My PSA level is high … do I have prostate cancer?

When a blood test shows that something in the body is elevated, it’s normal for patients to feel concerned that there’s a serious issue. 

This is especially true for men whose results show a high level of PSA, or Prostate-Specific Antigen—a protein that’s naturally produced by the prostate gland—because increased levels can indicate prostate cancer.

However, during Prostate Cancer Awareness Month, it’s important to know that high PSA does not automatically mean a diagnosis. In fact, 75 percent of men with elevated PSA are cancer-free, with other factors contributing to their numbers.

What causes high PSA?

According to Catherine Gu, MD, a urologist at Trinity Health Mid-Atlantic Medical Group’s Comprehensive Urology Langhorne, there are quite a few activities and conditions outside of cancer that can boost PSA:

• Peloton use
• Bike riding
• Horseback riding
• ATV riding
• Catheter insertion
• Urinary tract infection

“If you’re spending a lot of time on a Peloton or bike with the saddle pressing into your perineal area where the prostate is, that can elevate your PSA,” says Dr. Gu. “Anything that causes inflammation or irritation to that area can raise your PSA.”

An individual’s PSA may also become elevated due to BPH (benign prostatic hyperplasia), or an enlarged prostate. Dr. Gu explains that, as men get older, it’s natural for the prostate to grow and produce more PSA. In such instances, urologists must take into consideration PSA density, which can be measured through an ultrasound, MRI or CT scan.

“Are you making a normal amount of PSA for how large your prostate is? A man whose prostate is 200 grams may have a PSA of 14, which is a lot higher than the ‘normal’ level of 4, but his PSA density—which you get by dividing the PSA by the size of the prostate—is 0.07. Research has shown that if the density is below 0.15, then the chances you have prostate cancer are very low,” says Dr. Gu.

When is high PSA actually cancer?

Most men with elevated PSA are cancer-free, but there are instances when it does mean prostate cancer. While the PSA levels of a Peloton enthusiast or patient with BPH will lower or stay the same, those with cancer will likely see their PSA rise.

“I want to see how your PSA evolves over time. If it’s 14 now and still 14 in six months, great. It’s not going anywhere. But if your PSA is rising and doubling over a period of time, that’s a lot more concerning than your PSA being high but just staying at that same level over time,” says Dr. Gu. “If a patient has cancer, that PSA would never go back down.”

What if my high PSA is cancer?

If a PSA test does lead to a prostate cancer diagnosis, most patients can continue through life without any aggressive treatment because of its slow-growing nature. Many are put under active surveillance, where their provider carefully monitors the cancer and recommends surgery or radiation only if necessary.

“Research shows that you can watch these patients for many years with no impact on their overall quality of life, survival or metastases risk. Patients with low-grade, less aggressive prostate cancer are a lot more likely to die with prostate cancer than of prostate cancer,” says Dr. Gu. “Aggressive treatment comes at a cost to the patient. They can experience urinary symptoms from radiation, radiation cystitis down the line or complications from surgery, such as incontinence and erectile dysfunction.”

How often should I have my PSA checked?

A PSA blood test is the main way to see if anything abnormal, like cancer, is happening in the prostate. According to Dr. Gu, a good rule of thumb is an annual check between the ages of 50 and 70, though it can start earlier and continue later depending on family history and other risk factors.

While an elevated PSA doesn’t always mean prostate cancer, knowing your number and how it changes over time can provide important insight into your prostate health. Regular PSA testing allows your provider to identify concerning trends early and determine whether additional testing or monitoring may be needed.

Visit Urology Care for more information and to make an appointment.