been occasional studies that link prolonged bike riding to an increase in PSA levels, but others haven’t found this connection. “You would probably have to be a Lance Armstrong–type bike rider to worry about bike riding and a significant rise in your PSA,” says Castle.

The Takeaway on the PSA

“The most important thing to know about PSA is that it is still a really important screening test for prostate cancer,” Castle says.

Prostate cancer is the third leading cause of cancer death in American men, behind lung and colon cancer, according to the American Cancer Society.

The responsible use of antibiotics for an elevated PSA level

PSA levels vary spontaneously, rising and falling an average of 15% from week to week. A rise of <20–46% from one year to the next is more likely to be the result of biological variation than cancer (Ornstein DK et al. [1997] J Urol 157: 2197–2182). Changes in PSA levels are not surprising, since the level in prostatic fluid is nearly a million-fold higher than in serum; leakage from prostatic acini to surrounding capillaries can substantially affect serum levels. Consequently, the widespread practice of prescribing antibiotics for men with a newly elevated PSA level, on the presumption that the patient has infectious prostatitis, seems irrational.

About 10–15% of men tested will have a PSA level >4 ng/ml in any given round of screening. Over multiple tests 21–37% of men without cancer will have at least one abnormal PSA level, depending on the definition used, however, the level will return to normal at the next test in 26–37%, and will become normal with subsequent testing in 40–55%. Once normalized, 65–83% of men have normal PSA levels for several years with no therapy (Eastham JA et al. [2003] JAMA 289: 2695–2700).

“Despite the lack of evidence, antibiotics are often prescribed for men with an elevated PSA”

Despite the lack of evidence, antibiotics are often prescribed for men with an elevated PSA on the presumption that the elevation is caused by infection (Kaygisiz O et al. [2006] Prostate Cancer Prostatic Dis 9: 235–238). While antibiotics may influence the course of bacterial prostatitis, 90% of symptomatic prostatitis and almost all cases of asymptomatic prostatitis (NIH Category 4) are not caused by a bacteria (Habermacher GM et al. [2006] Annu Rev Med 57: 195–206). While prostatic inflammation has been associated with increased PSA levels, antibiotics have no effect on nonbacterial prostatitis. In several studies of men with elevated PSA levels, 32–42% had evidence of Category 4 prostatitis. The PSA level fell to normal in 43–46% treated with antibiotics and remained so in most men for 1–2 years (Bozeman CB et al. [2002] J Urol 167: 1723–1726).

Did the antibiotics affect PSA levels in these men? Almost certainly not; the changes in PSA with antibiotics were similar to the random variations in healthy men. Also, there were no significant differences in bacterial cultures before or after antibiotics between PSA responders and nonresponders (Potts JM [2000] J Urol 164: 1550–1553). None of these studies included a control group, and there have been no randomized trials to show that antibiotics are more likely to lower PSA levels than a placebo.

PSA often falls with the next test whether or not antibiotics have been used, so why is there a widespread belief that antibiotics given to asymptomatic men will lower PSA levels? If PSA levels do not fall, the probability of finding cancer is, in fact, higher than if levels decrease (of course, cancer is more likely in men with a sustained PSA elevation than those with a randomly variable PSA that is temporarily elevated).

What harm is there in taking a course of antibiotics if it makes the patient feel that something is being done? Besides the expense, the risk of toxicity and the propagation of unscientific medical practice, the widespread use of broad spectrum antibiotics promotes the development of resistant organisms and exposes the patient to an increased risk of sepsis from a resistant strain, if undergoing prostate biopsy.

In summary, when an asymptomatic man presents with a modestly elevated PSA level (<10 ng/ml) and a normal digital rectal examination, the most appropriate recommendation is to reassure the patient, repeat the PSA level once or twice and, if the levels remain elevated, to perform a biopsy. There is no evidence that antibiotics alter PSA levels except in the presence of bacterial prostatitis, which is an uncommon condition.

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   Peter T Scardino

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Scardino, P. The responsible use of antibiotics for an elevated PSA level.
Nat Rev Urol 4, 1 (2007). https://doi.org/10.1038/ncpuro0702

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Elevated Prostate-Specific Antigen Level: Ranges & Diagnosis

Overview

What is a prostate-specific antigen (PSA)?

Prostate-specific antigen, or PSA, is a protein produced by the prostate gland. When there’s a problem with the prostate gland, it releases more PSA. High levels of PSA can be a sign of prostate cancer.

What is considered an elevated prostate-specific antigen (PSA) level?

Researchers haven’t settled on a single normal PSA level. Previously, a level of 4.0 ng/mL or higher would lead to more testing, usually a prostate biopsy. During the biopsy, a healthcare provider removes a small sample of prostate tissue to check it for cancer.

However, healthcare providers now consider other issues together with the PSA level to decide whether to perform a biopsy. Your age, general health, family history and health history factor into the decision.

Does my PSA level determine whether I have prostate cancer?

Your provider looks at two factors related to your PSA:

• Your PSA level: A higher level means a higher risk of prostate cancer.
• A continuous rise: PSA levels that continue to rise after two or more tests may mean you have cancer.

But the PSA level alone doesn’t determine if you have cancer or not. Two men can even have the same PSA levels but different risks of prostate cancer. And a high PSA level may reflect prostate problems that aren’t cancer.

What are other risk factors for prostate cancer?

You may be at higher risk for prostate cancer if you:

• Are older than 50 years.
• Are of African-American or Caribbean descent.
• Have a family history of prostate cancer.
• Have certain genetic changes that make it more likely prostate cancer will develop.

How common is prostate cancer in men with an elevated PSA level?

Men can have prostate cancer even if they have a normal PSA level. But cancer is more likely with an elevated PSA level. When PSA levels are:

• Below 4: 15% chance of prostate cancer.
• Between 4 and 10 (the borderline range): 25% chance of prostate cancer.
• Above 10: More than 50% chance of having prostate cancer.

Symptoms and Causes

What causes an elevated PSA level?

Prostate cancer is the main cause of an elevated PSA level. But PSA levels increase with age and can reflect different prostate conditions. Other factors that may raise a person’s PSA level include:

Your healthcare provider will also consider whether your medications affect PSA levels. For example, 5-alpha reductase blockers treat enlarged prostates and will lower PSA levels.

Will elevated PSA cause symptoms?

An elevated PSA level does not cause symptoms, but it may be a sign of prostate problems like cancer. If you have any of these symptoms, your provider may want to do a PSA test:

• Difficulty urinating.
• Frequent urination, including during the night.
• Slow urine stream.
• Urinary incontinence (difficulty holding urine in).

Diagnosis and Tests

What is the test to see if I have elevated PSA?

Healthcare providers use a blood test to measure PSA levels.

You may have a digital rectal exam (DRE) together with a PSA test to check for signs of prostate cancer. During a DRE, your provider inserts a gloved finger into the rectum to check for bumps or other irregularities.

Depending on the results of your initial test, your provider may want you to repeat the test. PSA levels can change. A second test gives your provider more details about your prostate health.

What happens if my PSA level is elevated?

If you have a high PSA level, you will need ongoing PSA tests and DREs so your provider can look for any changes. If the PSA level continues to increase or if your healthcare provider finds a lump during a DRE, you may need other tests, including:

• Transrectal ultrasound and prostate biopsies.
• Prostate MRI.
• Iso PSA or 4Kscore® (more blood tests).

A biopsy can tell you definitively if you have prostate cancer. The biopsy results also affect your treatment. For example, if the biopsy shows a lot of cancer cells, you might need more aggressive treatment.

Management and Treatment

How is prostate cancer treated?

Treatment options for prostate cancer include:

• Surgery to remove the prostate (such as a robotic prostatectomy).
• Radiation therapy (external radiation therapy).
• Brachytherapy (internal radiation therapy).
• High intensity focused ultrasound (HIFU).
• Cryotherapy (using extreme cold to freeze off cancerous tissue).
• Hormone treatment, also called androgen suppression therapy.
• Chemotherapy.

You may continue to have PSA level tests during and after prostate cancer treatment. These tests check that the treatment is working.

Prevention

Who should have regular screening tests for high PSA?

The PSA test was first developed to observe prostate changes in men who had a history of prostate cancer. Then it became more widely used in the general population as a way to detect and prevent prostate cancer before symptoms developed. But routine screening can find prostate cancers that grow slowly and do not need treatment. Talk to your healthcare provider to see if you should have regular PSA tests.

Outlook / Prognosis

What should I expect if I’m told I have elevated PSA?

If your provider finds an elevated PSA level, you’ll have repeat tests to check your prostate. Many men with elevated PSA levels — even those who have prostate cancer — live long, healthy lives. Prostate cancer may not need treatment, depending on how slowly the tumor is growing. Keep up with your regular appointments and tests so your care team can keep tabs on your health.

What does an elevated PSA level mean if I’ve had prostate cancer in the past?

If you’ve ever had treatment for prostate cancer, you’ll have regular PSA screenings for the rest of your life. An increasing PSA level may mean the cancer has returned. Your care team may use other tests, including imaging scans and biopsies, to check for signs of cancer. If cancer returns, your team will discuss your treatment options with you.

Living With

How can I best take care of myself if I have elevated PSA?

Regularly visit your healthcare provider for PSA tests and digital rectal exams. If you notice any change in how you feel or function, especially problems with urination, talk to your provider.

If I have elevated PSA levels, what should I ask my healthcare provider?

If you have any symptoms of prostate cancer, or if it runs in your family, ask your provider:

• Should I have regular tests to check my PSA level?
• What can I do to lower my risk for prostate cancer?
• What other tests or monitoring do I need?
• What are my treatment options if I get prostate cancer?
• What other signs or symptoms should I look out for?

A note from Cleveland Clinic

An elevated PSA level can be a sign of prostate cancer, but it doesn’t always mean you have cancer. Your healthcare provider will watch you and do more tests to arrive at a diagnosis. Prostate cancer is often slow-growing and may never become life-threatening. If you have symptoms of prostate problems, such as difficulty urinating, don’t hesitate to let your provider know.

Prostate-Specific Antigen > PSA Levels and Test

What does PSA stand for?

PSA stands for prostate-specific antigen, a protein that is secreted by cells in the prostate gland to help liquefy the semen. Furthermore, PSA is thought to dissolve cervical mucus, allowing sperm to enter the uterus. Disease-related changes in the prostate usually trigger an increase in the production of PSA. In turn, this increased production leads to higher levels of PSA in the blood – and these higher levels of serum PSA can be detected via a simple blood test.

Given that prostate cancer is one of the diseases that can trigger an increase in the production of PSA, it is always important to determine the exact cause of an elevated PSA level. Prostate MRI is an optimal means of determining the cause of elevated PSA levels. This is because MRI enables your doctor to detect and specify the exact location of any of the various changes that can lead to elevated PSA levels.

PSA Parameters

Total PSA

Total PSA is the sum of the complexed (bound) PSA and the free PSA in the blood, typically expressed in nanograms (ng) per milliliter (mL).

Complexed PSA

The level of complexed PSA is the amount of PSA in the blood that is bound to proteins.

Prostate tumors tend to produce higher concentrations of complexed PSA as opposed to free PSA.

Free PSA

The level of free PSA is the amount of free-floating, or unbound, PSA in the blood.

Ratio of free PSA to total PSA

The ratio of free PSA to total PSA is calculated by dividing the amount of free PSA by the amount of total PSA. If the ratio of free PSA is less than 20%, the protein concentration qualifies as elevated. Cancer cells tend to produce more protein in general and more bound PSA in particular. Prostate cancer can therefore lead to an increased PSA level.

If the ratio of free PSA is above 20%, the protein concentration does not qualify as elevated and the likelihood of cancer is regarded as low.

However, experience shows that the free-to-total PSA ratio does not provide a sufficient basis for a diagnosis. That is why we at the ALTA Klinik don’t rely on free-to-total PSA ratios. Instead, we use the ratios merely as an additional indicator of the advisability of an MRI scan.

The Role of a PSA Level as an Indicator

It is not possible to diagnose a specific prostate disease solely on the basis of a PSA test. PSA levels may increase as a result of malignant, acute or age-related changes in the prostate.

Some men may even have all three of the common diseases that affect the prostate, with each disease contributing variously to an elevated PSA level.

The PSA level may reflect all of the relevant changes in the prostate. It is regarded as conspicuous when it is elevated or when it fluctuates.

The PSA level is a good indicator and should only be regarded as an indicator. When taken alone, it offers no certainty as to any specific changes to the prostate and cannot be used as a basis for a diagnosis.

In contrast, an MRI scan of the prostate does provide a reliable basis for a diagnosis.

MRI scans generate hundreds of high-resolution, cross-sectional images of the prostate gland. These images can reveal any changes that may have occurred in the tissue. Using the latest technology and multi-parametric software, we at the ALTA Klinik can even detect very small, early-stage changes in the prostate.

Causes of an Elevated PSA Level

Prostate cancer typically leads to an elevated PSA level. Given that early-stage prostate cancer is generally limited to asymptomatic malignant changes at the cellular level, men have no way of knowing that something is wrong. This is why prostate cancer screening in the form of PSA testing is the best method of early detection. Please refer to the PSA Table for help in interpreting your PSA scores.

In addition to prostate cancer, age-related prostate enlargement (benign prostatic hyperplasia, or BPH), prostatitis (inflammation of the prostate) and urinary tract infections can also lead elevated PSA levels.

PSA Score: A Man’s First Encounter with His Prostate

Many men’s first encounter with their prostate gland is an elevated PSA score. This is because the prostate gland is well hidden in the body and is usually not a source of any sensory experience. Most men also have no idea what its function is.

This state of blissful ignorance can change all of a sudden when their doctors inform them that their PSA levels are elevated. This is usually the moment when those affected begin to concern themselves with their prostate.

In the case of younger men, the cause of an elevated PSA level often turns out to be an acute condition such as an infection that leads to inflammation. For middle-aged men, the list of typical causes will also include age-related prostate enlargement and prostate cancer.

It is important to bear in mind that if your PSA level is elevated, it is important to determine the specific cause of the elevation, no matter what your age bracket is. And an MRI scan of the prostate represents an optimal means of determining the cause.

Changes in Your PSA Level

A PSA level that is in the normal range may nonetheless need clarification if recent blood tests show that it has increased. For instance, an annual PSA test may show that your PSA level has increased from 2 ng/mL to 3 ng/mL. Although your PSA level is under 4 ng/mL, and therefore within the normal range, the increase may have been caused by early-stage prostate cancer.

If your PSA level is already above 4 ng/ml and screening reveals another significant increase, then clarification is even more urgent. That’s why we recommend proactive PSA testing. That being said, regular PSA testing (e.g. once every 3 months) cannot provide a basis for diagnosing the cause of an elevated PSA level.

Family History and Early Prostate Cancer Screening

It is important not to underestimate a family history of prostate disease. For instance, if your father had prostate cancer, your chances of getting prostate cancer will tend to be higher than those of men with no family history of the disease.

Our experience with patients whose family history includes prostate cancer shows that the disease may even appear far earlier in sons than was the case for their fathers. Men with a family history of prostate cancer are therefore advised to begin regular prostate cancer screening in the form of PSA testing at an earlier age in order to enable an earlier response to any conspicuous findings.

We recommend that men begin regular PSA testing at the age of 40. This is because changes in a man’s prostate will generally cause his PSA levels to rise, although there are no physical symptoms of the changes that are taking place.

Diagnostic Examination for Elevated PSA Despite a Lack of Symptoms

Most men find it difficult to understand why they need to have a prostate examination if they’re experiencing no symptoms. Indeed, more than 90% of our patients indicate that they feel quite healthy. While age-related prostate enlargement is more likely to cause symptoms than prostate cancer, it is prostate cancer that men fear most when their PSA level is elevated.

We are able to determine the cause of an elevated PSA level by carrying out an MRI scan of the prostate.

Diseases That Cause Elevated PSA Levels

1. Age-related benign prostatic hyperplasia (BPH)

A significant enlargement of the prostate gland can cause your PSA level to rise. While the overall volume of the prostate tends to increase in men as they age, the increase actually develops only in the transitional zone of the prostate as an abundance of nodules form and begins to compress the peripheral zone. While men often don’t notice the growth directly, it can manifest itself in a more frequent urge to urinate.

2. Age-related BPH combined with chronic inflammation

In addition to BPH, chronic inflammation of the prostate can also lead to an elevated PSA level. In such cases, the two factors can act independently of one another, with each contributing to varying degrees to an increase in your PSA level.

3. Age-related BPH combined with prostate cancer

After learning from their urologists that they have benign prostatic hyperplasia, many men assume that this must also be the reason for their elevated PSA levels. However, while the enlargement will certainly tend to increase their PSA levels, prostate cancer may also be playing a role, for instance, by causing a continuous rise in their PSA levels.

4. Age-related BPH combined with acute prostatitis

The swelling associated with prostatitis usually leads to a noticeable enlargement of the prostate gland. Moreover, prostatitis can also lead to a significant increase in the concentration of PSA in the blood. Men often notice acute prostatitis by a burning sensation when urinating.

5. Age-related BPH combined with multiple different tumors

Some men may have two or more malignant tumors at different locations in the prostate. One tumor may be located in the peripheral zone and another in the transition zone. Such tumors may differ in terms of their malignancy, size and tendency to spread. However, any related PSA-level increases may also be influenced by prostate enlargement and chronic inflammation.

Understanding PSA Levels & The PSA Test

The prostate is a walnut-sized gland found between the bladder and the rectum in males. Its primary job is to produce seminal fluid. The prostate creates a protein, the prostate-specific antigen, or PSA. A PSA screening test is a blood test approved by the FDA in 1994 to measure the levels of PSA in a man’s blood.

Small amounts of PSA ordinarily circulate in the bloodstream and can be measured by a PSA test to monitor the health of the prostate. This test is intended to screen for prostate cancer, find other prostate-related conditions, or monitor PSA levels in those in treatment for prostate cancer. This is a simple blood test which reports PSA levels as nanograms of PSA per milliliter (ng/mL) of blood.

When You Should Screen For PSA Levels

Colloquially, prostate cancer screening is thought to be routinely undertaken by men over the age of 40. The American Urological Association recommends the following:

• Men under 40: No screening – there is no evidence to suggest a benefit of screening under 40
• Men aged between 40 to 54: No screening if you’re at average risk. If you’re at a high risk (such as having a family history of prostate cancer), the decision should be made by yourself and your doctor.
• Men aged between 55 to 69: Screening with doctor approval. This is the age group is identified as having the greatest benefit of screening
• Men aged over 70 or less than a 10-15 year life expectancy: Routine screening not recommended unless you are in excellent health where they may be benefit

Factors That Affect PSA Levels

It is important to note that PSA levels can rise naturally with age, and that a number of benign (not cancerous) conditions can also affect PSA levels, such as prostatitis (inflammation of the prostate), benign prostatic hyperplasia (BPH, enlarged prostate), urinary tract infection (UTI), or even injury to the prostate.

Other factors such as sexual activity right before testing, certain exercises, or even diet can impact the PSA levels as well. It is essential to consult a doctor regarding the meaning and next steps of your PSA testing results.

Understanding PSA Levels

• If your PSA levels are between 0 and 2.5 ng/mL, prostate cancer is not likely and there is a low chance that you would require further testing.
• A PSA level between 2.5 and 4.0 ng/mL is generally considered normal. In the absence of other risk factors, if your PSA levels aren’t fluctuating, and if you aren’t taking medication for BPH, your doctor may decide that no additional testing is needed until your next annual physical.
• If your PSA levels are over 4.0 ng/mL, or if they are rising, your doctor may wish to order additional testing to rule out other conditions. For example, a urine test might help check for a urinary tract infection. Although PSA levels between 4.0 and 10.0 are considered “suspicious,” there is only a 25% chance that you have prostate cancer.
• If your PSA levels are 10 ng/mL or higher, these levels are considered “dangerous.” This means your chances of having prostate cancer are 50%.

‘Normal’ PSA Levels By Age Chart

We mentioned earlier in this article that PSA levels increase with age due to age related growth of the prostate gland. A doctor will therefore take into account an age-adjusted PSA level when discussing your prostate health:

Although there are ‘normal’ PSA levels by age range, it is still important to screen routinely (as instructed by your doctor) to ensure these ‘normal’ levels are not rising.

How PSA Results Are Used For Diagnosis

In the past, many doctors wanted men with elevated PSA and/or an abnormal digital rectal examination to undergo a prostate biopsy. Today, this is not a course of action recommended by the American Urological Association. In such cases, multiparametric prostate MRI (mpMRI) is now recommended as the best front-line test to detect—or rule out—prostate cancer.

If a mpMRI shows a suspicious finding, a MRI-guided biopsy is the most accurate way to perform a biopsy of the prostate. If this is not possible, an MRI can be used with an ultrasound-guided biopsy. This is referred to as a “fusion” biopsy, and is more accurate than an ultrasound biopsy alone.

How To Get A PSA Test

Consult with your general practitioner or urologist about receiving a PSA test in their offices. PSA tests are typically covered without co-pay or deductible by Medicare once a year for men 50 years and older. Many states now have laws which require private health insurers to cover the costs for PSA testing. However, additional PSA test costs may need to be covered by the patient.

For those without insurance, or for those with insurance that does not cover PSA testing, free tools are available through advocacy groups, such as ZERO.

ZERO National Free Testing Map

Companies such as imaware^tm also offer in-home PSA testing kits and telemedicine appointments to discuss your PSA test results with a licensed physician. All imaware test kits are easy to use. After registering the test kit online, results will populate in the secure patient portal within 5-7 business days. You can submit your receipt of this test to insurance for potential reimbursement.

“At-Home testing is now at a point where results can be provided accurately and quickly within 5 business days, with real physicians providing telemedicine support through the entire testing process”

Dr. Diamandis – Lunenfeld-Tanenbaum Research Institute, Sinai Health System

Prostate cancer – Should I have a PSA test?

The PSA test is a blood test to help detect prostate cancer. But it’s not perfect and will not find all prostate cancers.

The test, which can be done at a GP surgery, measures the level of prostate-specific antigen (PSA) in your blood.

PSA is a protein made only by the prostate gland. Some of it leaks into your blood, but how much depends on your age and the health of your prostate.

There’s currently no national screening programme for prostate cancer in the UK because the PSA test is not always accurate.

Before deciding to have the PSA test, you may want to talk to a GP and practice nurse, as well as your partner or a friend or family member.

You have a higher risk of prostate cancer if you:

• have a family history of prostate cancer
• are of black ethnic origin
• are overweight or obese

What’s a raised PSA level?

The amount of PSA in your blood is measured in nanograms of PSA per millilitre of blood (ng/ml).

If you’re aged 50 to 69, raised PSA is 3ng/ml or higher.

A raised PSA level in your blood may be a sign of prostate cancer, but it can also be a sign of another condition that’s not cancer, such as:

How accurate is the PSA test?

About 3 in 4 men with a raised PSA level will not have cancer. The PSA test can also miss about 15% of cancers.

Pros and cons of the PSA test

Pros:

• it may reassure you if the test result is normal
• it can find early signs of cancer, meaning you can get treated early
• PSA testing may reduce your risk of dying if you do have cancer

Cons:

• it can miss cancer and provide false reassurance
• it may lead to unnecessary worry and medical tests when there’s no cancer
• it cannot tell the difference between slow-growing and fast-growing cancers
• it may make you worry by finding a slow-growing cancer that may never cause any problems

Before having the test

If you’re having a PSA test, you should not have:

• ejaculated in the past 48 hours
• exercised heavily in the past 48 hours
• a urinary infection
• had a prostate biopsy in the past 6 weeks

Each of these may give an inaccurate PSA reading.

Digital rectal examination (DRE)

A GP may also perform a digital rectal examination (DRE) to feel for any changes to your prostate gland.

A DRE is done by inserting a gloved, lubricated finger into your bottom.

A DRE on its own is not enough to detect cancer.

Biopsy

If you have a raised PSA level, you may need other tests, such as a biopsy.

This involves taking small samples of your prostate and checking them for cancer.

Biopsies miss 1 in 5 prostate cancers and can sometimes cause complications. The most common are bleeding and infections.

If you have prostate cancer

If you have prostate cancer, your specialist will discuss your options with you.

Possible treatments include:

• watchful waiting
• active surveillance
• radical prostatectomy (surgery)
• radiotherapy

Side effects of some treatments can include problems with erections, loss of fertility and incontinence.

You should talk to your cancer specialist about the benefits and risks of any treatment before you begin.

Read more about treating prostate cancer.

Page last reviewed: 12 June 2018
Next review due: 12 June 2021

Does A Rapid Rise in PSA Levels Indicate Prostatitis?

Prostatitis is swelling and inflammation of the male prostate gland, located just below the bladder.

The gland produces a fluid stored in the seminal vesicles and sperm cells produced by the testicles. The combined prostatic fluid and sperm cells are known as semen. 

Since the prostate surrounds the male urethra, inflammation, or swelling of the prostate often causes lower urinary tract symptoms, such as; painful or difficult urination. Severe prostatitis can cause pelvic pain, urinary retention, erectile dysfunction, and other issues. 

Prostatitis can occur suddenly or become a chronic condition. It often occurs in older men with an enlarged prostate, but physical stress in or around the pelvic region can trigger it in younger men.  

There are two main types of prostatitis. The most common form, especially among older men, is chronic prostatitis. This is an unpredictable swelling or inflammation of the gland, where symptoms come and go over time. It can be caused by a low-level infection in the prostate and is difficult to resolve completely.

Chronic prostatitis may be caused by a bacterial infection but is often of unknown origin. 

The second type is acute prostatitis, which causes more severe symptoms. The symptoms are usually intense and appear suddenly. This type is rarer and may be initiated by a bacterial infection in the prostate and, occasionally, spillover to the prostate from an active bacterial urinary tract infection. In severe cases, it can be life-threatening and requires immediate treatment. 1 

Recent studies indicate that a rapid rise in PSA levels may signal prostatitis. This article will discuss PSA levels and what they can signify, as well as prostatitis and its treatment options.

PSA (Prostate-Specific Antigen) Testing

Most men age 50 or older are familiar with the Prostate Specific Antigen (PSA) blood test that doctors typically order at routine examinations. PSA is a chemical released by, and unique to, the male prostate gland. Due to prostate enlargement, infection, or the presence of cancer, a larger gland can increase PSA results. 

The PSA test measures the total amount of PSA in the blood. Levels above the generally recognized limit of four might suggest the possibility of prostate cancer and often result in a recommendation for a prostate biopsy—a procedure that has its own set of risks, such as bleeding and infection.

Since the addition of prostate-specific antigen (PSA) testing to routine blood work for men over fifty, a man’s risk to be diagnosed with prostate cancer has increased substantially. Such a diagnosis usually results in extreme psychological duress and is often coupled with an emotional need for immediate treatment to “fix” or “remove” the problem.

However, since many cancers found via routine PSA testing are clinically insignificant, aggressive treatment can be more damaging than helpful—especially to a man’s quality of life. 

Men diagnosed with prostate cancer are frequently scheduled for aggressive treatment shortly after their diagnosis. This immediate rush to treatment has received considerable momentum from both the media and the medical community. Much of this is due to misinformation on the part of the patient.

Secondly, it is the result of a failure of the clinician to fully and truthfully explain the risk/benefit ratio to the patient. It is often easier to satisfy a patient′s emotional need for immediate treatment than it is to explain to a panicky patient and his wife that his cancer may never cause symptoms or become life-threatening. 

It is significant to note that a high PSA reading does not automatically indicate a man has prostate cancer, although some urologists foster that belief in their practice. Many men diagnosed with prostate cancer may never suffer any symptoms or debility from the disease. Thus, through a routine PSA test, a man can easily receive a diagnosis of prostate cancer, along with a recommendation for surgery to remove his prostate. 

What is not considered in the diagnosis or the surgery recommendation is the possibility that his prostate cancer may be of an indolent type that will likely never develop advanced or life-threatening symptoms. Thus, without further study and analysis, the man can be subjected to a major surgery that will have serious side effects for the rest of his life. 2 

Compounding this, urologists that typically make recommendations in this manner also tend to minimize the side effects of their treatment as well as the success rate in either avoiding such side effects or minimizing them. 

Thus, an unwary man accepts the treatment and then suffers through the myriad of serious side effects, often praising his doctor for “curing” his prostate cancer. 

Other tests can help determine if a PSA reading is significant or not. A free PSA test measures the percentage of unbound (or free) PSA in the blood instead of the usual total PSA reading. Benign Prostate Hypertrophy (BPH) tends to produce a higher free PSA percentage than a cancerous prostate. 

The free PSA test does not require a separate blood draw. It is done in conjunction with the total PSA test. 

Significance of a Rising PSA

Many doctors use PSA levels to determine the diagnosis and treatment of prostate problems. Unfortunately, some urologists subscribe to the theory that almost any rise in a man′s PSA value should be followed up with a prostate biopsy. 

Men are also led to believe that PSA levels are all-important for diagnosing prostate cancer both by their peers and by the media. However, many situations can significantly rise in PSA that does not indicate cancer or require significant treatment. 

Other conditions that can cause increased PSA levels include an enlarged prostate (benign prostatic hyperplasia, BPH) or an inflamed or infected prostate (prostatitis). In addition, PSA values can be temporarily increased by external stress on the prostate, such as; bicycle or motorcycle riding as well as sexual activity, especially intense sexual or physical activity. 

For older men, the general upper limit that is considered normal is 4.0 ng/mL. However, normal prostates emit a higher level of PSA as a man ages. The PSA level also tends to increase with the size of the prostate, especially with BPH. A CAT scan or an MRI can determine the size of a man′s prostate, but such tests may not always be warranted. 

Some doctors use rising PSA as a major factor in determining if a man needs a biopsy or further treatment, especially when the PSA rise is showing a steep slope. 

One measurement criteria used is called the PSA velocity. This represents the rate of rising PSA levels over a period of time. In the past, a rapid rise in PSA was thought to indicate the presence of cancer or an aggressive form of cancer. However, studies have cast doubt on this hypothesis, and reports suggest that a rapid rise in PSA is not always linked to cancer. Recent studies indicate that a rapid rise in PSA levels may signal prostatitis 3 

While a sudden significant rise in PSA value is cause for concern and should be checked, it is unlikely that the cause of the rise in prostate cancer. However, men with a normal digital rectal exam and an elevated PSA should schedule a repeat PSA test within 30 to 60 days test to confirm the elevated value before any further evaluation, or a treatment plan is initiated. 

A PSA rise is like a warning signal. It generally means that the prostate is unhappy and warrants attention. However, it does not mean that something is dramatically wrong. A sudden, significant jump in PSA level may mean an infection or a temporary upset in the prostate. 

In men that have already been found to have localized prostate cancer, a sudden rise in PSA may signal cancer has turned aggressive with the potential to metastasize. In any case, it is appropriate to further check it out. 

If an infection is present, a repeat PSA can be scheduled after the infection is cleared. If evidence suggests the rise is due to an external event, the PSA test can be repeated in 30 to 60 days. A biopsy to rule out cancer is not warranted simply because of a rise in PSA.

Treating Prostatitis

Prostatitis is not always treatable. In fact, one of the most common types is a chronic condition that is not due to bacterial infection or any other obvious identifiable cause. The medical community has called it chronic nonbacterial prostatitis or chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). It is a long-term condition marked by pelvic pain and various lower urinary tract symptoms. 

To date, there is no known cause for the CP/CPPS condition. Laboratory examinations do not indicate any bacterial involvement. Symptoms tend to stay about the same over time or go through cycles of being more or less severe. Unless symptoms are severe or debilitating, treatment is usually unneeded. Some urologists recommend removal of the prostate, but the long term side effects of the surgery usually rule out this approach. 

Bacterial infections of the prostate can be either acute or chronic. Acute prostatitis generally starts suddenly and causes pelvic pain and/or flu-like signs and symptoms, such as fever, chills, nausea, and vomiting. This type of prostatitis is usually caused by common strains of bacteria from either the urinary tract or the rectum and is treated with antibiotics. If left untreated, it can cause serious life-threatening infections. 

Chronic bacterial prostatitis is more common and a less severe infection than the acute version. Both are conditions where bacteria is found to have caused the infection. Antibiotics are usually used in this case as well but may have trouble reaching and killing bacteria deep in the prostate. 

For acute prostatitis, a short course of antibiotics (usually Cipro) for one week to ten days is often prescribed. This short-term treatment may resolve the prostatitis problem if it is randomly caused by a bacterial infection like a spillover from a urinary tract infection.

Short-term antibiotic treatment is unlikely to affect long-term chronic prostatitis. This condition is often treated with antibiotics for longer periods of time, typically 4 to 8 weeks. 

When antibiotics don’t eliminate the bacteria causing prostatitis, or, if they eliminate them temporarily, a difficult-to-treat recurring infection may ensue over the long term. Symptoms may disappear for a while, only to reoccur later on. 

Conclusions

Some urologists treat a rapid rise in a routine PSA test as an immediate indicator for a prostate biopsy. Fortunately, the number of urologists following this obsolete view is dwindling.

A biopsy is an invasive procedure that often results in unnecessary pain, risk, and possibly additional unneeded treatments. While such a rise in PSA levels may indicate prostate cancer, it can also indicate prostatitis or other conditions.

Acute prostatitis is usually the result of an infection spilling over from either the urinary tract or fecal material transferred to the prostate inadvertently. Treatment with antibiotics is usually successful in clearing the infection. When the prostatitis is chronic, antibiotics may work, but in many cases, it is likely the infection will return after a period of time.  

The prostate is an organ that contains many small vessels and capillaries. This makes it harder for antibiotics to get into prostate tissue to treat prostatitis. Chronic prostate infections typically are treated with a long course of antibiotics, usually several months. Additionally, many men undergo multiple short courses of antibiotic treatment as well as longer courses for chronic prostatitis. 

In acute cases, the infection may be cleared, but success is spotty in chronic cases. Since long-term antibiotic treatment has numerous undesired side effects, savvy doctors often enlist naturopathic doctors or herbalists to treat chronic prostate infections naturally. 

Herbal remedies or other natural prostatitis treatments can typically help reduce the infection without the use of powerful antibiotics. Additionally, herbal and/or natural remedies typically do not have debilitating side effects, making them the prime choice for this type of condition.

Some unconscionable urologists tend to order a biopsy for almost every man that enters their office with a prostate problem. A prostate biopsy is one of many methods for examining the prostate gland in the hunt for cancerous growth. Prostatitis is NOT cancer, and any doctor that reflexively orders a prostate biopsy due to out-of-range PSA levels is not putting the best interests of their patient first. 4 

Next Up

Find out 12 Steps To Better Prostate Health.

Prostate cancer

Prostate cancer (prostate cancer) is a malignant neoplasm that arises from the secretory epithelium of the prostate gland.

A number of tumor risk factors have been identified:

• age: the older the man, the higher the risk of developing a tumor;
• heredity: in men whose relatives suffered from prostate cancer, the risk of getting sick is much higher;
• the consumption of large amounts of animal fats contributes to the occurrence of malignant neoplasms;
• smoking.Chemical compounds in tobacco smoke have an impact on the development of prostate cancer.

Thus, in men under 40 years of age, the prevalence of the disease is 1 in 10,000 people, in men 60 years old – 1 in 100, and in men 75 years old – 1 in 8 people. In the case of the presence of prostate cancer in relatives, the risk increases by 4-7 times.

Prostate cancer symptoms

In the early stages prostate cancer usually does not manifest itself.Due to the fact that prostate cancer progresses relatively slowly, for several years the disease proceeds with practically no symptoms. The only sign of the disease in the absence of pronounced symptoms is an increase in the level of PSA (prostate specific antigen) in the blood. Unfortunately, some urologists regard this increase as a manifestation of prostate adenoma or exacerbation of chronic prostatitis. With an increase in the size of the tumor and its growth into the urethra and the neck of the bladder, the following symptoms are possible:

• Difficulty urinating;
• frequent urination;
• urinary incontinence;
• Frequent urge to urinate.

In some cases, symptoms of impaired outflow of urine from the kidneys may appear:

• formation of kidney stones;
• pain in the lumbar region;
• dilatation of the ureters and pelvicellular system.

In the later stages of the disease, symptoms associated with the spread of metastases appear. Most often, metastases of prostate cancer affect bones (spine, pelvic bones, ribs, etc.), retroperitoneal lymph nodes, less often – the liver, lungs.Bone metastases can restrict movement, cause pain in the bones, lower back, and pathological fractures occur. The defeat of the lymph nodes of the pelvis can lead to the appearance of edema of the legs, scrotum, penis, pain in the groin, lower back. As the tumor progresses, the patient’s condition worsens, cachexia (extreme depletion of the body) and anemia (a decrease in the number of red blood cells) develop.

Diagnosis of prostate cancer

Since prostate cancer in the early stages does not have vivid manifestations, it is necessary to undergo regular examination.A mandatory diagnostic method is a digital rectal examination of the prostate gland, which is carried out by a urologist. He probes the prostate through the rectal wall with a finger inserted into the anus.

During this examination, it is possible to identify compaction of the prostate, after which additional examinations are prescribed:

• determination of the PSA level;
• ultrasound of the prostate;
• prostate biopsy.

The “gold” diagnostic standard and the main screening method is the determination of the PSA level in blood, which allows one to speak about the presence or absence of a tumor.

After determining the PSA level of the blood, the next stage of diagnosis is an ultrasound examination of the prostate gland with a special rectal sensor through the rectum, which allows you to measure the volume of the prostate gland, as well as to identify the presence of formations and seals.

Prostate biopsy should be done if there are suspicious areas in the prostate gland or if PSA is elevated.

For this, tissue samples are taken from 12 different areas of the gland under the control of transrectal ultrasound (TRUS).

An accurate diagnosis of “prostate cancer” can be made only after the experts are convinced that the tumor is indeed malignant. For this, tumor cells must be examined under a microscope
. Puncture biopsy of the prostate is done to obtain pieces of the tumor.
An ultrasonic transducer is inserted through the anus into the rectum, with the help of which pieces of the prostate are taken from the desired area with a special needle. To obtain the required amount of material, as a rule, 12 injections are performed.Pain relief is usually not required. The whole procedure takes no more than 15 minutes and is usually done without complications. Very rarely, after a biopsy, an admixture of blood in the urine (hematuria) and semen (hemospermia), urinary disorders (rapid, difficult, painful), bleeding from the rectum, acute prostatitis (development of an infectious process in the prostate gland), acute urinary retention may appear. Hematuria
and rectal bleeding usually go away in a couple of days.

If a negative result is obtained and an elevated PSA level persists, a second biopsy is performed within several months.

If necessary, it is possible to perform MRI and CT of the small pelvis.

Prostate cancer treatment

The main treatments for prostate cancer include:

1. Expectant management is preferable in elderly men with severe concomitant diseases and slowly growing highly differentiated tumors.In this case, no treatment is carried out, however, the patient is constantly under the constant supervision of a doctor, an ultrasound scan is performed regularly and the PSA level in the blood is examined. In the future, if there is a progression of the disease and the appearance of symptoms of the disease, hormonal or radiation therapy is recommended.

2. Radical prostatectomy – surgical treatment for prostate cancer . Radical prostatectomy is the main treatment and preserves the normal function of the bladder sphincter and sexual function in the early stages of the disease.In the early stages of the development of the disease and in the absence of damage to the lymph nodes, the ten-year survival rate after surgery is more than 90%. In some cases, radiation or hormonal therapy for prostate cancer may be additionally used. The operation is performed by an open method or laparoscopically.

3. Radiation therapy is used to destroy malignant tissue and disrupt the DNA structure of the irradiated cells, as a result of which they lose the ability to reproduce.Separately, it is worth noting interstitial radiation therapy, in which irradiation occurs from the inside, and not from the outside, which excludes irradiation of healthy tissues and ensures the high efficiency of this method. It is not used in patients with difficulty urinating, the presence of residual urine.

4. Hormone therapy – treatment with hormonal drugs. This method is used when it is impossible to treat with other methods, and the effectiveness of the method is 70-80%. Recommended for patients with locally advanced disease, with severe symptoms, in elderly patients or with concomitant pathology.

PSA or PHI

Prostate cancer is one of the most common tumors in men after lung cancer. Early recognition has a great chance of a complete cure. For this purpose, the prostate-specific antigen, PSA, has long been used as a tumor marker. It is called specific because it is accurate for examining the prostate gland, but it is not accurate enough for detecting malignant tumors, because may increase with a number of other prostate diseases.The Prostate Health Index – PHI, is recognized by the international cancer community as the most reliable indicator among tumor markers at the moment.

Let’s get it clear right away. The only recognized and accurate method for diagnosing cancer is histological examination – the study of prostate tissue obtained by biopsy. Biopsy is an invasive procedure, it is performed strictly according to indications and can cause complications: bleeding, inflammation, pain, problems with urination.PSA and PHI allow you to distinguish the category of people who really need a biopsy.

Prostate gland. How does it change with age?

The prostate is a small chestnut-shaped gland located under the bladder and in front of the rectum. The function of the prostate is very important – it produces PSA, which is necessary for sperm thinning and sperm motility. With age, the tissue of the gland begins to grow, and every second man develops an adenoma, or benign prostatic hyperplasia (BPH).There is a risk of degeneration into malignant cells.

How to suspect a tumor?

The initial stages of the disease often do not manifest themselves in any way, and the patient is not alert to consult a doctor in a timely manner. “Alarming signs” are problems with urination, when the tissues of the prostate squeeze the urethra at the exit from the bladder: with strong urges, the stream is sluggish and there is little urine, and therefore frequent night trips to the toilet. Problems with erection appear, intercourse is accompanied by pain, blood in the urine is possible.It is not uncommon for a man to turn to other specialists with complaints of pain in the spine, ribs and pelvic bones, missing the primary signs – this may be a manifestation of advanced stages when the tumor spreads throughout the body, giving metastases.

This suggests a conclusion: there is no need to wait. It is recommended to be examined for PSA annually for every man over 40 years old. Other risk factors are also taken into account: familial cases of prostate cancer, obesity, smoking, alcohol abuse.

What is a PSA study for?

PSA is used as a tumor marker, its high level is associated with the development of cancer. Tumor cells disrupt the structure of the prostate gland, as a result of which PSA enters the general bloodstream. But sometimes PSA “leak” can occur in benign conditions. Total PSA is the sum of all forms of PSA and normally does not exceed 4 ng / ml. Values ​​up to 10 ng / ml are possible in benign pathology (BPH). A PSA level above 10 ng / ml indicates a high risk of cancer and is an indication for biopsy.

Total PSA is not a specific sign of oncology, values ​​from 2 to 10 ng / ml can be detected both in benign changes and in a malignant tumor.

Moreover, an increase in PSA levels is possible with inflammation of the prostate, trauma and other effects on the organ.

What is PHI and what is its advantage over general PSA?

PHI – Prostate Health Index – a test that determines the level of total PSA, the percentage of free PSA, – 2proPSA and calculates indicators that accurately indicate the risk of developing cancer.This is possible due to the fact that scientists have found and isolated the form – 2proPSA. It is produced by malignant cells of an aggressive tumor, and at an early stage may not affect the level of total PSA.

International research has highlighted a number of PHI benefits:

• Improves the detection of prostate cancer, especially with a PSA level of 2-10 ng / ml
• Reduces unnecessary biopsies – a rather traumatic procedure
• Increases the likelihood of detecting aggressive forms of cancer requiring active treatment
• During the initial examination, it makes it possible to more accurately identify patients in the category of high risk of developing cancer.

Who is the PHI study shown to?

• At a total PSA level from 2 to 10 ng / ml
• In case of suspicion of a tumor of the prostate gland by digital examination and ultrasound data
• In the presence of “warning signs”
• Observation of patients with established prostate cancer during or after anticancer treatment in order to detect early tumor progression
• Prophylactic examination of men over 40 years old

How to decipher the result?

A PHI of less than 25 indicates a low risk of cancer.Retesting for PSA and PHI is recommended after one year.

PHI greater than 25 indicates a high risk of prostate cancer and requires a biopsy.

How to properly prepare for the study?

Considering that PSA can increase after exposure to the prostate, the study should be carried out no earlier than:

• One month after prostate biopsy and cystoscopy
• 10 days after transrectal ultrasound (TRUS) and prostate massage
• Abstain from intercourse per day

You can donate venous blood during the day 3 hours after eating.

Remember! Timely examination allows you to detect cancer at an early stage, when a complete cure is possible.

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90,000 Prostate cancer – male disease

© Gettyimages.com photo

September 15 – International Day Against Prostate Cancer.

The September date, highlighted in the calendar, is intended to highlight the growing incidence of prostate cancer in men. Among cancer patients of the “strong half” of humanity, this form of cancer is the cause of almost 10% of deaths and one of the main causes of death among elderly men. The problem of early detection of prostate cancer is especially acute. Doctors recommend that all men after 40 years of age undergo a prophylactic examination of the prostate gland annually.

Algirdas Rumskas, a urologist at the Medical Diagnostic and Treatment Center located in Vilnius at ul. V. Gribo, 32A.

– What is prostate cancer and what are its symptoms?

– Prostate cancer is a malignant disease. Its symptoms are probably known to most men: heavy and painful urination, frequent, sometimes uncontrollable urge (especially at night), weak jet pressure, discomfort in the pelvic region and back pain, weight loss, blood or semen in the urine, weakening of potency.The trouble is, there are no symptoms of prostate cancer at the onset of the disease. That is why all men, upon reaching the age of 40-45, are recommended to be tested annually for prostate cancer.

– What are the causes of the disease?

– The reasons are not fully understood. Men who have had a history of cancer in their family are at higher risk. It is noticed that the disease is promoted by irregular, unhealthy diet with a high content of animal fat, insufficient intake of fresh vegetables and fruits.Most often, prostate cancer attacks men over 50.

– How to diagnose prostate cancer?

– First of all, two examinations are carried out: a blood test for the PSA level and a digital rectal examination.

PSA (prostate specific antigen) is a protein that is formed in the prostate tissue and is present in the blood of a healthy man in small amounts. An increase in PSA levels in the blood may indicate the presence of prostate cancer.But an elevated PSA level does not always indicate the presence of cancer. With prostate adenoma (benign enlargement) and inflammation of the prostate (prostatitis), PSA levels also increase.

Therefore, the second test is so important, during which the doctor feels the prostate through the rectum, assessing its shape, surface, sulcus, presence of nodes or soreness and size. With this examination, an experienced doctor can detect even a very small tumor – only 0.2 ml.

Blood counts and data obtained during examination can be a starting point for further mandatory studies that finally confirm the presence or absence of a diagnosis – this is an ultrasound examination (ultrasound) and a biopsy (a method in which a doctor uses a special needle to take a piece of prostate tissue for histological examination under a microscope).

When confirming the diagnosis, the doctor prescribes magnetic resonance imaging to find out if there are metastases, that is, whether the cancer has spread to other organs.

– How is prostate cancer treated?

– Choosing an effective treatment is not an easy task. Many factors need to be weighed: the patient’s age, health status, PSA values, stage of cancer, and the body’s willingness to tolerate possible side effects.

A patient with a confirmed diagnosis is surgically removed from the prostate gland.In the early stages of cancer, the tactics of waiting and observation (monitoring) are chosen or, if necessary, radiation therapy is used. Sometimes this tactic is the best, especially for older men with serious chronic diseases who do not feel any symptoms of cancer. The peculiarity of prostate cancer is that it grows very slowly. Some men do not need treatment for the rest of their lives.

It is also common practice in the treatment of prostate cancer to prescribe hormonal or chemotherapy.To relieve the disease, transurethral resection of the prostate or radiation therapy may be performed.

– How can men protect themselves from this disease?

– We, urologists, first of all recommend that you periodically take a blood test for PSA. For men over 40 – once a year, over the age of 50 – twice.

There are studies that men who include tomatoes and foods made from them, such as ketchup, are less likely to suffer from prostate cancer, as they contain a substance such as lycopene.

Dietary supplements containing selenium have also been found to reduce the risk of prostate cancer.

However, it is important for all men to remember: prostate cancer, diagnosed at an early stage, is now completely curable!

90,000 8 signs of prostate cancer. Early symptoms of prostate cancer

Prostate cancer is the second leading cause of cancer death among men. However, most men who develop prostate cancer are cured.And statistics show that the chances of survival with this oncology with timely diagnosis is more than 90%.

Little accessible physiology

In men, the urethra is a narrow tube that drains urine from the bladder. The urethra also passes through the prostate gland, which is responsible for the production of semen. The latter mixes with sperm and forms sperm.

As the prostate tumor grows in size, it presses on the urethra, causing blockage and prostate cancer symptoms.However, prostate cancer is a slow growing cancer, and symptoms may take years to appear.

Symptoms or signs of prostate cancer

Some of the symptoms a person with this cancer may experience include:

1. Strong urge, but weak urine flow when urinating.
2. Difficulty starting (starting) urination.
3. Increased frequency of urination.
4. The stream of urine can be unstable, repeatedly starting and stopping.
5. Feeling that emptying is incomplete and that the bladder is still not empty after urinating.
6. Pain or burning sensation when urinating.
7. Blood in the urine called hematuria.
8. Erectile dysfunction.

In more common cancers, pain can be felt in different areas of the body, depending on where the metastases are. Loss of appetite, general feeling of tiredness and malaise are common symptoms of cancer.

If the cancer has spread to the bone, the affected bone can become painful and fragile, making it difficult to move and increasing the chance of fracture. Involvement of the spine often results in pressure on the spinal cord, which can cause numbness and tingling in the legs. This is called malignant spinal cord compression.

What to do to diagnose prostate cancer?

Symptoms of prostate cancer can take years to build as it is usually a slow growing cancer.

The steps taken to diagnose prostate cancer are described below:

1. To check the infectious component, a primary check of urine and blood (general analysis) is carried out.
2. Digital rectal examination. This diagnosis is done by a doctor to identify abnormalities of the prostate gland through the rectal wall. The area is checked for enlargement, unevenness, or hardening of the prostate gland. The procedure is usually not painful, but it can be a little uncomfortable.In malignant oncology, the prostate can be felt in a hard and uneven (lumpy) shape.
3. Blood tests are performed to measure the level of prostate-specific antigen (PSA). PSA is a protein secreted by the prostate gland and small amounts are usually found in human blood. PSA levels increase with age, but rise significantly in the case of prostate cancer.
4. Transrectal ultrasound, which involves insertion of a probe into the rectum for evaluative generation of images of the prostate gland.
5. Cystoscopy can be performed to check the urethra and the inside of the bladder.
6. Biopsy is the gold standard for the detection and confirmation of prostate cancer. A small sample of tissue is taken and examined under a microscope for the presence of cancer cells.
7. For more complex prostate cancers, the entire body is examined using imaging techniques such as magnetic resonance imaging (MRI) or computed tomography (CT) to assess the spread of cancer to other organs.A bone scan may also be recommended to check for metastases.

Pay attention to for the harbingers of this oncology. The best prevention is periodic check-ups with a specialist, especially after 30 years. Due to the fact that prostate cancer is “getting younger” and cases of its occurrence at a younger age are no longer uncommon.

In 2018, 21 patients were registered at the dispensary in the primary oncological office of the State Healthcare Institution “Terengulskaya RB”

In 2019, 23 patients were registered at the dispensary in the primary oncology office of the State Healthcare Institution “Terengulskaya RB”

Notes:

Prevention of prostate cancer

The described methods for diagnosing prostate cancer can be used for its prevention.Current guidelines for the prevention of prostate cancer include the following:

• All men aged 45 and over 50 should have a PSA test and a digital prostate examination;
• If the PSA level rises above 4 ng / L, it is recommended to undergo transrectal ultrasound and other examinations of the prostate.
• When signs of a tumor are detected, the patient is referred to a urologist, and if indicated, to an oncourologist.

Therefore, it is very important to undergo medical examination once every three years from 18 to 39 years old, and from 40 years old annually.

Klyueva T.V.,
Doctor of the SEK “Terengulskaya RB”

dog blood test general for prostatitis norm

dog blood test general for prostatitis norm

The manufacturer positions the drug as a natural remedy of complex action. Testing, which was carried out in various urological clinics, showed the absolute safety of the drug, and also received a lot of positive feedback from both doctors and patients.

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General analysis of PSA for prostatitis.There is the only way to detect prostate cancer in its asymptomatic course – it is a PSA blood test for general prostatitis. The need for a general PSA analysis in prostatitis. The norm of the indicator of the presence of antigen in the blood is overestimated. PSA in chronic prostatitis makes it possible to detect inflammation and oncology in the prostate, so it is mandatory for diagnosis. If the PSA blood test for general prostatitis is performed correctly, and the protein level is at least 4 ng / ml and not more than 10.A general PSA blood test for prostatitis, the cost of which is specified in the clinic, is recommended for men over the age of 50 every year. Moreover, for. The PSA test rate for prostatitis differs for men of different ages. And an increase in PSA in chronic prostatitis may indicate. Free and total PSA in prostatitis: blood test rates and causes of abnormalities. The prostate is a vital gland of the endocrine system, which. What is a PSA blood test for prostatitis? Dangerous values ​​of total PSA: from 10 to 20 ng / ml – probably oncological damage to the lymph nodes in the region of the gland, at 50, the presence of a malignant neoplasm is practically not in doubt, at 100, an extensive one is usually diagnosed.The accumulation of PSA in prostatitis in the blood of a male representative directly reflects. Permissible PSA level for prostatitis. What is PSA ?. Indications for PSA testing. A specialist prescribes a blood test for the amount of prostate-specific antigen. PSA analysis for prostatitis – concept and norm. The index of prostate specific antigen (PSA) is significant. Exceeding the norm in terms of a general blood test varies proportionally with the degree of development of the inflammatory process in the prostate gland: the more.To determine the level of protein, a general PSA blood test is taken for prostatitis. The antigen rate is no more than 4 ng / ml. The production of this protein increases significantly with the formation of malignant cells. One of the ways to diagnose inflammation in the prostate gland is to donate blood for the PSA tumor marker. Knowing the indicators are normal, an experienced doctor will not only confirm the preliminary conclusion about the disease.

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This drug improves immunity and treats inflammation without secondary reactions to the kidneys and liver.It has been tested by various clinical trials, and is GOST and ISO certified. My patients were convinced from their own experience that Urotrin quickly relieves the symptoms of nephritis and reduces the number of exacerbations. Constant stress, bad habits and an unhealthy lifestyle cause a number of diseases, among which the most common are diabetes, cardiovascular diseases, and erectile disorders in men. A decrease in immunity causes the development of inflammatory processes even with the slightest cold.But if angina is a local infectious disease, then inflammation of the bladder adversely affects the kidneys and the prostate gland. To prevent such exacerbations and protect men’s health, I recommend taking the drug Urotrin. It suppresses infections by preventing exacerbations of cystitis, urethritis and prostatitis. After another course of treatment for prostatitis, the doctor said that he should take care and take something prophylactic. I wrote a whole bunch of different native medicines, but when I broke through their prices, it turned out that they bite a lot, and the reviews are very contradictory.Stumbled upon urotrin by chance. I did not find analogues in terms of composition, except for mono-drugs, so I decided to buy. Although the site said it was only sold online, I found it in a dietary supplement store. I was alarmed that the price was slightly lower than on the site, so I did not take it and ordered it on the Internet.

90,000 What men need to know to avoid cancer – Rossiyskaya Gazeta

Every third case of cancer in men is either lung cancer or prostate cancer.But if everything is more or less clear with the lungs – smoking is to blame, then how to protect the “second heart” of a man from cancer? Vsevolod Matveev, a well-known urologist-oncologist, deputy director for scientific and innovative work of the NN Blokhin National Medical Research Center of Oncology, Corresponding Member of the Russian Academy of Sciences, spoke about this to “RG-Week”.

The older the man, the higher the risk of developing prostate cancer, in 60-year-olds and older this type of cancer is already in first place. In our country, 38 thousand men die from it every year. What are the reasons for the increased incidence? After all, we will know the reasons – we will be able to defend ourselves.

Vsevolod Matveev : There are several reasons. First, the aging of the population. Cancer occurs mainly in older men. The second reason for the alarming statistics is actually a blessing: we have become more active in detecting early forms of this type of cancer, since in our arsenal there is such a marker as a prostate specific antigen – it is determined by a blood test. A normal PSA level in men indicates the absence of deviations, and exceeding the established norms – they depend on age – may indicate the presence of a pathological process, including oncology.And in such cases, the man must undergo additional tests.

Earlier, when this marker was not yet known, men consulted a doctor when symptoms of the disease already appeared. And as a result, the diagnosis was made at a later stage of the disease.

The third point – we see not only an increase in the incidence associated with a more thorough and early diagnosis, but also a true increase. Indeed, prostate cancer is more common today. There is no one reason that would lead to the development of cancer.But there are risk factors: old age, heredity, black race, overweight, sedentary lifestyle, unbalanced diet – fatty foods, diet high in calcium.

What symptoms can indicate that a person has prostate cancer? When does a man need to run to the urologist without delay?

Vsevolod Matveev : Any violations of urination should be alerted – frequent, difficult, painful, blood in the ejaculate, in the urine.But, of course, similar symptoms occur in other diseases as well. There are no specific signs that specifically indicate cancer. Therefore, trouble is not a reason for panic, but for a thorough examination.

This type of cancer is not the most severe, it develops slowly and is not difficult to diagnose. With prostate cancer, it’s no secret, people today can live for 10 years or more.

Vsevolod Matveev: Today in the world, about every fifth man has a probability of contracting prostate cancer.But only one in 30 dies from it. This suggests that in most men the disease is latent and does not lead to death. In addition, effective treatments have emerged. This difference between morbidity and mortality is not typical for all cancers, but for prostate cancer.

What can a man himself do in order not to miss the disease? Should he himself, for example, control the PSA level?

Photo: Infographics “RG” / Leonid Kuleshov / Irina Innocent

Vsevolod Matveev : Here you need to understand: PSA marker is not specific for prostate cancer.It increases not only in malignant tumors, but also in benign hyperplasia (prostate adenoma), in inflammatory diseases, with mechanical action on the prostate gland – massage, instrumental studies. Therefore, the interpretation of the result is a very difficult thing. One cannot judge anything from one analysis, dynamics is important to decide what to do with the patient – take a biopsy or leave him under observation, etc. But this does not mean that this test should be done by everyone in order to “catch” the oncological disease.In Europe, America, large-scale studies have been conducted on the feasibility of screening for prostate cancer based on PSA. Since this type of cancer develops very slowly, there is no need to carry out such studies “just in case”, young patients who do not have any deviations and complaints. The result will not be comparable to the costs. Another thing is early diagnosis, which is carried out if the patient has at least some symptoms. Here a PSA test is required, and the doctor will, of course, prescribe it.

But you asked what the patient himself can do. We welcome the so-called “risk adapted” early diagnosis. If a man knows that his closest relatives had cancer, he should be wary of his health. This is an ironclad reason for doing a PSA test. Moreover, we are talking not only about cases of cancer in the male line, but also on the female line. In men, it is prostate cancer – in the father, brother, and in women, breast cancer – in the mother, sister. The fact is that there are hereditary diseases associated with the mutation of a certain gene, and the presence of this mutation greatly increases the risk of malignant neoplasm.

Can you give specific recommendations?

Vsevolod Matveev : Men, especially those at risk, need to have their first PSA test at 40-45 years old. The indicator should normally be less than one. If it is more than one, then it must be repeated annually. If everything is in order, the next time it can be repeated after 8 years.
For men 60 years old, the approach is the same, but the norms are different. For them, PSA should be less than 2. If more, then you need to repeat the test annually and watch the dynamics.If the result is less than 2, the next control is carried out at age 68.

If there are abnormalities in the PSA test, does this mean that the patient should be examined with an eye to possible cancer?

Vsevolod Matveev : First of all, the analysis needs to be repeated, and if it is still elevated, expand the examination to address the need for a biopsy. Additional tests such as PHI (Prostate Health Index) and MRI of the prostate (magnetic resonance imaging) can be performed.

Do all patients, if the diagnosis is confirmed, need to start treatment immediately?

Vsevolod Matveev : With regard to non-aggressive forms of prostate cancer, which, as I said, develops slowly, we use this type of therapeutic approach as active observation. That is, the patient does not receive any treatment, but is regularly examined. If there are signs that the tumor is becoming aggressive, begins to grow, then we carry out treatment.Basically, this tactic is applied to elderly patients. If a man of 70-75 years old has found a non-aggressive initial form of prostate cancer, the probability that he will need treatment is no more than 50 percent. He would rather die from other causes – cardiovascular diseases, for example.

Cancer causes fear that is close to horror, although we are told that today cancer is treated much better. But we see that people are still dying from it. What do we have in terms of treatment options for prostate cancer?

Vsevolod Matveev : The treatment options are the same all over the world, and in Russia they are absolutely the same as in other countries.If we are talking about the initial stages, then this is a treatment aimed at healing. As a rule, surgical and radiation methods are used, if necessary, a combination of them: surgery plus radiation therapy. The surgery can be performed openly, laparoscopically, using robotic systems. There are also many different techniques in radiation therapy, and new ones are constantly being developed. There is interstitial radiation therapy, brachytherapy, there is external conformal radiation therapy, not so long ago they began to use proton therapy, etc.e. The essence is the same. There is radiation therapy and there is surgery. These are the two main treatments for prostate cancer.

If we talk about the more advanced stages of cancer, up to the fourth stage, then here, too, great success has been achieved in treatment. Today, patients with even widespread metastases live on average five years, and of course, it is extremely important to preserve the quality of life for such patients. In addition to the usual hormone therapy, which has been used since the 60s and 70s, second, third and fourth line drugs have appeared.Usually, treatment is started based on the stage, symptoms, age of the patient, treatment tolerance, and side effects that arise. All this together makes it possible for an experienced oncologist to decide which drug is preferable at the first stage of treatment, which at the second, etc. Ideally, patients receive all existing drugs, because each one adds something to increase longevity.

Recently, a new isotope preparation of radium-223 chloride, which is used in metastatic prostate cancer, has been registered in Russia.This is a new step in the development of oncology and the treatment of prostate cancer. In general, radiation exposure to bone metastases has been used for many years – isotopes of samarium and strontium are used. But these drugs give beta radiation, it negatively affects the bone marrow, hematopoiesis. In addition, their treatment was more palliative in nature, they reduced pain, but did not affect life expectancy. The isotope of radium-223 is a source of alpha radiation, its effect is not so deep, while the bone marrow does not suffer.Accordingly, it is possible to increase the radiation dose to metastases with minimal toxicity to the bone marrow. But most importantly, in addition to the analgesic effect, it acts on tumor cells in bone structures and actually prolongs the life of patients with bone metastases.

How affordable are modern medicines in our country?

Vsevolod Matveev : I can say one thing, the situation is gradually improving. In Moscow, for example, the government buys a huge amount of drugs, our patients are well supplied with drugs.In other regions, the situation is worse. The availability of many drugs is limited. Of course, it is necessary to address the issue of including innovative drugs in treatment standards and protocols, in various restrictive lists, for example, in vital and essential drugs. It is necessary to make the most of the possibilities of high-tech medical care in the field of oncology. It is very important to make sure that even such expensive therapy is available to our patients and is provided free of charge. And yet, in general, if you look at what happened five years ago and now, the situation is improving.

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Photo: RIA Novosti

Vsevolod Matveev .

Graduate of the 1st MMI im. THEM. Sechenov. Has been engaged in medical work since 1990. For several years he worked as a urologist at the Royal Free Hospital, London, received an internship certificate from the Royal College of Surgeons of England. Doctor of Medical Sciences, Professor, Corresponding Member of the Russian Academy of Sciences. Has over 350 scientific papers. Head of the urology department of the N.N.N.N. Blokhin of the Ministry of Health of Russia “. President of the Russian Society of Urological Oncology. Expert of the European Association of Urologists (EAU), Section” Prostate Cancer. ” and proven facts: for example, smoked and fried food is evil Meat, fish, eggs, potatoes cooked in hot oil or with “smoke” contain substances that provoke disease.Not so long ago, scientists found out that milk is not at all such a harmless product as we used to think. Scientists at the US National Cancer Institute were the first to identify a pattern: women who consume a lot of dairy products are more likely to develop breast cancer. More recent studies have confirmed that excess milk (more than 4 servings per day) increases the risk of breast and ovarian cancer in women and prostate cancer in men. Scientists explained that milk contains a lot of saturated fatty acids, estrogens, insulin-like growth factors that provoke tumor processes.The risk of prostate cancer in men is also associated with excess calcium in food, and its main source is just dairy products. On the other hand, calcium protects against rectal cancer. So oncologists do not urge men to completely abandon milk, but not to overdo it with its amount and give preference to fermented milk products.

What food can protect against cancer? Antioxidants, which are abundant in fresh vegetables and fruits, are powerful cancer protectors. Lycopene is well studied – there is a lot of it in tomatoes.Such a “protector” as indole-3-carbinol is also very much needed – all types of cabbage are rich in them, especially dark green broccoli. The flavonoid with the long name epigallocatechin-3-gallate, abundant in green tea, is the most active of the four tea catechins. Its anti-cancer efficacy is 100 times higher than that of vitamin C and 25 times higher than that of vitamin E. In countries where green tea is drunk every day, prostate cancer is rare.

Prostate Health Assessment (Multivariate Prostate Cancer Risk Assessment)

Study material
Blood serum

Method of determination
Immunoassay (UniCel® DxI 800 technology, Beckman Coulter).

1. PSA (prostate specific antigen, total PSA, PSA)

2. Free PSA (free PSA, fPSA)

3. [-2] -pro-PSA ([-2] -pro-PSA, p2PSA)

4.% free PSA / PSA ratio (% fPSA / PSA)

5. Index of health of the prostate (Prostate Health Index, phi)

Beckman Coulter technology.

Prostate specific antigen (PSA), a protein produced by prostate cells, is often elevated in men with prostate cancer.This indicator is used in complex diagnostics for suspected prostate cancer, as well as when observing a patient as a marker of the progression of an already diagnosed disease. Since prostate cancer is one of the most common causes of death from cancer in men, regular laboratory testing of PSA in the blood in combination with rectal digital examination of the prostate is often recommended for men over 50 years of age as a screening for early detection of this pathology.According to the results of such screening, in the presence of deviations (both according to the results of the PSA study above the conditional threshold, and according to the results of a digital rectal examination), the doctor may recommend a biopsy to clarify the nature of the changes. The threshold level of PSA elevation is usually considered to be> 4.0 ng / ml.

But the PSA level can be increased not only in prostate cancer, but also for other reasons – with benign prostatic hyperplasia, inflammatory diseases (prostatitis), against the background of infection.Thus, quite often the result of laboratory screening of the risk of prostate cancer turns out to be false positive, while the appointment of a prostate biopsy to confirm or deny the screening result carries the risk of complications and side effects.

According to statistics, in the group of patients with PSA values ​​in the area of ​​a slight increase from 4 to 10 ng / ml, during a biopsy, the presence of malignant changes is detected on average in only 25%. In recent medical literature, the issues of the effectiveness of screening, overdiagnostics, and over-treatment of clinically insignificant tumors are widely discussed.Therefore, it is important to maximize the specificity of laboratory screening in the range of the so-called “gray zone” of PSA increase from 4 to 10 ng / ml.

To increase the specificity of screening and reduce the number of referrals for biopsy, in the current algorithms of laboratory examination, when PSA is detected in the range of 4-10 ng / ml, it is recommended to simultaneously study the free PSA fraction (not complexed with other proteins), with the calculation of the% free PSA ratio / PSA total. It has been shown that the percentage of free PSA / PSA in benign variants of prostate pathology is on average higher than in malignant ones.But there is no single threshold for this indicator, which is characterized by equally high sensitivity and specificity, i.e. allowing not only not to miss the majority of patients with prostate cancer who need a biopsy, but also to exclude the majority of patients with benign pathology options that do not need a biopsy.

The search for additional informative markers drew the attention of researchers to one of the free PSA isoforms – a truncated PSA precursor molecule – [-2] -pro-PSA (p2PSA).The concentration of truncated forms of pro-PSA is increased in the peripheral zone of cancerous tissue compared to benign prostatic hyperplasia, while [-2] -pro-PSA is the predominant and most stable of them.

The p2PSA test was developed by Beckman Coulter, its clinical use is recommended in combination with the study of total PSA and free PSA, performed by the same technology, with the calculation of the multifactorial index of prostate health (Prostate Health Index – phi). phi = (p2PSA pg / ml / free.PSA ng / ml) * (total PSA ng / ml) 1/2.

An increase in phi is associated with an increased risk of prostate cancer.

The phi index is not age dependent. The use of the phi index additionally enhances the specificity of laboratory PSA screening in the 2-10 ng / ml zone and can be used to individually assess the likelihood of prostate cancer in a patient, in combination with data from the individual and family history, clinical picture, age of the patient, to discuss the need for biopsy or choice of treatment.The specificity of the phi index relative to the% PSA f / PSA ratio, when the thresholds of these indicators are selected at the level of 95% of the sensitivity for detecting cancer (phi> 23, the free PSA / PSA ratio <25%), is higher by about 10%. When choosing a threshold at a lower sensitivity level - 90%, 85%, 80% (phi = 27; 30; 32), which may be preferable to reduce the detection of possibly "insignificant" tumors, phi also has a significantly higher specificity than the ratio % PSA f / PSA, regardless of age, PSA level and ethnic group of the patient.

The question of the need for a biopsy also arises regardless of the PSA level, based on the results of a digital rectal examination. The PSA threshold on which a biopsy recommendation can be based ranges from 2.5 to 4.0 ng / ml. The feasibility of using the phi index has been demonstrated in clinical studies that included data from patients with PSA from 2-10 ng / ml according to the Hybritech calibrator (1.6 to 7.8 ng / ml according to the WHO calibrator)

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