Prostate-Specific Antigen (PSA) is a protein found produced in the prostate gland cells. If found at high levels, it may indicate prostate cancer, but this is not the case at all times. Although prostate cancer is a common condition with over 100 thousand cases yearly in Nigeria, other factors that can impact PSA levels are, enlarged prostate, a urinary tract infection, or recent ejaculation.
The purpose behind this article is to help consolidate the fact that alone, results of PSA levels aren’t good determinant factors of prostate health. Best practices involve using PSA levels alongside other risk factors, like age, digital rectal exam results, and family history. For a better understanding of why your PSA levels may be high, I employ you to read this article to the end.
Age may increase PSA levels. This normal rise may result from the growth of benign, prostatic tissue. It is also common in some men to also experience enlargement of their prostate as they age. This is also capable of elevating PSA levels.
2. Benign Prostatic Hyperplasia (BPH)
BPH, also known as enlarged prostate, is a condition common in men advanced in age. BPH can cause an increase in PSA levels and affect the bladder and urinary tract. BPH manifests symptoms like urination difficulty. If symptoms persist, it may also interfere with kidney function if left untreated after a while.
Common symptoms include:
- Difficulty initiating urination
- Weak urine output, which includes dribbling or straining, or stops and starts during urination
- Frequent urination
- Urgent need to urinate
- Inability to empty bladder completely
Prostate enlargement occurs in many men as they age, largely due to changing hormonal levels. BPH should not be left untreated once the symptoms are affecting the quality of life and health. Treatments include medications, such as alpha blockers or 5-alpha reductase inhibitors. If your symptoms are severe or do not respond to medication, a minimally-invasive surgical procedure or laser therapy may help to alleviate the problem.
3. Urinary Tract Infection (UTI)
UTIs can also elevate PSA levels. Urine samples are commonly collected for diagnosis and treated with antibiotics. Symptoms of a UTI include:
- a constant urge to urinate, which is not always fully relieved after urination
- inability to fully relieve the bladder
- lower back pain, particularly in the flank
- abdominal pain
- a burning sensation or pain during urination
- cloudy, foul smelling, or bloody urine
- fevers or chills
UTIs become more common as you age. Some men are also at greater risk for UTIs. Risk factors include having:
- kidney stones
- an enlarged prostate
- a compromised immune system
Talk to your doctor if you think you have a UTI. They are often treated with antibiotics. If you have high PSA levels and a known UTI, you will need to wait until you’ve recovered from your UTI before repeating the PSA test.
4. Prostatitis (prostate inflammation)
A condition common in men under 50, prostatitis is caused by a bacterial infection. It results into swelling, inflammation, and irritation of the prostate gland. Symptoms are quite similar to those of a UTI, and may include:
- lower back or abdominal pain
- pain or discomfort when urinating
- difficulty urinating
If bacterial infection is causing your prostatitis, you may also experience flu-like symptoms and be treated with antibiotics. Nerve damage in the urinary tract may also cause prostatitis. This can occur as a result of injury or as a surgical complication. If no infection is found, anti-inflammatory medication or alpha-blockers may be used to reduce discomfort.
5. Parathyroid Hormone
This naturally occurring hormone is produced by the body as a moderator of calcium levels in the blood. Pieces of evidence have suggested that it may also promote prostate cancer cell growth, even in men who do not have prostate cancer. Therefore, high levels of parathyroid hormone may cause a surge in PSA levels.
6. Prostate Injury
When there is an injury to the groin, whether by a fall, surgical procedures, impact, or accident, it may lead to a spike in PSA levels temporarily. Let your doctor know if you suspect an injury may have affected your PSA levels.
7. PSA and Cancer
High PSA level can also be an indication of Prostate cancer, so your doctor may recommend that you get a PSA blood test alongside other tests, such as a digital rectal exam, to better understand and assess your potential risk.
Generally, because of age-related factors, Doctors often recommend PSA testing in men aged 50 and older. At other times your doctor may recommend testing your levels at an earlier age if you have known risk factors for prostate cancer, like family history of the disease.
A biopsy is usually a confirmatory test to diagnose prostate cancer. It is usually the last resort if your PSA levels are high and other diagnostic tests also indicate an increased risk for prostate cancer.
It is alright to ask your doctor about all of the risks associated with biopsy. For some men, holding off on a biopsy and taking a watchful approach is a good option because prostate cancer is generally slow growing. Your doctor will go over all of your options and explain the risks associated with each option.
8. Seeking a second opinion
It is always advisable to get a second medical opinion. Doing so will help put your mind at ease about your current care or give you a different perspective. In the end, you are better informed to decide upon your best options for treatment.
Postscript, if your current doctor recommends PSA testing or further testing or biopsy after a PSA test, make sure to discuss the benefits against the risks of each procedure being recommended. Take notes or bring someone with you to your appointment to take notes for you. If you feel the need to discuss this information with another doctor, you absolutely should.
Statistics from the American Cancer Society says “Men with a PSA level between 4 and 10 (often called the “borderline range”) have about a 1 in 4 chance of having prostate cancer”. And “if the PSA is more than 10, the chance of having prostate cancer is over 50%.”
Remember that elevated PSA levels can mean many things. Prostate cancer is one of those things. Therefore it is needless to worry without further confirmatory analysis. If it feels medically necessary to have a biopsy or other testing done, make sure to weigh the benefits against the risks of each test. Prostate cancer, especially when caught early, is treatable. So are many of the other causes of elevated PSA.