Elevated PSA Doesn't Always Mean Prostate Cancer

NEW YORK, Sept. 8, 2015 /PRNewswire/ -- An elevated PSA is not a diagnosis for prostate cancer, nor does it always lead to a biopsy.

The PSA blood test is often the first step in screening for prostate cancer. It is included in a two-part screening process that also includes the digital rectal exam (DRE).

"The PSA level may differ depending on many factors such as age, race and family history of prostate diseases such as prostatitis. An elevated PSA doesn't always mean Prostate Cancer, that's why it is critical for every patient to receive an individualized approach," said Dr. Samadi, Chairman of Urology and Chief of Robotic Surgery at Lenox Hill Hospital.

Since the PSA is not prostate-cancer specific, abnormal results are further, or an elevated PSA is not a diagnosis for cancer.  Things like evaluating a patient, knowing their medical and family history, following a PSA trend, as well as the velocity at which PSA changes can help a physician make an informed decision about what an elevated PSA might mean.   Because PSA tests are not necessarily straightforward, simple or easy diagnostic tools, knowing the risk factors and tracking the changes in PSA can help you and your physician interpret a PSA properly.

"The PSA test is not a prostate cancer test, but it is a vital first step in identifying the potential presence of the disease. I am a firm believer in routine PSA screenings. In my experience, an elevated PSA is how many of my patients were diagnosed, combined with knowing their risk factors like family history. In the end, when we look back, that test saved their lives," noted Dr. Samadi.

So why doesn't a PSA blood test mean cancer, if that is how we screen for prostate cancer?  The truth is, that a PSA alone is not an informative enough diagnostic tool to distinguish between prostate cancer and other benign prostate conditions.  An elevated PSA can be the result of benign conditions such as prostatitis or an enlarged prostate.  Other factors that affect the interpretation of a "high" PSA are things like age, ethnicity, and family history of prostate cancer.  The only way to diagnose prostate cancer is with a prostate biopsy.

An elevated PSA is not a diagnosis for prostate cancer, nor does it always lead to a biopsy. It may indicate other conditions such as Benign Prostatic Hyperplasia (BPH), Prostatitis (enlarged prostate) or a urinary tract infection.

So besides prostate cancer, what else can cause a PSA to rise, fluctuate or become elevated?

• Age: PSA levels can increase gradually as you age
• Prostatitis: Inflammation of the prostate gland, due to infection or some unknown cause
• Benign prostatic hyperplasia (BPH): This condition refers to an enlarged prostate.  More prostate means more cells making prostate specific antigen, increasing the potential for an elevated PSA.
• Urinary tract infection: can irritate and inflame prostate cells and cause PSA to go up
• Medications: Some medications like Proscar, Avodart, or Propecia can falsely lower your PSA.  This too is important to remember.  If you are on any of these medications, talk to your doctor.  The general rule of thumb is to double your PSA for an accurate score.
• Sex/ejaculation:  This can cause a mild elevation in the PSA, but should return to normal after a few days.
• Prostate trauma: Anything that causes direct trauma to the prostate such as riding a bike, having a catheter in, a prostate biopsy, or a bladder exam can significantly increase the PSA temporarily.

"At the Dr. Samadi Prostate Cancer Center, our key approach is measuring the trend and velocity of the PSA over time. PSA mapping by a prostate cancer expert is the best way to determine if elevations are a cause for concern. A PSA level of 4.0 ng/mL is normal, while changes of more than 2.0 ng/mL over the course of a year could be an indicator of the presence of Prostate Cancer. But an elevated PSA must be weighed against specific Prostate Cancer risk factors such as age, family history and lifestyle habits," stressed Dr. Samadi.

Seeing as there are many different things that can cause an elevated PSA aside from prostate cancer, it is important to evaluate each patient individually and thoroughly.  The next step after an elevated PSA is not necessarily a biopsy, as the PSA is NOT diagnostic of cancer.  Rather, it is a "red flag" to bring attention to a potential issue.  Further treatment, as in a biopsy, depends on how high the PSA is and how much it's changed from previous readings. Coupled with a detailed history and physical, a urologist may be able to identify the cause of the elevated PSA.  After evaluating the overall clinical picture, a physician can recommend a biopsy to rule out cancer, antibiotics to treat an infection, or a scope procedure to evaluate the size of the prostate.

If an elevated PSA is first treated with antibiotics, and once retested still remains high, an MRI to examine the prostate may be needed. If further results lead to suspicion around the prostate, an MRI Fusion Guided Biopsy is the next step to determine if an elevated PSA is an indication of prostate cancer.

Patients newly diagnosed with prostate cancer or an elevated PSA can contact Dr. Samadi for a free phone consultation at 212.365.5000. Visit ProstateCancer911.com for more information and treatment options and understanding an elevated PSA.

Photo - http://photos.prnewswire.com/prnh/20150908/264199

SOURCE Dr. David Samadi

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