Definition & Overview

Prostate Specific Antigen (PSA), which is also referred to as Human Kallikrein 3 (HK3), is a substance produced by cells in the prostate gland. Its role is to liquefy semen after ejaculation and ensure that most of it is secreted from the body this way. However, small amounts of PSA may make it to the bloodstream, which is why blood tests will reveal a low PSA count. If PSA levels are elevated, this will indicate a higher risk of prostate cancer.

It’s important to note that elevated PSA does not automatically indicate the presence of cancer although it could mean a higher risk of finding cancer in a biopsy. This is the reason why a PSA test is not considered a standard diagnostic procedure when diagnosing prostate cancer as it can result in a false negative or false positive finding. Nevertheless, a PSA test is still useful in determining the presence of cancer while it’s still in its early stages. In fact, the test can even detect cancer that isn’t likely to develop and cause any symptoms.

The normal PSA level is between 1.0 to 4.0 ng/ml. Nevertheless, the risk of prostate cancer in people with elevated levels of PSA begin at <2.0 ng/ml, which would mean a risk factor of 7.1%. If the levels increase to between 2.0 and 3.9 ng/ml, the risk factor increases to 18.7%. Levels between 4.0 and 5.9 ng/ml have a risk factor of 21.3%. Between 6.0 and 7.9% are at 28.6%. 8.0 to 9.9 ng/ml at 31.7%, and above 10.0 ng/ml at 56.5%.

As earlier mentioned, elevated PSA levels do not automatically mean the presence of prostate cancer. These levels can be caused by other conditions that irritate the prostate gland. Therefore, although elevated levels do not necessarily mean the presence of cancer, they do mean the presence of a variety of diseases that affect the prostate, such as benign prostatic hyperplasia (prostate enlargement).

Cause of Condition

Elevated PSA is caused by a disruption of the prostate structure, which can be caused by certain diseases, including cancer. PSA levels can also be elevated due to the manipulation of the prostate, which usually happens during a prostate examination, catheter placement, prostate biopsy, or urinary retention. Age may also be a factor.

Elevated PSA levels can also be caused by ejaculation after sex or by riding a bicycle. However, these conditions will only result in a minor increase in PSA levels.

Key Symptoms

The symptoms associated with an elevated PSA depend on the cause of the condition, such as prostate cancer, benign prostatic hyperplasia, and other benign prostatic diseases.

It’s important to note that if an elevated PSA level indicates the presence of prostate cancer, it could be likely that the disease is still in its early stages. If so, most people won’t be displaying symptoms of the disease. The symptoms will only appear when the cancer causes urinary blockage. By then, the patient will experience difficulty in urinating, pain while urinating, and urinating in dribbles.

The symptoms of benign prostatic hyperplasia are similar to prostate cancer. The person may experience a weak urine flow or urine flowing in dribbles. There is usually a feeling that the bladder is not fully emptied after urinating. Pain during urination and an urge to urinate frequently are also common symptoms.

Prostatitis is another non-cancerous condition that can result in an elevated PSA level. It is characterized by the inflammation of the prostate, and display symptoms such as blood in the semen or urine, pain during urination, pain during ejaculation, difficulty in urinating, low back pains, and pain during bowel movement.

If an elevated level of PSA is caused by a urinary tract infection (UTI), the symptoms are pain in the lower back, cloudy urine with a strange smell, lower abdominal pain, and a need to urinate frequently.

Who To See & Types Of Treatment Available

If you experience any of the above symptoms, you should consult your doctor. The symptoms may not automatically indicate an elevated PSA level or a prostate condition, but they do indicate a problem, which could be serious.

Your doctor will likely ask questions on when you first noticed the symptoms. Your medical history will also be reviewed, including the history of diseases in the family. A family history of prostate cancer increases your risk of having the disease. However, a series of tests will be performed to confirm the presence of prostate cancer, and these include a PSA test.

Since a PSA test is an early cancer detection method, you can have this performed even if you don’t experience any symptoms. If the presence of prostate cancer is confirmed through a PSA test combined with other tests, then it would be easier to treat the condition while in the early stages.

However, before you undergo a PSA test with the goal of early cancer detection, you’ll need to understand that elevated levels alone will not confirm the presence of cancer, but they do indicate the presence of a disease. Therefore, if the results are elevated, you can expect to undergo treatment for some form of condition that affects the prostate.

An elevated PSA level will result in you requiring more tests, such as a biopsy, which can be painful and may result in the presence of blood in the urine. It can also result in a prostate infection, which will require treatment.

If a PSA test, a biopsy, and other diagnostic tests confirm cancer, you’ll need to undergo treatment as soon as possible and this may involve medications, radiotherapy (external or internal), and active surveillance. Keep in mind that some early stage cancers may not progress. However, if you do choose to undergo active surveillance over other forms of treatment, there is a risk that the condition will get worse and by then, it will become more difficult to treat.

References:

  • American Urological Association Education and Research, Inc. PSA testing for the pretreatment staging and post treatment management of prostate cancer: 2013 Revision of 2009 Best Practice Statement. Linthicum, MD:

  • American Urological Association Education and Research, Inc. 2013. Available at: http://www.auanet.org/common/pdf/education/clinical-guidance/Prostate-Specific-Antigen.pdf. Accessed October 2, 2013.

  • Getzenberg RH, Partin AW. Prostate cancer tumor markers. In: Wein AJ, Kavoussi LR, Novick AC, et al., eds. Campbell-Walsh Urology. 10th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 98.

  • U.S. Preventive Services Task Force. Screening for prostate cancer. Available at: http://www.uspreventiveservicestaskforce.org/prostatecancerscreening/prostatefinalrs.htm. Accessed July 26, 2013.

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