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
PSA is a small protein that is secreted from the prostate into the blood and can be measured in the blood in nanograms per milliliter (ng/mL). PSA is used throughout the world as a marker of prostate cancer but it is worth noting that PSA is ‘prostate specific’ but not ‘cancer specific’.
There are in essence three ways in which PSA can be elevated.
- The prostate could be very enlarged, this is usually through a benign process i.e. BPH.
- The PSA could be elevated through activity in the prostate usually due to inflammation. This inflammation could be because of a current or previous infection or recent instrumentation of the urinary tract. This is an entireley benign process and is the most common cause of artificially elevated PSAs.
- The third and most concerning cause of an elevated PSA is cancer of the prostate.
Because men’s prostates tend to enlarge with age and because benign enlargement of the prostate leads to a slightly higher PSA there are age specific ranges which are considered a normal PSA. Consultant urologists would be keen to see any man with a persistantly elevated PSA beyond his age specific range.
Diagnosing Raised PSA
Digital rectal examination (DRE) or per-rectal examinations (PR)
The back of the prostate (posterior aspect) lies next to the lining of the rectum and can be easily felt when a trained professional inserts a lubricated gloved finger into the rectum to feel the shape and texture of the prostate glands.
This (although some men feel this is a somewhat undignified procedure to undergo) is a completely painless one. It does not in itself completely exclude prostate cancer but taken together with a PSA is very valuable to a consultant urolgist.
If a gentleman is found to have an elevated PSA bloodtest plus / minus an abnormal feeling prostate, then the next stage of an investigation is a multi-parametric MRI scan of the prostate.
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