If your PSA level is high, this may be a sign of prostate cancer. However, it’s also possible that you have a different condition that’s causing the increase, such as an enlarged prostate (also known as benign prostatic hyperplasia or BPH) or inflammation of the prostate (prostatitis).
Many factors can affect your PSA levels and it’s important to know them so that you can discuss your results with your doctor and make an informed decision about next steps. For example, some urologic procedures raise PSA levels for a short time. And some medicines, particularly 5-alpha reductase inhibitors used to treat enlarged prostates (such as finasteride or Propecia and dutasteride or Avodart) can lower PSA levels. Your age also affects your PSA levels. They normally rise slowly with age, even if you have no symptoms or problems with your prostate.
Your doctor will evaluate your results and factor in your age, family history and other personal information to determine if you have an increased risk of prostate cancer. Only about 25-30 percent of men with a PSA level between 2.5 and 10 will develop prostate cancer, and most of these will have very early-stage prostate cancer.
While the PSA test can be a useful tool to help diagnose prostate cancer, it doesn’t give you a complete picture of your health. The test can have false positive and false negative results. A false positive can lead to unnecessary, invasive testing that can cause anxiety and distress. A false negative can allow a cancer to spread before it’s detected, leading to a worsening prognosis.
PSA levels can also be misleading because they don’t reflect the number of cancer cells present in the prostate. A biopsy is the only way to know if you have cancer, and the type of treatment you receive will depend on the results of the biopsy.
After a prostate biopsy, your doctor will probably recommend continuing PSA tests to watch for any signs of new or recurrent cancer. These tests will also let your doctor know how well your treatment is working.
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If you’re a man of African-American or Caribbean descent, you have a greater chance of having an elevated PSA than other men your age. Your doctor will evaluate your PSA level and other risk factors and recommend other tests to screen for prostate cancer based on your unique situation.
If you have a PSA result that’s above the normal range, your doctor will likely order an ultrasound-guided prostate biopsy to get a more precise diagnosis using advanced imaging technology. If your doctor suspects that you have cancer, they’ll also likely perform a magnetic resonance imaging (MRI)-guided prostate biopsy to detect cancer cells that were missed in the first ultrasound-guided biopsy. Then they’ll decide on your best treatment options. Depending on the biopsy results, you may have surgery to remove your prostate gland (such as robotic prostatectomy), radiation therapy, cryotherapy (using extreme cold to freeze away cancerous tissue) or hormone treatment (also called androgen suppression therapy). And they’ll continue to monitor your PSA levels after your treatment to see if your cancer is still growing.
