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8 Non-Cancerous Causes Of High PSA Levels
Prostate-specific antigen (PSA) is a protein produced by the prostate gland. A test result of 10 nanograms of PSA per milliliter (ng/mL) of blood is generally considered high. Although an elevated PSA is often associated with cancer, this can happen for a variety of reasons.
PSA levels aren't a good indicator of prostate health on their own. Instead, your healthcare professional will consider other risk factors, like age, digital rectal exam results, and family history.
Keep reading to learn more about why your PSA levels may be high.
PSA levels may increase as you get older.
This natural rise may be caused by the growth of benign prostatic tissue.
BPH, also known as enlarged prostate, is common in older adults. BPH can increase PSA levels and affect the bladder and urinary tract.
Symptoms may include:
BPH only requires treatment if symptoms affect your quality of life or overall health. Treatments include medications, such as alpha-blockers or 5-alpha reductase inhibitors.
If your symptoms are severe or do not respond to medication, your healthcare professional may recommend a minimally invasive surgical procedure or laser therapy.
UTIs may spike PSA levels.
Symptoms may include:
UTIs become more common as you age. Other factors may also increase your risk, including:
Consult with a healthcare professional if you think you have a UTI. They're usually diagnosed through a urine test and treated with antibiotics.
If you have high PSA levels and a known UTI, you must wait until you've recovered from your UTI before repeating the PSA test.
Prostatitis is often the result of a bacterial infection. It causes swelling, inflammation, and irritation of the prostate gland.
Symptoms may include:
If bacterial infection is causing your prostatitis, you may also experience flu-like symptoms and be treated with antibiotics.
Nerve damage in the urinary tract may also cause prostatitis. This can occur as a result of injury or as a surgical complication. If no infection is found, anti-inflammatory medication or alpha-blockers may be used to reduce discomfort.
One 2016 study found that PSA levels rise in some people after ejaculation. They may remain higher than their typical baseline level for up to 24 hours afterward.
More research is needed to understand the potential effects of ejaculation on PSA levels fully. However, if you have a PSA test scheduled, consider abstaining from sexual activities that may result in ejaculation for 24 hours before the test.
PTH is a naturally occurring hormone the body produces to regulate calcium levels in the blood.
It may also promote prostate cancer cell growth, even in people who do not have prostate cancer. For this reason, high levels of parathyroid hormone may escalate PSA levels.
An injury to the groin may temporarily spike PSA levels. If you suspect a fall, impact, or other injury may have affected your PSA levels, let your healthcare professional know.
Any procedure that causes temporary bruising or trauma to the groin can affect PSA levels.
This can include inserting any type of instrument, such as a catheter or surgical scope, into the bladder.
Prostate cancer can cause your PSA levels to increase, so your healthcare professional may recommend that you get a PSA blood test in conjunction with other tests, such as a digital rectal exam, to assess your potential risk.
Healthcare professionals often recommend PSA testing at age 50. Your doctor may recommend testing your levels at an earlier age if you have known risk factors for prostate cancer, like a family history of the disease.
If your PSA levels are high and other diagnostic tests also indicate an increased risk for prostate cancer, your healthcare professional will likely recommend a biopsy to confirm a prostate cancer diagnosis.
Prostate cancer is generally slow-growing, so some people may prefer to hold off on a biopsy in favor of watchful waiting. Your clinician will go over all of your options and explain the risks associated with each option.
Getting a second medical opinion can help put your mind at ease about your current care or give you a different perspective, which may help you to decide upon your best options for treatment.
If your healthcare professional recommends PSA testing or further testing or biopsy after a PSA test, make sure to discuss the benefits versus the risks of each procedure being recommended.
It's important to remember that elevated PSA levels can mean many things. If a biopsy or other testing feels medically necessary, make sure to weigh the benefits versus the risks of each test.
Prostate cancer, especially when caught early, is treatable. Many other causes of elevated PSA are also treatable.
Myths About PSA Tests And Prostate Cancer Screening
The understanding of prostate cancer has significantly evolved in the past 15 years. However, many people—including primary care providers—may not be aware of the current guidelines for prostate cancer screening, says Andrew Vickers, Ph.D., of Memorial Sloan Kettering Cancer Center (MSK).
The main screening tool for prostate cancer is the PSA test, which measures levels of a protein called prostate-specific antigen (PSA) in the blood. In the past, some experts have suggested that PSA testing caused more harm than good, saying it can lead to unnecessary biopsies and therapies for cancers that actually don't need to be treated.
Today, the PSA test should be used as one part of the tool kit for finding cancer and identifying which cancers should be treated, Dr. Vickers says. An expert in health outcomes related to the detection and treatment of prostate cancer, Dr. Vickers spoke at the 2024 Annual Meeting of the American Association for Cancer Research.
In his presentation, "Seven Myths About PSA and Prostate Cancer Screening," Dr. Vickers sought to raise awareness about the best way to use the PSA test. Here, we recap those myths.
Myth: PSA test results will show you whether your levels of PSA are elevated or normalMany people are not clear about what a PSA test really shows.
"I often hear from friends that the result of their PSA test was negative," Dr. Vickers says. "But the PSA test result is not like a COVID-19 test. It doesn't suddenly turn positive when you develop prostate cancer."
The test tells you how much PSA protein is in your blood, measured in nanograms per milliliter (ng/ml). Results between 0 and 3 ng/ml were once considered "normal," but recent research has shown a gradient of risk, even at these low levels of PSA.
For patients with results of 3 ng/ml or higher, Dr. Vickers says the test should always be repeated to confirm the results. Elevated PSA levels can be caused by conditions other than cancer, including an enlarged prostate or a prostate infection. It's important to rule out those potential causes.
If your doctor can't find a benign (not cancerous) cause for your elevated PSA level, the next step should be additional tests like an MRI scan or a 4Kscore test—rather than going straight to an invasive prostate biopsy. An MRI can detect the presence of a tumor. The 4Kscore test, a blood test developed at MSK, looks at additional markers in the blood and can help determine whether a biopsy is needed.
Doctors used to believe that changes in PSA (known as "PSA velocity") were an indicator that cancer might be present, even in patients with no history of the disease. But researchers from MSK published several studies showing that looking at changes in PSA was not of value. Since then, PSA velocity has been removed from practice guidelines.
Myth: PSA is not an accurate test for prostate cancerWhat makes this a myth is that it actually isn't very important at all.
"Almost all men will get prostate cancer if they live long enough," Dr. Vickers explains. "So we aren't at all interested in prostate cancer as an endpoint. What we want to know is whether PSA can predict who gets the sort of prostate cancer that can cause symptoms and threaten a patient's life. It turns out that PSA is very good at doing that."
"We know there are benefits, and that's not controversial," Dr. Vickers says. "We have evidence that prostate cancer screening reduces the risk of dying from prostate cancer."
One of the most well-known randomized studies demonstrating that PSA reduces cancer mortality was conducted in Sweden in collaboration with MSK researchers. Dr. Vickers explains that the real controversy "isn't whether there are any benefits at all, but whether the benefits outweigh the harms."
Myth: PSA screening inevitably leads to a large amount of overtreatment and overdiagnosis"Over the past few decades, many hundreds of thousands of American men have been diagnosed and treated for prostate cancer that never would have become apparent if not for PSA testing," Dr. Vickers says. "But the amount of overdiagnosis and overtreatment depends on how the test is used. If screening guidelines based on more up-to-date knowledge are followed and treatment is limited to aggressive cancers, the number of men being unnecessarily diagnosed with and treated for prostate cancer can be dramatically reduced."
For patients with prostate cancer that does not appear aggressive or likely to spread, MSK's Active Surveillance Program offers the option for regular monitoring. This program can help patients avoid the side effects associated with treatment.
Myth: PSA screening reduces prostate cancer mortality by about 1 in 1,000PSA screenings have reduced deaths significantly more than 1 in 1,000. "This number is frequently cited, and it makes it look like the benefits are small, but it is based on a misunderstanding of a well-known trial," Dr. Vickers says. "Experts disagree about the best estimate, but one study published in The New England Journal of Medicine gave a number closer to 10 in 1,000."
He adds that cancer mortality rates have also improved thanks to better prostate cancer treatments, including many developed at MSK.
Myth: The best national policy for PSA screening is to only test men who ask their doctorMost countries have adopted a policy that PSA testing should be done after "shared" decision making. "But for the most part, anyone who asks their doctor for a PSA test is going to get one," Dr. Vickers says. "The result we see across the globe is overuse of the test in men who are not going to benefit from it."
Another major problem with these policies is that they exacerbate inequality, with PSA testing more common in wealthier rather than in underserved communities, he adds.
Myth: Population-based PSA screening would dramatically increase the number of PSA tests as well as the number of prostate cancer diagnoses and treatmentsIf PSA screening is limited only to patients who fall within the appropriate age group, the number of PSA tests given should not dramatically increase. The guidelines recommend PSA testing based on age and risk factors, explained in detail here.
"If we are systematic and organized about who gets the PSA tests, it would actually reduce the number of PSA tests given, especially as most men would get only two or three tests in their lifetime," Dr. Vickers says. "When PSA is being offered only to patients in the appropriate age range—meaning between the ages of 45 and 70—the amount of overdiagnosis and overtreatment will also go down."
Citation: Myths about PSA tests and prostate cancer screening (2024, April 9) retrieved 6 May 2024 from https://medicalxpress.Com/news/2024-04-myths-psa-prostate-cancer-screening.Html
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AUA Posters Highlight Racial Gaps In PSA Screening, Prostate Cancer Risk
Speakers discussed the disparities in prostate-specific antigen (PSA) screening rates among different racial groups and explored the potential of free PSA percentage as a predictive marker for future prostate cancer risk.
During a podium session at the American Urological Association (AUA) 2024 Annual Meeting, 3 speakers focused on prostate-specific antigen (PSA) testing, which can indicate prostate cancer in men with higher PSA levels.
Jonathan Ryan, a third-year medical student at Nova Southeastern University Dr Kiran C. Patel College of Allopathic Medicine, presented on PSA testing rates and disparities among nearly 100,000 men in the All of Us database.1 The study included White, Black, Hispanic, and Asian men aged 40 years and older. To ensure a focused analysis, those with a history of prostatitis, hematuria, urinary retention, or prior prostate cancer diagnosis before their first PSA measurement were excluded from this study.
Despite the large cohort, the researchers found that less than 19% of men in the database had received PSA testing. A significant proportion of those tested were White men (75%), followed by Black (15%), Hispanic (8%), and Asian (2%) men.
The study also showed that White men were being screened at older ages, contrary to AUA guidelines. By race, the median age at first screening was 53 for Black and Asian men, 54 for Hispanic men, and 58 for White men. Despite starting PSA screening at a younger age, Black (12.1%), Hispanic (11.8%), and Asian (13.1%) men were less likely to undergo PSA testing compared with their White counterparts (22.2%).
The largest gap based on age was seen in the proportion of men being screened at age 70 and older, of which 89% were White, followed far behind by Black (5%), Hispanic (4%) and Asian (2%) men. Men who were first screened at an older age were also more likely to have at least a college education (85% vs 79%) and be homeowners (77% vs 67%) compared with all patients with a PSA screening.
PSA testImage credt: angellodeco – stock.Adobe.Com
During the podium session, Adam S. Kibel, MD, chair of urology at Brigham and Women's Hospital and professor of surgery at Harvard University School of Medicine, said this may be reflexive, and that minority patients who believe they're at higher risk of prostate cancer may be getting screened on the younger end of AUA guidelines.
Multivariate logistic regression showed that race, age, income, education, insurance type, and home ownership status all remained significant predictors of who received PSA screening.
"This suggests that minorities are being screened earlier per guidelines but disproportionately affected by PSA screening disparities, and the incidence of PCa [prostate cancer] in Black men may be further underestimated," Ryan said.
A different study on midlife baseline (MB) PSA testing also found racial disparities in predicting lethal prostate cancer.2 Presented by Giuseppe Chiarelli, MD, research fellow at Humanitas, this study focused on White and Black men aged 40-59 years who underwent MB PSA testing between 1995 and 2019. The researchers categorized patients into 4 age groups and analyzed the impact of MB PSA levels on predicting lethal prostate cancer using multivariable Fine-Gray regression.
Their analysis, which included data from more than 112,000 men, revealed striking racial disparities in the incidence of prostate cancer and its severity. White men were more likely to have their first PSA test at age 50 to 54 years (33.9%), while Black men tended to undergo testing in the youngest age group at 40 to 44 years (27.6%). Additionally, Black men had a significantly higher rate of prostate cancer diagnosis (7.0% in Black patients vs. 3.9%) and lethal prostate cancer (1.2% vs 0.6%) compared with White men (both P < .0001).
When comparing the risk of lethal prostate cancer based on MB PSA levels, the study found that Black men faced almost double the risk of developing lethal prostate cancer compared with White men within the same age category and with similar MB PSA levels. According to the authors, this highlights the importance of considering separate and different cutoffs for MB PSA when guiding prostate cancer screening in clinical practice, particularly to address the heightened risk faced by Black men.
Finally, a study presented by Giuseppe Cirulli, MD, research fellow at Vattikuti Urology Institute delved into the potential of free PSA percentage (%fPSA) in predicting the future risk of developing prostate cancer.3 %fPSA is a marker recommended by AUA guidelines for guiding biopsy decisions in cases of mildly elevated PSA levels, but it has not been explicitly considered as a tool for future PSA screening. This study sought to address this gap by examining its potential role in predicting prostate cancer incidence in a contemporary North American population.
The research focused on men aged 40 to 59 years who underwent %fPSA testing between 1995 and 2019, resulting in a cohort of 1308 patients. Using established methodology, %fPSA levels were categorized into three groups: less than 10%, 10% to 25%, and greater 25%. The main outcome of interest was the incidence of prostate cancer, with cumulative incidence curves used to illustrate the risk of developing prostate cancer over time based on %fPSA categories. Multivariable Fine-Gray regression was employed to assess the role of %fPSA as a predictor of future prostate cancer development after adjusting for potential confounders.
Patients in this study were mostly aged 55 to 59 years (33.4%), had a Charlson comorbidity indexof 0 (67.1%), were White (75.6%), and had a %fPSA between 10% and 25% (68.8%). The median (IQR) follow-up was 2.9 (0.9-5.1) years, and during this time, 228 (17.4%) patients developed prostate cancer.
At 5 years, patients with %fPSA less than 10% had the highest risk of developing prostate cancer (22.8%), followed by those with %fPSA 10% to 25% (8.9%) and greater than 25% (3.1%; P < .001). These findings revealed that men with %fPSA less than 10% had a significant 6.21-fold increased risk of developing prostate cancer compared with those with %fPSA greater than 25%.
This study marks the first comprehensive examination of %fPSA in the context of PSA screening, according to the authors. The results underscore the practical utility of %fPSA in enhancing PSA screening strategies in clinical practice, allowing for more targeted screening approaches where individuals at the highest risk of developing prostate cancer can receive intensified screening efforts.
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