Elevated PSA

What is PSA?

Prostate-specific antigen (PSA) is a protein that is made by normal prostate cells, and also by prostate cancer cells. It is measured by obtaining a blood test, and is primarily used to screen for prostate cancer. There is no absolute cutoff for an elevated PSA level, as it can vary depending on a patient’s age, race, and other factors. However, in general a PSA level above 4 ng/mL is considered elevated.

What can cause an elevated PSA?

There are several conditions that can cause an elevated PSA. These include prostatitis, having an enlarged prostate, recent ejaculation, and prostate cancer. If a patient has an elevated PSA, it is recommended that they be evaluated by a urologist to determine whether there is a possibility that they may have prostate cancer.

When do I need to begin screening for prostate cancer?

The American Urologic Association (AUA) recommends to begin screening at age 45. Screening is performed by obtaining a PSA test and a digital rectal exam. This can be done by either a primary care physician or a urologist. There are patients who are considered to be high risk for prostate cancer- those with a positive family history or African-American heritage. These patients are recommended to begin screening at age 40.

When is an MRI of the prostate used?

Over the past decade, technology advancements and research have validated the utility of obtaining an MRI during an elevated PSA workup. An MRI helps to determine the size of the prostate and to determine whether there are any areas suspicious for cancer. The lesions are graded by a scoring system known as the PI-RADS, which are given scores between 1-5. In general, PIRADS scores of 3-5 are considered to be suspicious for cancer. An MRI can help improve the accuracy of obtaining a prostate biopsy, but is typically not used by itself to diagnose cancer.

What is the difference between a transrectal versus transperineal prostate biopsy?

There are two methods for obtaining a prostate biopsy, either via the rectum or the perineum (the skin between the scrotum and rectum). Transrectal biopsies carry a slightly higher risk for infections (between 2-6%) than do transperineal prostate biopsies. In addition to having a decreased risk of infections, transperineal biopsies are also superior in sampling the anterior zone of the prostate.