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What Everyone Should Know About Prostate-Specific Antigen (PSA) Levels

  • Screening for prostate cancer often involves a prostate-specific antigen (PSA) test, which measures the level of PSA (a protein made by the prostate) in the blood. When your PSA level is elevated, it could be a sign of prostate cancer.

    Because of this, an elevated PSA level may warrant a biopsy of the prostate, but according to Andres Correa, MD, a urological oncologist at Fox Chase Cancer Center, this isn’t always the case.

    “There are a lot of reasons for an elevated PSA level, and cancer is only one of them,” Correa said. “For instance, it may be due to an enlarged prostate, prostate inflammation or other non-malignant conditions.”

    When to See a Urologist

    According to Correa, the most important thing men should know about PSA testing is that they need a baseline test when they’re in their 40s. Knowing your individual PSA value early on allows your urologist to personalize your screening recommendations and follow any PSA elevation you experience with better accuracy.

    “And if you’re African American or have a family history of prostate cancer, you should start getting PSA tests at age 45,” he said.

    If your PSA starts rising persistently, a urologist will look at the big picture of your health to determine if there is cause for concern. They will ask about urinary symptoms, a family history of prostate cancer or prostate enlargement, other medical conditions such as those leading to metabolic syndrome, the start of new medication or supplements, and even new changes to their diet.

    Next Steps

    If your urologist thinks you might have prostate cancer, there are three diagnostic options they may recommend:

    Blood/Urine Tests: There are several commercially available blood and urine tests that can help assess the risk of the PSA elevation representing a worrisome prostate cancer. Used in the correct setting, this test may help the patient avoid invasive testing such as a prostate biopsy and in some cases the need for imaging.  

    MRI: Has become the standard of care for men who are deemed to be at risk for harboring a worrisome prostate cancer. This imaging test looks for concerning lesions in the prostate, graded using the PIRDAS system, which helps your care team identify the need for a biopsy and target areas where the cancer maybe be the most aggressive. Moreover, an MRI can also help avoid unnecessary biopsies in men who have no lesion or intermediate lesion and no other concerning factors

    High-resolution micro-ultrasound: This new technology allows for the visualization of the prostate with similar capabilities to an MRI but without the need to be inside the MRI machine or contrast agent. During this outpatient test, a probe is placed in the rectum and allows the urologist to see the architecture of the prostate. This enables them to identify any concerning lesions and, if needed, take targeted biopsies. Importantly, patients are able to get the results on the same day of the procedure.  

    Biopsy: This test is the most definitive way to diagnose prostate cancer, and the result of one or a combination of the tests above showing concern for prostate cancer. During this procedure, a probe is placed in the rectum and samples are taken to be examined under a microscope. There are some risks associated with the procedure including a chance of rectal bleeding and infection, which can be avoided with the use of a transperineal technique.  

    Additional Advice

    Having a baseline of what’s normal for you can help doctors identify possible problems in the future, so regular PSA testing later in adulthood is key.

    Knowing your risk is incredibly important, too. A family history of prostate cancer—or breast or ovarian cancer—puts you at an increased risk of developing prostate cancer.

    Also, don’t be afraid to reach out to a urologist for advice. Now, it’s easier than ever before to do that at Fox Chase.

    “With our telehealth initiative, a lot of patients don’t even have to leave their house for us to provide guidance,” Correa said. “In reality, a majority of the elevated PSA cases we see can be explained by something other than prostate cancer. However, we don’t know that for sure and can’t give patients peace of mind until we meet with them.”

    Learn more about prostate cancer diagnosis at Fox Chase Cancer Center.

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