What is a high PSA level, and why does it matter?

For many men, a routine blood test may reveal a high PSA (prostate-specific antigen) level, which can lead to concern and questions. PSA is a protein produced by both normal and cancerous cells in the prostate gland, and its levels can be measured to assess prostate health. While a high PSA level may be concerning, it doesn’t necessarily mean cancer. A leading urologist explains what a high PSA level could indicate and the potential next steps can provide clarity.

How is PSA measured, and what counts as “high”?

A PSA test is a blood test that measures the concentration of PSA in nanograms per millilitre (ng/mL) of blood. In general, PSA levels below 4 ng/mL are considered normal for most men. However, PSA levels tend to increase with age, and levels slightly above 4 ng/mL may still be normal for older men. PSA levels above this threshold can be considered elevated, but the significance of a high reading depends on factors such as age, family history, and overall health.

In addition, PSA levels can vary due to factors other than prostate health. For example, recent sexual activity, certain medications, infections, and even cycling can temporarily increase PSA levels.

Could a high PSA level indicate prostate cancer?

A high PSA level can be a warning sign for prostate cancer, but it is not a definitive diagnosis. However, having a high PSA level does not always indicate that a man has prostate cancer. Instead, conditions like benign prostatic hyperplasia (BPH), which is an enlarged prostate, and prostatitis, an inflammation of the prostate, are often to blame. BPH is common in older men and may cause urinary symptoms but is not cancerous. Prostatitis can also raise PSA levels and may cause discomfort, but it is typically treated with antibiotics and does not increase cancer risk.

If your PSA level is high, your doctor may recommend additional testing, such as a digital rectal examination (DRE) or imaging scans, to determine the underlying cause.

What should you expect if you need further testing?

If initial PSA results are elevated, additional testing is often needed to get a clearer picture. Your doctor may perform another PSA test to confirm the result, as levels can fluctuate naturally. Additionally, a DRE may be performed, where a healthcare provider examines the prostate by gently pressing against it through the rectal wall to check for any unusual lumps or firmness.

Further investigation may involve imaging, such as MRI, to visualise the prostate more clearly, or a biopsy, where a small sample of prostate tissue is taken and examined for cancer cells. Biopsies can provide more detailed information about whether cancer is present and, if so, how aggressive it might be.

Are there ways to lower PSA levels?

For some men, simple lifestyle changes can help lower PSA levels. Reducing stress, maintaining a healthy weight, and eating a balanced diet rich in fruits, vegetables, and healthy fats may help. However, it’s essential to consult a doctor before making any drastic lifestyle changes. In some cases, medical intervention is required if the cause is an infection or BPH.

Medications are also available that can help lower PSA levels in men with BPH or other non-cancerous prostate conditions. These medications work by shrinking the prostate or reducing inflammation, ultimately helping to reduce PSA levels. Always discuss the potential benefits and side effects of any medication with your doctor before beginning treatment.