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Elevated PSA

Prostate Cancer Risk Assessment

Prostate cancer is the most common solid organ malignancy in men. The prostate gland is a sexual organ, and the disease and its treatment can have a devastating impact on a man’s sexual health and overall well-being.

Prostate Cancer screening includes a test to measure the levels of prostate-specific antigen (PSA) in your blood. Elevated PSA levels are often an early indication of prostate cancer as well as other prostate disorders. Results from regular PSA screenings will show whether your PSA levels have changed year to year and whether that change is cause for concern.

Unfortunately, prostate specific antigen (PSA) testing and prostate cancer screening are not routinely offered to all appropriate men by their primary care providers. Men with a family history of prostate cancer as well as African American men are at especially high risk for developing prostate cancer.

What is Elevated PSA?  

PSA is a protein produced by the prostate that helps keep semen liquid outside the body. When the prostate is healthy, a very small amount of PSA escapes from the prostate and enters the bloodstream. When the prostate is unhealthy-if it is inflamed, enlarged or contains cancerous cells-larger amounts of PSA leak into the bloodstream.

Most men without prostate cancer have PSA levels under 4 nanograms per milliliter (ng/mL) of blood. The chance of having prostate cancer goes up as the PSA level goes up. When prostate cancer develops, the PSA level may go above 4. Still, a level below 4 does not guarantee that a man doesn’t have cancer. Here are some statistics:

  • About 15% of men with a PSA below 4 will have prostate cancer on a biopsy.
  • Men with a PSA level between 4 and 10 have about a 1 in 4 chance of having prostate cancer.
  • If the PSA is more than 10, the chance of having prostate cancer is over 50%.

What Causes Elevated PSA?  

PSA elevation may be due to many different prostate changes, such as benign (non-cancerous) enlargement, inflammation or infection. Prostate cancer may also cause an elevation in the PSA level.

How is Elevated PSA Diagnosed?  

A simple blood test is used to measure a man’s PSA level.

Can I lower my PSA?  

While age and genetics are major factors affecting PSA levels, there are many lifestyle factors that may play a role in PSA levels.

Learn More About Ways You May Be Able to Lower Your PSA here.

What’s Next if I have Elevated PSA: Assessing Prostate Cancer Risk

An elevated PSA result does not automatically mean that a man has prostate cancer. Other conditions of the prostate may cause the PSA to rise as well, such as infection, inflammation, or benign enlargement of the prostate. In the past, any man with an elevated PSA would routinely undergo a painful, and possibly unnecessary, prostate biopsy in the office without anesthesia, oftentimes due to a false elevation of his PSA.

By contrast, Dr. Steinberg is an expert at prostate cancer risk assessment. He will assess a man’s risk for prostate cancer and perform a careful exam in the office. He will also consider family history, race, and PSA velocity to determine whether further testing should be performed. Dr. Steinberg is an expert at evaluating and monitoring patients who have Elevated PSA levels for prostate cancer. A physical exam, evaluation, and diagnostic testing are used to determine a patient’s risk of having or developing prostate cancer.

Medical History and Physical Exam  

During an initial office visit, Dr. Steinberg will perform a Digital Rectal Exam (DRE), inserting a gloved, lubricated finger into your rectum to examine your prostate for any irregularities. Dr. Steinberg may ask you about any symptoms you are having, such as any urinary or sexual problems, and how long you have had them. You might also be asked about possible risk factors for prostate cancer, including your family history.

Diagnostic Testing For Elevated PSA

If appropriate, Dr. Steinberg will order advanced diagnostic tests to better assess a man’s risk of having or developing prostate cancer. Dr. Steinberg promptly reviews all findings with his patients to determine if further testing is indicated.

4K Score Blood Test

Dr. Steinberg often utilizes the 4Kscore, a blood test drawn in the office, which combines four prostate-specific biomarkers with clinical information, to provide men with an accurate and personalized measure of their risk for aggressive prostate cancer. The 4K score can be used to help determine the need for a prostate biopsy. The 4-K score can also help predict the likelihood of cancer spreading to other parts of the body over the next 20 years. The blood sample is sent overnight to a lab and results are usually available and discussed with patients within one week.

Select MDX Urine Test 

This simple urine test performed in the office is often used to determine the risk of finding high-grade cancer on a subsequent prostate biopsy. This information can help guide the decision for recommending a biopsy. Results of the test are usually available in 24 hours. Learn more about the Exosome DX Urine test here.

Multiparametric MRI of the Prostate

If indicated by the results of diagnostic urine and blood tests, Dr. Steinberg will order a state-of-the-art painless radiology study which is now the gold standard for detecting the presence of an aggressive prostate tumor. Dr. Steinberg reviews the MRI results with his patients and determines whether a prostate biopsy is indicated.

MRI/Ultrasound Fusion Prostate Biopsy

The advanced MRI/Ultrasound Fusion Prostate Biopsy is performed in the operating room, under anesthesia as an outpatient procedure. Using the MRI images, a 3-D model of the prostate is created, and the exact areas of possible malignancy are targeted for tissue sampling. The procedure is painless, and the patient may resume all regular activities the following day. Dr. Steinberg reviews the biopsy results with his patients within a week and will discuss further management strategies.

Genomic Prostate Score

For patients who have a positive Prostate Biopsy result, Dr. Steinberg may Recommend further testing. The Genomic Prostate Score (GPS) evaluates the expression of several cancer-related genes in biopsy tissue. The GPS assay generates a score from 0 to 100, with higher scores indicative of more aggressive disease.

Active Surveillance and Monitoring

In addition to traditional methods of treatment for prostate cancer, such as radiation and surgery, Dr. Steinberg frequently manages patients with an Active Surveillance protocol when appropriate. This management approach for men with low grade and low volume prostate cancer involves regular visits and continued diagnostic and genetic testing and monitoring.

Dr. Steinberg is an expert in determining risk and diagnosing Prostate cancer. If you are concerned about your risk of Elevated PSA or of developing Prostate cancer, please call Urology Specialists of Milford at (508) 473-6333 to schedule an evaluation with Dr. Steinberg in his Milford, MA office. 

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