Elevated PSA
What is PSA?
PSA (prostate-specific antigen) is a small protein molecule, which is released from the prostate gland into the bloodstream. It has a role in processing of semen.
What are the causes of a raised PSA?
PSA may be raised in prostate cancer, but is not a test that is specific for prostate cancer. Raised levels of PSA may also be caused by inflammation, infection, benign enlargement or recent surgery or sexual activity.
How is raised PSA investigated?
Whilst PSA is far from being an accurate marker of prostate cancer, it is an important marker in deciding who needs further investigation. It is usually combined with prostate MRI which has approximately 80-85% chance of predicting significant prostate cancer. Based on your age, general health, risk-factors for prostate cancer (family history of prostate cancer, race), prostate examination, as well as PSA metrics (PSA subtype, density, rate of rise and age-specific cut-offs) and results of prostate MRI, together, are used to decide your risk of having prostate cancer. Based on your calculated risk, your urologist will recommend if you should have a prostate biopsy.
Majority of prostate biopsies are now done transperineally (through the area between the scrotal skin and the anus) – either under a local anaesthetic or sedation. Any abnormal areas seen on the MRI can be targeted.
Even when cancer is found on biopsy done for elevated PSA, not all such cancers require treatment. Only detailed urological investigation can determine whether a prostate cancer is "incidental" (requiring no treatment) or "significant" (requiring active treatment).
What happens once the biopsies have been performed?
It may take up to 1-2 weeks before you get the results of your prostate biopsies. The biopsies are analysed to determine whether prostate cancer is present and to determine the volume and grade of cancer.
If your prostate biopsies are negative for prostate cancer, you will normally be advised about treatment of any prostate symptoms you may have and your urologist will arrange for you to have regular (6-12 monthly) blood tests to check your PSA. If the PSA level remains raised or increases with time, you may be advised to have repeat biopsies with more extensive sampling.
If your prostate biopsies are positive for prostate cancer, to find out the extent of your prostate cancer, your urologist may arrange a CT and bone scan, or a PET scan. Together with the Gleason grade found on the biopsies, these will determine what treatment is needed. Not all patients, however, require staging investigations before treatment.
Once the results of all the tests are available, your urologist will discuss what treatment options are available and what is best for you. This will take into account your age, general health, PSA level, Gleason grade and stage of the tumour as well your personal preference.
Your urologist will help you decide whether treatment by active surveillance (cancer is monitored closely and treated only if there are signs of progression), surgery, radiotherapy, hormones or chemotherapy is best for you.