Reasons
for an Elevated PSA or Abnormal DRE
What
elevates PSA?
Normally, small amounts of prostate-specific
antigen (PSA) enter the blood from the prostate
gland. However, when the prostate becomes enlarged, infected,
or diseased. larger amounts of PSA enter the blood, elevating
the PSA level.
Elevated
PSA levels are commonly caused by the following conditions:
What causes an abnormal DRE?
During a digital rectal examination
(DRE), the doctor inserts a lubricated, gloved
finger into the patient's rectum in order to feel for any
irregular or abnormally firm area of the prostate gland. The
following conditions may cause changes in the size, shape,
or firmness of the prostate gland, producing an abnormal DRE:
Normal DRE
Abnormal DRE
-
Prostate cancer: Because of the significant
risk for prostate cancer, prostate
biopsy is recommended for all men who have an
abnormal DRE, regardless of PSA level, because 25 percent
of men with cancer have PSA levels within normal range,
or less than 4.0 ng/ml. The DRE is also conducted on men
who are already known to have prostate cancer, to help determine
whether the cancer has spread beyond the prostate gland
or if cancer has come back after treatment.
- Benign prostatic hyperplasia (BPH), or an
enlarged prostate gland, is a common non-cancerous condition
in men over 50. The enlargement is often detectable with
a DRE.
- Previous
prostate surgery produces a DRE where the area of the
prostate gland feels hard and flat. The normal prostate
landmarks are lost when the prostate gland is completely
or partially removed.
- Prostate infections: Acute bacterial
prostatitis usually produces an extremely tender, swollen
prostate gland that is partially or totally firm, irregular
and warm to the touch. The symptoms of chronic bacterial
prostatitis are so variable that a DRE cannot specifically
diagnose it. The DRE for nonbacterial prostatitis and prostatodynia
may reveal tenderness of the prostate and surrounding tissue,
or no specific abnormalities may be found.
- Prostatic
or rectal calcifications (stones): Although most prostatic
calculi cannot be found by means of DRE, some can. It is
more common to discover rectal calcifications, small,
hard deposits in the rectal blood vessels. Rectal stones
are unrelated to any prostatic conditions.
The Prostate Cancer pages of this Web site are part of the
Comprehensive Prostate Cancer Awareness Program (CPCAP), a
major regional effort to reduce the rates of death and illness
caused by prostate cancer in southwestern Pennsylvania. Funding
for CPCAP is provided by a grant from the Commonwealth of
Pennsylvania.
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