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March 17, 2018
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Elevated PSA
An elevated PSA is associated with a higher risk of prostate cancer and is also the best method for monitoring prostate cancer progression and response to treatment.
Basic Facts

  • Prostate specific antigen (PSA) is a protein produced by the prostate gland that increases in a man's blood when the prostate gland is disrupted.
  • Elevated PSA levels may indicate a prostate condition.
  • PSA is the best method for monitoring prostate cancer progression and a man's response to treatment.
  • Men should have an annual PSA test beginning at age 50, or as early as age 40 if they are in a high-risk group (patient who are black or whose father, grandfather, uncle, brother have had prostate cancer).
An elevated PSA does not cause symptoms and is not considered a disease. However, it indicates that a prostate condition, or in some cases a procedure, has disrupted the prostate gland, such as:
  • Infections or inflammation;
  • Benign prostatic hyperplasia (BPH) or enlargement;
  • Prostate cancer;
  • A biopsy
  • The placement of a device, such as a Foley catheter.

The following conditions or treatments can cause a man's PSA level to rise:

  • Enlarged prostate;
  • Prostatitis;
  • Biopsy;
  • Medication; and
  • Cancer.

The level of PSA is determined by a blood test called a PSA test. PSA testing measures the number of nanograms (ng) of PSA in a milliliter (mL) of fluid. PSA is considered elevated if it is 4 ng/mL or higher. PSA levels that are 10 ng/mL or higher signal that a man should be aggressively evaluated for cancer.

Clinical research is also showing that the rate that PSA increases may be as important, or even more important in some cases, than the actual PSA value. An annual increase in PSA greater than 20 percent warrants investigation. Men who have an elevated PSA, who are in the age group at risk for prostate cancer, should undergo prostate ultrasound studies in addition to digital rectal exam.

PSA is the most sensitive marker for monitoring prostate cancer progression. Given this sensitivity, men should have an annual PSA test done according to the following guidelines:

  • At age 40 years old, for black men or if a man has a father or brother who had prostate cancer; or
  • At age 50 for all other men.
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