Raised PSA
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.
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’.
What is a normal PSA level for my age?
The normal range of PSA is debated. While some guidelines include a range of less than 3ng/ml being ‘normal’ if you do not suffer from urinary symptoms, others use an age-specific range to determine ‘normal’.
The age specific ranges recommended by NICE are:
- Men in their 40s: A PSA score greater than 2.5 ng/ml is considered abnormal.
- Men in their 50s: A PSA score greater than 3.5 ng/ml is considered abnormal.
- Men in their 60s: A PSA score greater than 4.0 ng/ml is considered abnormal.
- Men in their 70s: A PSA score greater than 6.5 ng/ml is considered abnormal.
Other factors that are taken into consideration are the size of your prostate (PSA density) and how fast PSA has been rising (PSA velocity).
When should I start getting my PSA checked?
For any man it’s a good idea to start screening your PSA level from the age of 50, as it’s from this age and onwards men are at most risk of developing prostate cancer.
We recommend men with a higher risk of getting prostate cancer (e.g. a family history of prostate or breast cancer, are of black ethnic origin, or are overweight/obese) start screening at the earlier age of 45.
If your PSA is higher than the ‘normal’ level for your age. Or if your doctor sees a significant rise since your last test, they may recommend further tests.
It’s worth noting that your PSA level isn’t the only factor in deciding next steps. A doctor will also take into consideration a range of other factors that can cause raised PSA.
Causes of raised PSA levels
There are a number of reasons PSA can be raised:
1. Enlarged prostate
The prostate is very enlarged, usually through a benign process such as Benign Prostatic Hyperplasia (BPH).
If your prostate is enlarged it is more likely to secrete higher amounts of PSA. If your MRI scan shows an enlarged prostate without suspicion of prostate cancer we will calculate the PSA density (amount or PSA released per millilitre), which might give a reason for the PSA to be raised and provide reassurance.
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. Trauma or exercise while cycling could also transiently raise PSA, although this should go back down with time.
3. Prostate cancer
The main reason to investigate raised PSA is to rule out prostate cancer. Prostate cancer comes in many forms, from slow growing cancers that will not make a difference to a patient’s length or quality of life to aggressive tumours that can spread.
Diagnosing Raised PSA
Diagnosing a raised PSA involves a series of steps starting with an initial PSA blood test. As an elevated PSA level itself isn’t a definitive sign of prostate cancer, further investigations are usually required.
These investigations typically include a digital rectal exam (DRE), an MRI scan of the prostate and potentially a prostate biopsy to determine the cause and confirm or rule out cancer.
1. A 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 can’t alone can’t tell you whether you have prostate cancer. So further investigative tests and diagnosis may be recommended.
2. Digital rectal examination (DRE)
As well as a PSA test we might also perform a digital rectal examination. This allows a consultant urologist to feel for any changes to your prostate gland. They do this by inserting a gloved, lubricated finger into your rectum. While a little undignified, it is painless and provides a consultant urologist with valuable information.
3. Prostate MRI scan
If you are found to have a raised PSA or a suspicious digital rectal examination you will be recommended to undertake an MRI scan of your prostate.
Prostate MRI has been shown to be accurate in being able to predict whether there is prostate cancer in your prostate. If there is suspicion of prostate cancer then we will arrange a targeted biopsy of your prostate, targeting abnormal areas on MRI.
4. Transperineal prostate biopsy
A transperineal prostate biopsy involves collecting small tissue samples from your prostate gland for laboratory analysis. Analysis of these samples helps detect the presence of prostate cancer, assess abnormal prostate growth and guide appropriate treatment options.
At The Urology Partnership we offer targeted transperineal prostate biopsies based on MRI findings. This allows us to perform an optimal biopsy while minimising the risk of infection.
We perform these biopsies under local anaesthetic which has a number of patient benefits:
- It avoids the risks associated with general anaesthetic.
- It might reduce the chance of difficulty passing urine (urine retention) following the procedure.
- The procedure can be done in an outpatient clinic therefore avoiding a hospital visit.
- There are quicker recovery times as no general anaesthetic.
- It’s less expensive with no hospital/anaesthetist fees.
Treatment of prostate cancer
If you are diagnosed with prostate cancer you will be given a Gleason score, which is made up of the two most common patterns of prostate cancer seen in your prostate. This combined with your PSA and stage (how far the prostate cancer has spread locally) will be used to determine how aggressive your prostate cancer is and how we should treat it.
More recently NICE has recommended using the Cambridge Prognostication Group to help decide on treatment options.
| Cambridge Prognostication Group | Risk Factors |
|---|---|
| 1 | Gleason score 6 and PSA less than 10 microgram/L and stages T1–T2 |
| 2 | Gleason score 3 + 4 = 7 or PSA 10–20 microgram/L and stages T1–T2 |
| 3 | Gleason score 3 + 4 = 7 and PSA 10–20 microgram/L and stages T1–T2 or Gleason 4 + 3 = 7 and Stages T1–T2 |
| 4 | One of: Gleason score 8, PSA more than 20 microgram/L, Stage T3 |
| 5 | Two or more of: Gleason score 8, PSA more than 20 microgram/L, Stage T3 or Gleason score 9–10 or Stage T4 |
Here at The Urology Partnership we offer a full range of treatments, from active surveillance for low risk disease to robotic assisted radical prostatectomy for intermediate or high risk localised prostate cancer.
Our specialists Luke Stroman and Adam Jones both regularly perform a high volume of robotic radical prostatectomy, ensuring a high quality of surgery.
A problem with a prostate is usually first noticed by a change in urination. If you notice a change in your normal urinating patterns, such as needing to urinate more frequently or having a weaker urine flow, 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.
Fast access to PSA tests and results
If you’re at all concerned about your prostate health we offer fast access to tests and diagnostics to identify the cause of raised PSA, before recommending the best course of treatment for your individual case.
Please contact The Urology Partnership on 0118 920 7040 or make an appointment with one of our specialists.
Next Steps
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If you would like more information or wish to arrange a consultation with one of our specialist consultant urological surgeons then please either Call 0118 920 7040 or complete the form below.
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Contact your GP and ask for a referral to the Urology Partnership.
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