Urologic evaluation of an elevated PSA or abnormal DRE may include additional evaluation of blood PSA, assessment of symptoms and risk factors and if necessary, analysis of urine and prostatic fluids.
What
was the PSA in the past?
A comparison of a man's PSA levels from year to year is an
important way to measure prostate health. PSA levels remain
relatively unchanged in men with normal, healthy prostate
glands. Benign prostatic hyperplasia (BPH) will cause PSA
to rise from year to year, but not rapidly. Prostate cancer,
which grows at a much faster rate than BPH, causes a faster
rise in PSA level in a shorter period of time.
What
is the PSA velocity?
PSA velocity is the rate of change in PSA level over a
period of time, usually from year to year. In general, prostate
cancer increases PSA levels more than BPH does and so it is
likely that prostate cancer will cause PSA to rise more quickly.
An average consistent PSA increase of more than 0.75 ng/ml
per year, over the course of three tests separated by at least
12 to 18 months, is a significant change which may indicate
the presence of prostate cancer -- even when PSA levels are
still within the normal range.
What is the free-to-total PSA?
Some PSA binds together with other proteins in the blood,
while other PSA circulates alone, or "free" in the bloodstream.
The free-to-total PSA test compares the amount of free
PSA to total PSA in the blood -- both free and bound. A low
percentage of free PSA (25 percent or less) means a greater
likelihood of prostate cancer than higher percentages.
PSA elevation due to BPH
Benign prostatic hyperplasia (BPH),
commonly known as an enlarged prostate gland, is a non-cancerous
growth of prostate tissue. The chance of developing BPH increases
with age. More than half of men over 50 have BPH and about
80 percent have BPH by age 80. Symptoms of BPH include restricted,
weak, or intermittent urine flow; leakage after urination;
a feeling of being unable to empty the bladder completely;
or urinary frequency or urgency.
PSA elevation due to prostatitis
Prostatitis is
an inflammation of the prostate gland. Some types of prostatitis
are caused by infection; other causes are unclear. Symptoms
of prostatitis include difficulty urinating; urinary frequency
or urgency; pain or burning during urination; or pain in the
lower back or perineum, penis, scrotum and/or pubic region.
Testing for prostatitis involves looking for signs of inflammation
or infection in the fluid secreted by the prostate gland and
in the urine.
If there is no other explanation for PSA elevation, such as BPH or prostatitis, then the next logical step is to check for prostate cancer. Most early prostate cancers cause no symptoms. When symptoms are present, they may include changes in urination flow, frequency, or urgency; erectile difficulties; or pelvic, hip, or back pain. While there is no known cause for prostate cancer, risk factors include age, race, family history and diet.
DRE findings
During the digital rectal examination (DRE) a doctor inserts a lubricated, gloved finger into the patient's rectum to feel for lumps, enlargements, or areas of hardness that might indicate prostate cancer. A doctor can often detect the size of the prostate, whether it is likely that the cancer is limited to one side of the prostate or spread to the other side as well and the probability of its spread beyond the prostate gland. A DRE cannot detect very small tumors or tumors located away from the rectal side of the prostate gland.
Significance of DRE on prognosis
Current studies report that the probability of cancer being present if a DRE is abnormal ranges from 21 percent to 53 percent, depending on whether the men studied were participating in an initial screening or referred for further evaluation. Other studies noted that the prostate cancer discovered from a DRE tended to be more advanced in 50 percent of the men.
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.
