What Is PSA?
A prostate-specific antigen (PSA) is a protein produced by the prostate gland, a small organ located just below the bladder in men. Its primary function is to liquefy semen, aiding in sperm motility. PSA levels are measured by a blood test, usually as part of routine prostate cancer screening for men in their 40s or older. Generally, low levels of PSA are normal, but elevated PSA levels may indicate an underlying issue.
Understanding Elevated PSA Levels
When a PSA test reveals higher-than-normal levels, it does not necessarily mean a man has prostate cancer. Several things can contribute to elevated PSA levels, including:
1. Benign Prostatic Hyperplasia (BPH)
Benign prostatic hyperplasia, commonly known as an enlarged prostate, is a non-cancerous condition that affects many aging men. As the prostate gland grows, it can put pressure on the urethra, causing urinary symptoms such as frequent urination, weak urine flow, and the need to urinate at night.
Prostatitis refers to prostate gland inflammation, usually caused by infection, and can temporarily raise PSA levels. Symptoms of prostatitis include pelvic pain, urinary discomfort, and sometimes flu-like symptoms.
3. Urinary Tract Infection (UTI)
In some cases, a urinary tract infection can cause elevated PSA levels. UTIs are common and can affect men of all ages. Symptoms may include pain or a burning sensation during urination, frequent urination, and cloudy or bloody urine.
4. Prostate Cancer
Prostate cancer can lead to elevated PSA levels, which is why PSA testing is a valuable screening tool for prostate cancer. However, since the above conditions can also lead to higher PSA levels, it’s important to do additional testing to determine the cause of an elevated PSA.
Next Steps for Evaluation and Management:
If your PSA level is elevated, your urologist will recommend additional tests and procedures to determine the underlying cause. These may include:
1. Digital Rectal Examination (DRE)
During a DRE, your urologist will manually examine the prostate gland for any abnormalities, such as lumps, asymmetry, or pain. This physical examination provides additional information to complement the PSA test results.
2. Imaging Tests
Your urologist may order imaging tests, such as a transrectal ultrasound (TRUS) or a prostate MRI, to view detailed images of the prostate gland. These tests can help assess the size, structure, and potential abnormalities within the gland.
3. Prostate Biopsy
A prostate biopsy is the definitive test for diagnosing prostate cancer. It involves the collection of small tissue samples from the prostate gland, which are then examined under a microscope. A biopsy is typically performed under local anesthesia, and the samples are sent to a pathology laboratory for analysis.
PSA and Prostate Cancer Screening
There isn’t necessarily a “normal” level of PSA, so many doctors recommend that a baseline PSA test be performed when a man is in his 40s. That number can be used as a guideline for future PSA tests. Combined with a digital rectal exam (DRE), a PSA test can help identify the presence of prostate cancer. Early detection is important for the best treatment outcomes.
Most men should begin regular prostate cancer screening at the age of 50, though men at a higher risk of developing prostate cancer should begin earlier. Based on your history and health status, your urologist will partner with you to determine the best time to begin prostate cancer screening, including regular PSA tests.
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