Monday, January 28, 2008

"Does a PSA level of 6 mean that prostate cancer exists??"

This questions was asked by an anonymous person.

Thank you for this very important question!

The answer is no. 
But cancer is possible and further investigation (clinical exams) is necessary.  
[On the other hand, cancer is also possible with a PSA (Prostate Specific Antigen) level of 3]. 

PSA levels can be elevated due to several reasons: cancer, benign prostatic hyperplasia (enlargement of the prostate - in elder men; larger prostates produce more PSA), inflammation/infection (prostatitis), mechanical irritation (e.g. horse or bicycle riding), and ejaculation, and others.  
However, in case PSA is elevated further exams are indicated.  [a PSA level of 6  - before we know the size of the prostate  - has to be considered as elevated; levels between 4-10 are suspicious]: 
1) Digital rectal exam (DRE; Urologists examine manually the prostate), 2) trans-rectal ultrasound (TRUS), or 3) MRI (magnetic resonance imaging). 
Based on the results  of these exams, a decision has to be made if biopsy is necessary at this point.  

In other words: PSA levels between 4 and 10 ng/mL (nanograms per milliliter) are considered to be suspicious and should be followed by trans-rectal ultrasound imaging and, if indicated, prostate biopsy should be performed. Some urologists prefer to ask for MR Imaging prior to the biopsy to better locate any suspicious, "cancerous" area, and consequently target the biopsy.  

PSA is an excellent screening test and helps to detect prostate cancer early. Yet, PSA is false positive-prone (7 out of 10 men with PSA levels 4-10 will still not have prostate cancer) and false negative-prone (2-3 out of 10 men with prostate cancer have no elevation in PSA). Recent reports indicate that refraining from ejaculation 24 hours or more prior to testing will improve test accuracy.


Anonymous said...

If PSA is elevated, can ultrasound or MRI rule out cancer ?

Anonymous said...

If PSA of 3 can still indicate cancer, why is only a PSA > 4 suspicious?

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Anonymous said...

My PSA level has increased from 5.0 to 6.0 all in a matter of 2 weeks. I feel fine and there are no signs of anything being wrong. What's the best avenue to take to cure and/or prevent things from getting worse?