Elevated PSA levels could indicate prostate cancer, prostate inflammation (prostatitis) or BPH. At Comprehensive Urology in Beverly Hills, Dr. Kia Michel uses PSA tests with in-office exams at his best in class facility to provide an accurate diagnosis.
What is a Prostate Specific Antigen (PSA) test for Prostate Cancer Screening?
PSA (Prostate Specific Antigen) is a protein produced by the prostate gland. The Prostate-Specific Antigen (PSA) test is a blood test that measures the level of PSA in the blood. The level of PSA in the blood can be elevated in men with prostate cancer, so the PSA test is often used as a screening tool for prostate cancer. The PSA test is typically recommended for men over the age of 50 or for men who have a family history of prostate cancer.However, there are other reasons why your PSA may be elevated, which is why consulting a board certified urologist like Dr. Kia Michel at Comprehensive Urology in Beverly Hills is so important.
Is a PSA Test alone sufficient to definitely diagnosis prostate cancer?
Elevated PSA (Prostate Specific Antigen) is a significant indicator that prostate cancer may be present; however, it is not sufficient, as a stand-alone test, to definitively diagnose prostate cancer.
At Comprehensive Urology, we’ve put a lot of time and effort into the highest technologies possible. If your PSA results are elevated, we have the technology in office to perform a variety of other tests and imaging, so when a patient comes in we’re able to provide a diagnosis on the spot. Many patients come in with urinary incontinence, for instance, so we’re able to diagnose if the source of the problem may be from BPH, prostatitis, or another source using in-office diagnostics such as:
- Urodynamics Studies
When it comes to diagnosis, factors such as ethnicity and age are also important to consider. For example, Black men tend to have slightly higher PSA levels. Additionally, the older men get, the higher their PSA tests tend to be. This is why a board-certified urologist will take into account other determining factors, such as:
- Prostatitis: This painful condition, usually caused by bacterial infection, can cause inflammation, swelling, and tenderness in the prostate, resulting in high PSA levels.
- Benign prostatic hyperplasia (BPH): An enlarged prostate can make urination or ejaculation difficult and may cause a spike in PSA levels.
- Prostate size: If a man has a larger-than-usual prostate, it can result in a higher-than-usual normal PSA level.
- Prostate stimulation: Sexual activity, a DRE (digital rectal exam) or manual stimulation of the prostate, or even an extended bike ride can temporarily increase PSA levels. However, this type of elevation is not necessarily connected with prostate cancer.
- Urinary tract infection (UTI’s): Infection or irritation of the urinary tract caused by medical procedures involving the bladder or urethra may irritate the prostate and result in an increased PSA production.
- Medications: Some medications, such as dutasteride (Avodart) and finasteride (Proscar or Propecia) can lower PSA levels. Other drugs, such as the 5-alpha-reductase inhibitor drugs (finasteride and dutasteride) are designed to decrease the size of an enlarged prostate. In the presence of prostate cancer, PSA levels would remain persistently high despite prostate shrinkage.
A trained urologist will use more than one factor to diagnosis prostate cancer; however, an elevated PSA is usually the warning flare that prompts a full work-up, making it an essential early indicator of issues with the prostate.
What are the stages of Prostate cancer?
The most commonly used system for tracking how far prostate cancer has advanced is the American Joint Committee on Cancer (AJCC) TNM system. The TNM system uses five pieces of information to classify the stage of cancer progression:
- T Category, which is the extent of the main tumor. There are two T categories:
- Clinical T (cT), which is a doctor’s estimate of how advanced the cancer is based on physical exam, imaging, or other tests.
- Pathologic T (pT),which is only measured if the prostate gland is removed
- Whether the cancer has spread to lymph Nodes
- Whether or not the cancer has Metastasized, or spread, to other parts of the body
- PSAlevel at time of diagnosis
- The Grade Group, which is a measure of how likely the cancer is to grow or spread quickly.
Using these five pieces of information, the cancer can be grouped into one of four stages. Each stage is also broken down into substages, so determining the stage you are in can be somewhat complex. Generally, stage one means the cancer is very small and hasn’t spread. As the size of the tumor(s), the amount of spread, and PSA levels rise, the staging moves up to stages two through four.
What is the life expectancy of a man with prostate cancer?
A 2019 study from the UK found that 95% of men with prostate cancer will live longer than one year past diagnosis, and 80% will live longer than ten years after diagnosis. John’s Hopkins Medicine says that men diagnosed in the earlier stages are typically cancer-free after about five years.
Generally speaking, the earlier the cancer is detected and treated, the better outlook you can expect, which is why regular testing is such an important part of your health maintenance.
What is the most common treatment for prostate cancer?
Treatment for prostate cancer varies based on how advanced the cancer is. For early-stage cancers of sarcoma (stages one and two), radiation treatments or surgery may be recommended. Depending on the Gleason score, a person’s cancer may grow faster, and radical prostatectomy and radiation therapy are commonly prescribed.
Can prostate cancer be 100% cured?
When treated early, prostate cancer is very treatable, which is why early detection is essential. Including a PSA test with your routine blood work for men 40 and above is a great way to ensure that prostate cancer detection happens early.
What is normal PSA by age?
PSA test ranges take age into consideration since Prostate Specific Antigen (PSA) tend to naturally rise as men get older. Normal levels by age range:
- Ages 40 to 49: 0-2.5 ng/mL
- Ages 50 to 59: 0-3.5 ng/mL
- Ages 60 to 69: 0-4.5 ng/mL
- Ages 70 to 79: 0-6.5 ng/mL
A trained urologist will take several PSA tests over time and compare the trends between the tests to see if there is a significant increase in prostate specific antigen. If you’ve recently taken a PSA test and received a result, please contact Dr. Kia Michel’s team at Comprehensive Urology for an evaluation. Early detection saves lives.
What is an alarming PSA level?
In general, PSA concentrations under 4 ng/mL are in the normal range. Men of African American and African descent tend to naturally have slightly higher PSA levels, which isn’t necessarily an indication of prostate cancer; however, it is cause to be evaluated by a board certified urologist. PSA levels over 10 ng/mL are linked with a significantly higher risk of prostate cancer, and a full evaluation is recommended.
What level of PSA indicates cancer?
Historically, PSA levels below 4ng/mL were considered acceptable. Some people with a low PSA level have been diagnosed with cancer, and many have a higher PSA level between 5-8 mg/mL. A number of other factors could also influence the PSA level of an individual, so an elevated PSA level is not an immediate cause for alarm; but it does warrant additional testing to rule out cancer.
What are the 5 warning signs of prostate cancer?
The warning signs of prostate cancer can vary, and some men with early prostate cancer may not have any symptoms at all. However, the following warning signs could indicate the presence of prostate cancer:
- Changes in urinary habits: This can include increased frequency of urination, especially at night, a weak or interrupted urine flow, difficulty starting or stopping urination, or the need to strain to urinate.
- Blood in the urine or semen: This can be a sign of a problem with the prostate gland or another part of the urinary or reproductive system.
- Erectile dysfunction: This can be caused by a variety of factors, including prostate cancer, and may be accompanied by other symptoms.
- Pain or discomfort in the pelvic area: This can be a sign of advanced prostate cancer that has spread beyond the prostate gland.
- Bone pain or tenderness: This can be a sign that prostate cancer has spread to the bones, which is more common in advanced cases.
These symptoms can be caused by conditions other than prostate cancer, as well, and not all men with prostate cancer will have these symptoms. If you are experiencing any of these symptoms, or if you have concerns about your prostate health, it’s important to talk to your healthcare provider for further evaluation and guidance.
Factors that might affect PSA levels
Another issue with using PSA tests when evaluating prostate cancer is that several other causes can affect PSA levels. Factors that can affect PSA levels in the blood include:
- Age: PSA levels tend to increase with age, so older men may have higher PSA levels than younger men.
- Prostate conditions: Conditions such as prostatitis (inflammation of the prostate gland) or benign prostatic hyperplasia (BPH) can cause PSA levels to rise.
- Digital rectal exam (DRE): A DRE, which involves a doctor inserting a gloved finger into the rectum to feel the prostate gland, can cause PSA levels to temporarily rise.
- Ejaculation: Ejaculation, either through sex or masturbation, can cause PSA levels to temporarily rise.
- Certain medications: Certain medications, such as finasteride or dutasteride, which are used to treat BPH, can lower PSA levels.
- Obesity: Obesity has been associated with higher PSA levels.
How do I Naturally Reduce my PSA Levels?
There is no proven way to naturally reduce PSA levels. However, some lifestyle changes may help improve overall prostate health and may help prevent conditions that can cause elevated PSA levels. Here are some suggestions:
- Eat a healthy diet: A diet rich in fruits, vegetables, whole grains, and lean protein sources such as fish and poultry may help improve overall health and reduce the risk of prostate problems. Eat More Lycopene-rich foods, such as tomatoes (avoid canned tomatoes; in a glass jar, or fresh, is fine). You can also drink green tea, and take vitamin D supplements.
- Maintain a healthy weight: Obesity has been associated with higher PSA levels, so maintaining a healthy weight through a healthy diet and regular exercise may help reduce the risk of elevated PSA levels.
- Avoid tobacco: Smoking has been associated with an increased risk of prostate cancer and other prostate problems.
- Manage stress: Chronic stress may affect overall health and contribute to the development of prostate problems. Stress-reducing techniques such as meditation, deep breathing, or yoga may be helpful.
Exercise regularly: Regular physical activity has been associated with a lower risk of prostate cancer and may help improve overall prostate health.
Repeating the PSA test
If the results of your first test are abnormal, doctors repeat the PSA test every 2-4 weeks to see if the results remain high. The PSA level should generally fall below the age range limit of 0.5 ng/mL. If you have a high PSA, your doctor may recommend another test, or even a prostate biopsy.
Are Prostate Biopsies more accurate than a PSA test to diagnose prostate cancer?
A prostate biopsy is generally considered to be more accurate than a PSA test for diagnosing prostate cancer. While the PSA test can provide an indication of the possibility of prostate cancer, it is not a definitive diagnostic tool. PSA levels can be elevated for reasons other than cancer, such as prostate inflammation or an enlarged prostate gland.
A prostate biopsy involves taking small samples of tissue from the prostate gland and examining them under a microscope to check for the presence of cancer cells. This allows for a more definitive diagnosis of prostate cancer.
How much does a PSA test cost?
In general, the cost of a Prostate Specific Antigen PSA test will be between $25-$50. The cost will likely depend on your insurance coverage, so to ensure an accurate quote, it’s best to contact your insurance provider to ask if it is covered, if there will be a copay, and what providers are in-network.
Where can a PSA test be done?
In addition to your Primary Care Physician, Comprehensive Urology offers affordable prostate cancer screening options, including Prostate Specific Antigen PSA tests, to help you with early detection.
What are the options for Treating prostate cancer?
In addition to prostate cancer screening tests, we also offer several therapies in the event that you are diagnosed with prostate cancer.
- Focal Therapy is a non-surgical treatment option best suited for those in the early stages of prostate cancer. TULSA-Pro and HIFU are two types of Focal Therapy procedures that treat prostate cancer. Dr. Kia Michel is currently running clinical trials to see if TULSA-Pro cancer treatments have a lower incidence of side effects, and it is highly effective in treating prostate cancers when compared to other prostate cancer treatment options.
- Robotic Surgery for prostate cancer treatment is usually used to treat advanced prostate cancer by removing part or all of the prostate (also called radical prostatectomy).
- Radiation therapy uses high-frequency energy to damage or destroy cancer cells. The radiation affects the DNA inside the cancerous cells, preventing them from replicating.
- Hormone Blockade Therapy uses hormone-suppressing medication to reduce the production of male hormones, called androgens. This can help prevent prostate cancer from spreading.