Urology Conditions
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      Elevated Prostate-Specific Antigen (PSA)

      Condition: Elevated Prostate-Specific Antigen (PSA)

      Brief Overview: An elevated PSA is a higher-than-expected blood level of prostate-specific antigen. PSA can rise due to prostate cancer, but also from benign conditions such as benign prostatic hyperplasia (BPH), prostatitis, recent ejaculation, instrumentation, or even vigorous cycling. PSA is a screening/risk marker, not a diagnosis.

      Per UpToDate, “A number of assays are available to measure serum PSA; although the exact value that is considered "abnormal" is highly controversial, historically, most clinicians consider a PSA above 4 ng/mL as abnormal. Different normal reference ranges may be appropriate based upon a man's age:

      • 40 to 49 years – 0 to 2.5 ng/mL
      • 50 to 59 years – 0 to 3.5 ng/mL
      • 60 to 69 years – 0 to 4.5 ng/mL
      • 70 to 79 years – 0 to 6.5 ng/mL

      Etiology:

      • BPH
      • Prostate cancer
      • Prostate inflammation or infection
      • Trauma to the perineum – including bicycling, digital rectal exam, sexual activity, and prostate manipulation
      • Certain medications
      • UTI

      Risk Factors:

      • Age
      • Family history
      • African ancestry

      Commonly Associated Conditions:

      • Benign prostatic hyperplasia (BPH)
      • Prostatitis/UTI
      • Lower urinary tract symptoms (LUTS)
      • Urinary retention
      • Prostate cancer

      Common Medications: Medication would be based on what’s causing the PSA to be elevated.

      Common Labs, Imaging, and Tests:

      • Repeat PSA testing
      • Digital Rectal Exam (DRE)
      • MRI, Ultrasound
      • Prostate biopsy

      Common Symptoms:

      • Often asymptomatic.
      • If symptoms are present, they’re typically due to BPH/prostatitis/etc.: weak stream, frequency, urgency, nocturia, pelvic/perineal discomfort, dysuria, hematuria, urinary incontinence fever (if acute infection).

      Common Treatments:

      If you are found to have an elevated PSA, your healthcare provider may recommend:

      • Repeat PSA tests
      • Digital rectal exams
      • Additional tests – blood tests, urine tests, imaging (MRI, ultrasound)
      • Prostate biopsy

      Any additional treatment would be based on any underlying etiology or cause of the PSA elevation

      Physical Findings:

      • Often, normal physical exam
      • May have abnormal prostate exam/DRE

      Potential Complications and Contraindications:

      • Overdiagnosis/overtreatment if low-risk disease biopsied/treated aggressively.
      • Missed high-risk cancer if evaluation deferred in high-risk patients.
      • Biopsy risks: bleeding, infection, urinary retention.
      • Medication considerations: interpret PSA correctly if on certain medications

      General Health and Lifestyle Guidance:

      • Before repeat PSA, ask your healthcare provider if there are any recommendations you should follow like: avoid ejaculation and vigorous cycling for 48 hours; defer testing if ill or with UTI.
      • Adequate hydration and infection prevention; complete antibiotics if prescribed.
      • Know your meds: tell clinicians if taking 5-ARIs or new urologic meds/procedures.
      • Shared decision-making with your healthcare team about biopsy versus surveillance, considering age, comorbidity, family history, race/ethnicity, and personal values.

      Suggested Questions to Ask Patients:

      • Have you had your PSA testing repeated under standardized conditions (no ejaculation/cycling; no infection)?
      • Any urinary symptoms (weak stream, frequency, nocturia), pelvic pain, fever?
      • Prior PSA values and trends? Any abnormal DRE?
      • Family history of prostate cancer?
      • Recent urologic procedures, catheterization, or prostatitis/UTI?
      • Are you taking finasteride/dutasteride or alpha-blockers?
      • What are your goals and preferences if further testing/biopsy is suggested?

      Suggested Talking Points:

      • An elevated PSA doesn’t always mean cancer; many benign factors can cause elevations
      • Your healthcare provider will like plan to standardize a repeat test and consider adjunct tests or MRI
      • If your risk remains concerning, a biopsy may be recommended; if not, your healthcare provider may monitor the situation
      • If cancer is found, treatments range from active surveillance to definitive therapy; decisions are typically personalized.”
      • If you’re on certain medications, your healthcare provider may interpret your PSA differently.
      • Always ask your healthcare provider for specific advice on when to call to report symptoms, and when to seek urgent/emergency care.  

      Sources:

      This resource is for educational purposes only and is not a substitute for professional medical advice. The patient should always follow your healthcare provider’s instructions.

      This content was created with the assistance of AI. Any AI-generated content was reviewed by a Nurse Practitioner