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Increased PSA value

Increased PSA value

What is the PSA test?

PSA (or prostate-specific antigen) is a protein produced by both normal and cancerous prostate cells. It is mainly found in semen, where it helps to liquefy it, but there is also a small amount that escapes into the blood. This amount is detected by the PSA test.

At what age should I have a PSA test?

The measurement of PSA is proposed to start at the age of 50. However, if a man has a first-degree relative (father or brother) with a history of prostate malignancy, it is recommended that PSA measurement begin at the age of 40, as he is approximately twice as likely to develop cancer as the general population.

What is the exam preparation?

As a preparation, we should mention: avoiding any procedure that stimulates the prostate, such as ejaculation, prostate rectal finger examination, cystoscopy, urinary catheter insertion, or prostate biopsy. Even some intense exercise, such as cycling or horse riding, can affect it. For this reason, you should avoid ejaculation and bicycle or horse riding for at least 1-2 days before the PSA test and not having a rectal finger examination or cystoscopy-catheter insertion on the same day. Blood can be given at any time of the day, even if one is not fasting.

In which conditions the PSA is increased?

If the PSA is given according to the specifications we mentioned above, the increase in the PSA value is observed in:  

  • Benign prostatic hyperplasia (BPH): PSA may increase over time as the prostate progressively increases in size and thus produces more PSA.
  • Acute or chronic prostatitis: they cause irritation and inflammation of the prostate, which swells and produce more PSA.
  • Prostate cancer: cancer cells multiply at a rapid rate affecting the structure of normal cells resulting in increased PSA release.
  • Other causes: high levels of parathyroid hormone (PTH).

How do we evaluate PSA?

There are no absolute boundaries between normal and pathological values. The PSA test should be evaluated in relation to:

  • The rate of PSA increase over time : At least 3 measurements with a time difference between them are required to evaluate. A rapid increase, of at least 0.75ng/mL per year (high rate of PSA change), may indicate the presence of cancer. Even if the PSA value is within the normal range, an increase is considered abnormal and should be investigated.
  • PSA Ratio: It is the ratio of FPSA to total PSA. It is usually measured when total PSA values are between 4 and 10ng/mL. There are no clear limits for the Ratio, but generally when it is above 0.20 it means there is no malignancy, when it is below 0.10 there is a high probability of prostate cancer.
  • Prostate rectal examination: a soft prostate is normal, a painful prostate is inflamed and a hard prostate is suspicious for malignancy.
  • Transrectal ultrasound of the prostate: the size of the prostate is evaluated and signs of inflammation or suspicious signs of malignancy are looked for.
  • Multiparametric prostate MRI (mpMRI) : it shows suspicious areas and stages them based on the likelihood of malignancy (PIRADS I to IV). In case of a PIRADS III or above, a fusion prostate biopsy follows.
  • Prostate Biopsy: When there is an ultrasound or mpMRI finding with suspicion of malignancy.