What Exactly Does a High PSA Level Mean?

High PSA Levels
Keith Brofsky Collection/Photodisc/Getty Images

Question: What exactly does it mean when a person has a high PSA level?

I had my first PSA test last week, and the doctor said it was a little high. I am having the test done again, but I am worried that it may mean I have cancer. What exactly does having a high PSA mean?

Answer: A high PSA test means further screening is needed.

The PSA is a test used to measure a protein called prostate-specific antigen in the blood.

Men with prostate cancer often have elevated PSA levels, But a high level is not a reason to panic, a number of factors that are unrelated to cancer can also lead to a high result.

The PSA test is notorious for producing false positives and false negatives. This means it may be high when cancer isn't present and it may be low when there is cancer present. Often the first step a doctor will take if your PSA level is high is to repeat the test.

Due to these variables, the PSA is not considered to be a diagnostic tool or even an effective screening test when used alone. It is coupled with a digital rectal exam for prostate cancer screening. For diagnosis when prostate cancer is suspected, a prostate biopsy is performed to confirm or rule out cancer.

What May Cause High PSA Levels Besides Prostate Cancer?

A high PSA level can be the result of factors and diseases other than prostate cancer. While the result may alarm you, your doctor will be considering what the numbers mean and what else could be causing them.

  • Ejaculation: While your doctor may not recommend avoiding ejaculation prior to having a PSA test, it can slightly elevate your levels. If your PSA level is high and you ejaculated within 48 hours of the test, your doctor may want to conduct a retest and ask that you abstain from sexual activity (or masturbation) before the test.
  • Enlarged Prostate: If you have benign prostatic hyperplasia (BPH), your PSA levels may be elevated. BPH is a common non-cancerous condition that occurs as men become older.
  • Prostatitis: Another common culprit of high PSA levels, prostatitis is the inflammation or infection of the prostate. It can be caused by bacteria, but many times we don't know why some men develop prostatitis.
  • Age: PSA levels can naturally increase as men grow older.

What Happens When I Have a High PSA Level?

For men who have no symptoms of prostate cancer and no suspicious finding with the digital rectal exam (DRE), the doctor will usually repeat the PSA test. If it is still high on repeat, the doctor may recommend watching-and-waiting with repeated testing at regular intervals to see if levels rise.

Continued rising PSA levels, especially with a suspicious DRE can be followed up with tests to rule out urinary tract infection and with imaging studies.

When Does a High PSA Level Warrant a Prostate Biopsy?

When symptoms and exam results raise suspicion of prostate cancer, the doctor will recommend a prostate biopsy.

The doctor does not do this lightly as biopsies can cause discomfort and have the potential to lead to infection.

Recommendations are Changing for Prostate Cancer Screening

The advice you may have seen in the past about prostate cancer screening has been changing. It is best to check with reliable sources that are continuously updated with the current recommendations. These two sources should be checked for in-depth information and the latest thinking.

Sources:

"Prostate cancer screening." UpToDate. Last updated July 23, 2015. Accessed: December, 2015

"Prostate-Specific Antigen (PSA) Test," National Cancer Institute. Reviewed July 24, 2012. Accessed December, 2015.

Continue Reading