What is a high PSA level, and why does it matter?

For many men, a routine blood test may reveal a high PSA (prostate-specific antigen) level, which can lead to concern and questions. PSA is a protein produced by both normal and cancerous cells in the prostate gland, and its levels can be measured to assess prostate health. While a high PSA level may be concerning, it doesn’t necessarily mean cancer. Leading urologist Mr Arun Jain explains what a high PSA level could indicate and the potential next steps to provide clarity.

How is PSA measured, and what counts as “high”?

A PSA test is a blood test that measures the concentration of PSA in nanograms per millilitre (ng/mL) of blood. In general, PSA levels below 4 ng/mL are considered normal for most men. However, the upper level of normal may vary with age and race. PSA levels tend to increase with age, and levels slightly above 4 ng/mL may still be normal for older men.

Significance of PSA levels above this threshold depends on factors such as age, family history, and overall health. PSA levels can also vary due to factors other than prostate health. For example, recent sexual activity, certain medications, infections, and even cycling can temporarily increase PSA levels.

Could a high PSA level indicate prostate cancer?

A high PSA level can be a warning sign for prostate cancer, but it is not a diagnostic test. A high PSA level does not always indicate that a man has prostate cancer. Instead, conditions like benign prostatic hyperplasia (BPH), which is a medical term for enlarged prostate, and prostatitis, an inflammation of the prostate, are often to blame. BPH is common in older men and may cause urinary symptoms but is not cancerous. Prostatitis can also raise PSA levels and may cause discomfort, but it is typically treated with antibiotics and does not increase cancer risk.

If your PSA level is high, your doctor may recommend additional testing, such as a digital rectal examination (DRE) or imaging scans, to determine the underlying cause.

What should you expect if you need further testing?

If initial PSA results are elevated, additional testing is often needed to get a clearer picture. Your doctor may perform another PSA test to confirm the result, as levels can fluctuate naturally. Additionally, a DRE may be performed, where a healthcare provider examines the prostate via the back passage by gently pressing against it through the rectal wall to check for any unusual lumps or firmness.

Further investigation may involve imaging, such as MRI scan, to visualise the prostate more clearly, or a biopsy, where a small sample of prostate tissue is taken and examined under microscope for cancer cells. Biopsy can provide more detailed information about whether cancer is present and, if so, how aggressive it might be.

Are there ways to lower PSA levels?

PSA is a marker protein. High level of PSA in the blood by itself does not cause you any harm. The treatment of the causative factor will automatically result in the lowering of PSA. 

Some medications given to treat BPH can lower PSA levels in men. These medications work by shrinking the prostate thus reducing PSA levels. 

However, in such men, the health professional will work out a corrected PSA value. You should discuss the potential benefits and side effcts of any medication for BPH with your doctor before beginning treatment.

If you are concerned about high PSA and would like to book a consultation with Mr Jain, do not hesitate to do so by visiting his Top Doctors profile today.