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What will urologist do for elevated PSA?

If you have an elevated PSA level your doctor may perform a digital rectal exam to check for lumps on the prostate. They will also likely order another PSA test to see if your level continues to rise. They may order imaging tests to check for cancer on the prostate.

advancedurology.com - What Does Having a High PSA Level Mean? - Advanced Urology
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What Does Having a High PSA Level Mean?

Your body fights off foreign substances like viruses or other diseases with proteins called antigens. Antigens are produced throughout the body and can indicate if there is a problem with a specific region. For example, men produce prostate-specific antigen (PSA) which can signal potential problems with prostate or urinary tract health if levels are too high.

What is Prostate-specific Antigen?

Prostate-specific antigen, also known as PSA, is a protein produced in the prostate gland. When there are issues with the prostate gland, it affects the amount of PSA that is produced. A high PSA level can indicate a range of bigger health problems from urinary tract infection to cancer.

How is PSA level tested?

PSA level is tested with a PSA test, which is performed through a simple blood draw that shows the amount of PSA in a man’s blood stream.

What does having a high PSA level mean?

An elevated PSA level can indicate something is wrong with the prostate or an issue with another area of the body that is impacting the prostate. Although there is no “standard” range for PSA level, typically, if a man has a PSA level above 4.0 ng/mL he should have further testing done to check for larger health problems.

What can cause PSA to rise quickly?

Sudden elevated PSA can be caused by prostatitis. Prostatitis is inflammation of the prostate. When the prostate is inflamed, it can be difficult or painful to urinate. If you have prostatitis, you may experience a persistent urge to urinate, wake up at night to urinate, or feel like you need to make frequent trips to the restroom. You may also have pain in the testicles or anorectal region or general pelvic discomfort. Chronic prostatitis is usually caused by autoimmune diseases, stress, and pelvic floor spasms. Urinary tract infections, bladder infections, urinary retention, and prostate stones usually cause bacterial prostatitis. Prostatitis is usually treated with antibiotics.

How high can PSA levels go with prostatitis?

PSA levels can vary by age and individual. As mentioned before, there is no “standard range” for PSA levels, but typically anything greater than 4.0 ng/mL indicates a problem. However, your PSA level can be below 4.0 ng/mL and you can have prostatitis. After antibiotic treatment, an elevated PSA level due to prostatitis should decline.

Can a UTI raise PSA levels?

Yes. This is another cause of a high PSA level that can be treated with antibiotics. For elevated PSA levels caused by a urinary tract infection (UTI), your doctor can prescribe a course of antibiotics to treat the infection. After treatment, your PSA level should decline.

Can kidney stones affect your PSA count?

Typically, no. While kidney infections or UTIs can cause an elevated PSA count, kidney stones generally do not. Kidney stones are formed in the kidneys and pass through the bladder and urethra. PSA is produced in the prostate. If you had a kidney stone that got caught in your urethra at the prostate, and caused further inflammation of the prostate, it could result in a spike in your PSA level.

Other Reasons for an Elevated PSA Test

In addition to urinary tract infection and prostatitis, there are other reasons that can cause a high PSA level. These include:

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Should elevated PSA be repeated?

Routinely repeating a PSA test in patients with an elevated PSA level is independently associated with decreased risk of prostate biopsy and prostate cancer diagnosis. Men with an elevated PSA level should be given a repeated PSA test before proceeding to biopsy.

mayoclinicproceedings.org - Repeated Prostate-Specific Antigen Testing - Mayo Clinic Proceedings

Objective

To determine if repeating a prostate-specific antigen (PSA) test in men with an elevated PSA level is associated with a decreased risk of prostate biopsy and cancer diagnosis.

Patients and Methods

A cohort of patients referred to the Ottawa Regional Prostate Cancer Assessment Clinic from April 1, 2008, through May 31, 2013, who had referral PSA levels between 4 and 10 ng/mL were included in the study. Univariate and multivariate associations between a normal result on repeated PSA testing and the risk of prostate biopsy, cancer diagnosis, and Gleason score of 7 or higher were examined.

Results

The study cohort included 1268 patients. Repeated PSA test results were normal in 315 patients (24.8%). Men with normal results on repeated PSA testing were younger (mean ± SD age, 61.5±8.2 years vs 65.2±8.2 years; P<.001) and had lower referral PSA levels (mean ± SD, 5.5±1.4 ng/mL vs 6.6±1.5 ng/mL; P<.001) than men with an abnormal repeated PSA result. In multivariate analysis, men with normal results on repeated PSA testing were less likely to undergo prostate biopsy (relative risk [RR], 0.42; 95% CI, 0.34-0.50) and were at lower risk for cancer diagnosis (RR, 0.22; 95% CI, 0.14-0.34) and Gleason score of 7 or higher (RR, 0.16; 95% CI, 0.08-0.34) compared with men who had an abnormal repeated PSA test result.

Conclusion

Routinely repeating a PSA test in patients with an elevated PSA level is independently associated with decreased risk of prostate biopsy and prostate cancer diagnosis. Men with an elevated PSA level should be given a repeated PSA test before proceeding to biopsy.

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