High PSA reading: what does it mean?

A PSA test is used to determine how much of the PSA protein is in the blood. It can signal prostate problems, including prostatitis and prostate cancer and while there are times that a PSA test may prove very useful, other times its use may be questioned. Mr Aidan Noon is highly specialised in reading PSA test results and in this article, he provides you with insight into the test benefits, what PSA readings really mean and if they need lowering.

What is the PSA test and who needs to take it?

The PSA test is a blood test to measure the levels of PSA (a naturally occurring protein) in the bloodstream. PSA stands forprostate-specific antigen and is a protein that has a role in reproduction; the PSA protein helps sperm to become mobile after ejaculation so that fertilisation can take place. PSA is made by the prostate gland, which is situated between the bladder and the base of the penis, and its secretions contribute to the volume of fluid that is ejaculated. When the prostate gland is diseased or has been operated on, higher levels of PSA might enter the bloodstream. Doctors have discovered that higher levels of PSA in the bloodstream can sometimes indicate the presence of  prostate cancer.

Are PSA tests regularly done?

The UK government has not introduced a prostate cancer screening programme and therefore, no men are currently called in to have their PSA levels measured. Patients with new urinary symptoms, for example, decreased urinary flow, may be advised to have a PSA test once the implications of the test have been discussed. Unfortunately, the PSA test is not always accurate and can lead to further investigations in some men who do not actually have prostate cancer (a false-positive result).

Some men, who have no urinary symptoms, may want to undergo a PSA test . This can be because they have become anxious about the possibility that they have prostate cancer and “want to get checked out”. A PSA test can be performed provided that the patient has had a proper discussion about the pros and cons of the test. NHS England has produced a guidance leaflet (last update Jan 2020 – access checked 27.4.20) for men aged over 50 who are considering a test and have no urinary symptoms.

What is considered a dangerous level of PSA?

There is no such thing as a “dangerous PSA level”. PSA, as described above, is a naturally occurring protein in men. A man is not harmed by high levels of PSA but high PSA levels may indicate there is an underlying health issue affecting the prostate gland.

Patients with a prostate gland (not those that have had their prostate surgically removed for cancer) may have a PSA level between 0 and 10,000. Therefore, it is important that a PSA result is interpreted by a doctor who will be able to examine your prostate (digital rectal examination) and take a full medical history.

Does a high level of PSA always indicate prostate cancer?

As discussed above, very high levels of PSA are more likely caused by prostate cancer. High PSA levels also occur when the prostate gland is infected ( prostatitis ) or if the prostate is enlarged. Again, it is important that the PSA test result is interpreted by a doctor.

A PSA level of 3 is now used as a “cut off level” for referring men to a specialist for further evaluation if the doctor feels the diagnosis of prostate cancer will help the patient. Some elderly and frail men may not benefit from having prostate cancer diagnosed and this should always be considered by a doctor before referring the patient for further evaluation.

What factors can affect a PSA level?

When I assess a man who has had a raised PSA test, I always ask about symptoms of infection, as urinary infection can cause PSA to be raised. If I consider that further evaluation for prostate cancer is needed (normally after performing an examination of the prostate gland and taking a full history), I will make sure the PSA test has been repeated.

The timing of a PSA test in relation to ejaculation, a long bike ride and bouts of illness are often cited as possible causes of altering PSA levels. I am not convinced that these activities will change a PSA level sufficiently to alter the clinical decision making, especially if a second test is also raised.

How can PSA levels be lowered naturally?

There is no need to “lower the PSA” – a high PSA level doesn’t cause any harm. If you are worried about developing clinically significant prostate cancer (which will cause harm) then there are no evidence-based strategies that are currently recommended . Unfortunately, this does not stop people offering dietary advice or other interventions that lack peer-reviewed evidence to support their use (especially on the internet).

For patients that have been diagnosed with prostate cancer, there has been lots of research looking at interventions that might improve their well-being and possibly delay their cancer progression and that could be classed as “natural”. Exercise is one example. I do not make recommendations to my patients to try and lower their PSA levels. For patients worried about prostate cancer or that have been diagnosed with prostate cancer, I do try and promote a healthy lifestyle.

Mr Aidan Noon is extremely experienced in interpreting high PSA levels and providing professional guidance for the next steps. Click here to learn more and to get in touch.