Prostate specific antigen (PSA) is a small protein secreted from the prostate into the blood. Low levels of PSA are normal but raised PSA could indicate prostate problems.
Overview of Raised PSA
What is PSA?
Prostate-specific antigen (PSA) is a small protein that is secreted from the prostate into the blood and can be measured in the blood in nanograms per millilitre (ng/ml).
It’s normal for men to have a small amount of PSA in their blood. However, raised amounts of PSA may indicate a prostate problem including prostate cancer.
When it comes to levels of PSA in the blood it’s worth noting a few things:
- The amount of PSA per millilitre rises slightly as you get older, and your prostate gets bigger.
- A raised PSA may suggest a problem with your prostate, but it does not automatically mean you have prostate cancer.
- PSA is used as a marker of prostate cancer, but PSA is ‘prostate specific’ not ‘cancer specific’.
Causes of raised PSA
In essence there are three ways in which PSA can be elevated.
1. Enlarged prostate
The prostate is very enlarged, usually through a benign process such as Benign Prostatic Hyperplasia (BPH).
2. Inflamed prostate
PSA is elevated through activity in the prostate usually due to inflammation. This inflammation could be because of a current or previous infection (e.g. prostatitis) or recent instrumentation of the urinary tract (e.g. a catheter). This is an entirely benign process and is the most common cause of artificially elevated PSAs.
3. Prostate cancer
The third and most concerning cause of an elevated PSA is cancer of the prostate.
As men get older the risk of prostate cancer goes up. Because of this we advise any man over 50 to know what their normal PSA level is. For men at greater risk of prostate cancer (e.g. a family history of prostate or breast cancer) we advise they know their normal level from the earlier age of 45.
Knowing your normal PSA level is important in helping to identify early any changes from the norm.
Symptoms of Raised PSA
A problem with a prostate is usually first noticed by a change in your normal urination. This might be:
- The need to urinate more frequently, especially at night
- Difficulty starting to urinate
- Straining or taking a long time to finish urinating
- A weak urine flow
- A feeling that your bladder hasn’t emptied properly
- Getting sudden urges to urinate
- Leaking urine before you get to the toilet
- Dribbling urine after you finish peeing
Other less common symptoms include:
- Pain when urinating
- Pain when ejaculating
If you notice a change in your normal urinating patterns and are concerned it is advisable to seek medical advice.
Urinary problems are often caused by something other than cancer, for which there are treatments that will help.
Diagnosing Raised PSA
1. PSA Test
The PSA test is a blood test that measures the amount of PSA in your blood. An elevated PSA level may suggest you have a problem with your prostate.
The test involves taking a sample of your blood. A laboratory then tests this sample to establish the amount of PSA you have in your blood. The result is then given as the number of nanograms per millilitre of blood (ng/ml).
While a PSA test can help to indicate a prostate problem. It alone can’t tell you whether you have prostate cancer. Further investigative tests and diagnosis may be recommended.
2. Digital Rectal Examination (DRE)
As well as a PSA test, we also perform a digital rectal examination. This allows a consultant urologist to feel for any changes to your prostate gland. This is done by inserting a gloved, lubricated finger into your rectum. While a little undignified, it is painless and provides a consultant urologist with valuable information.
A DRE on its own is not enough to detect cancer. Further tests such as an MRI scan and biopsy may also be performed.
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