PSA and concerns about prostate cancer

One of the major symptoms of prostate cancer is the prostate getting bigger. However, not every case of prostate enlargement suggests or leads to cancer – sometimes, the prostate increases in size on its own as time goes by, in a phenomenon called benign prostate enlargement (BPE).

An enlarged prostate will produce a prostate-specific antigen (PSA), a type of protein that will be present in the blood, regardless of the cause of the enlargement. In this article, a consultant urologist explains more about the relationship between PSA and prostate cancer concerns.

Signs of prostate issues

An enlarged or diseased prostate for any reason may be externally asymptomatic at first, but after ample time, there will be sexual dysfunction and urination issues such as:

• Difficulty starting urination
• Painful urination
• Painful ejaculation, or inability to ejaculate
• Blood in the urine (haematuria)

Prostate cancer and PSA

Prostate cancer is extremely common, affecting every 1 in 8 men and mostly those above the age of 70, but it is notoriously undiagnosed across all ages due to a lack of testing, the lack of visible symptoms, and a general undereducation about this condition, its testing, and the signs. When unaddressed, the cancer can spread to other organs and become very difficult to treat and excise, which is why so many healthcare providers stress the importance of early diagnosis and consistent screening, even when there are no symptoms.

When a prostate becomes enlarged or inflamed, it starts to produce more PSA. A PSA blood test is used to evaluate the levels of PSA, and high levels can suggest an issue with the prostate, like prostate cancer. However it is important to note that high PSA levels do not immediately indicate cancer – it could be BPE, prostatitis, a urinary tract infection (UTI), ageing, medications like testosterone-replacement therapy, or even just vigorous exercise.

PSA testing

It is recommended that men begin partaking in routine PSA blood testing from the age of 50, although those with a family history of prostate cancer or of African descent should start a little earlier at age 45.

PSA is made by cells in the prostate gland – both normal and abnormal cells. A PSA blood test measures the amount of PSA in a sample of blood in nanograms per millilitre of blood (ng/ml). Most men who don’t have prostate cancer will have PSA levels under 4ng/ml and will not be cause for concern, and those who have a PSA level between 4-10ng/ml have a higher likelihood of having prostate cancer, about 25 per cent. However, men with a PSA level of more than 10ng/ml have a chance of over 50 per cent having prostate cancer.

These test results will not tell patients whether they have prostate cancer or not, but a high result can inform doctors that further testing may be needed or that something could be wrong. Further testing to diagnose prostate cancer can involve a digital rectal exam, MRIs, or a biopsy to confirm and assess the presence of cancerous tissues.

At this point and taking into consideration a patient’s age and symptoms, there will be options for treatment and management like chemotherapy, active monitoring, cryoablation, or a prostatectomy (surgical prostate removal) – depending on the extent of the disease.

If you are worried about your prostate and would like to get a PSA blood test, you can consult with a specialist on Top Doctors.