Do All PSA Rises Spell Cancer?

Purple glove holding PSA test tube by the cap over diagnostic paper

When men reach middle age, they are often struck by the number of tests needed to prevent disease and keep them healthy. One such test that used to be controversial simply because it was misinterpreted but is now very useful is the prostate-specific antigen or PSA test. Let’s briefly touch on the idea of this incredible comeback – PSA was widely used in the 80s and 90s as a measure of prostate and guidance for a biopsy. At the time, we didn’t know much, certainly not as much as we do now, about prostate cancer. Often, these PSA readings were misinterpreted, and the following occurred:

  • PSA levels found to be above four, immediately biopsy
  • If the biopsy shows any cancer, go straight to the prostatectomy
  • Manage post-prostatectomy side effects, including incontinence and erectile dysfunction

As you might imagine, this treat-everything approach led to over-treatment of a cancer that can be alternately slow-growing or very aggressive. When it was recognized that many patients were over-treated, PSA screening became controversial

We now use PSA as a screening test in conjunction with many additional tests including urine and blood genomic markers for prostate cancer as well as a multiparametric prostate MRI to determine which patients need a biopsy. Furthermore, we are also more selective about which patients need treatment if prostate cancer is diagnosed after a biopsy.

But Do All PSA Rises Mean Cancer?

The short answer is no, and this is where a very experienced urologist in matters of the prostate can help patients understand if they have a slow-growing or an aggressive form of prostate cancer.

Other factors can also increase PSA levels.

You’ve probably heard it a lot more as you’ve gotten older, but BPH, or benign prostatic hyperplasia, is a widespread concern among men starting in their 40s and 50s. This non-cancerous growth of the prostate can also increase PSA levels. However, specialist urologists like Dr. Kapadia can distinguish between this and PSA rises due to a malignancy.

Prostatitis, or an inflammation of the prostate gland, can also lead to higher levels of PSA, yet this concern is certainly not malignant, nor does it lead to cancer.

Age in and of itself also contributes to the rise in PSA. Once again, these rises are perfectly normal, and after consulting with their urologist, patients can feel at ease.

The Bottom Line

The prevalence of low-grade prostate cancer that does not require active treatment, but rather active surveillance is significant enough that many have called for the “cancer” label to be dropped. On the other hand, high-risk prostate cancer is deadly and must be treated similarly aggressively. Getting screened and talking to a knowledgeable and experienced urologist who specializes in prostate, like Dr. Kapadia, can help you differentiate between these forms of cancer and develop the appropriate treatment plan moving forward. Please give us a call to schedule a consultation. We look forward to seeing you at the office and helping you with any PSA-related concerns.