What Are The Complications Of Prostatitis
Men with acute bacterial prostatitis may develop . This widespread inflammation can be life-threatening. It requires immediate medical treatment.
Antibiotics can cause an upset stomach. Men with chronic bacterial prostatitis may need lots of antibiotics to treat recurring infections. Some people develop antibiotic resistance, making treatment ineffective.
Asymptomatic inflammatory prostatitis can lower sperm count, affecting fertility.
Elevated Psa In Men May Signal Problems With The Prostate Gland
Prostate specific antigen is a glycoprotein produced by normal prostate tissue and is measured by obtaining a blood sample. Several factors can cause an elevated PSA in men, including prostate cancer. However, having an elevated PSA does not always mean a cancer diagnosis. The best recommendation is to be evaluated by a urologist to determine why PSA levels are high.
Several non-cancerous conditions can cause an increase of PSA in the blood. Even common factors such as ejaculating during intercourse or having digital rectal exam of the prostate can cause slight elevations of PSA for a short period of time. Other contributors can include:
- BPH or enlarged prostate
- Prostatitis an inflammation of the prostate / infection. Prostatitis can be bacterial or non-bacterial.
- Slow urinary stream
How Are Researchers Trying To Improve The Psa Test
Scientists are investigating ways to improve the PSA test to give doctors the ability to better distinguish cancerous from benign conditions and slow-growing cancers from fast-growing, potentially lethal cancers. None has been proven to decrease the risk of death from prostate cancer. Some of the methods being studied include:
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What Happens If My Psa Comes Back High
Should your PSA level return higher than expected or above the normal physiologic range based on your age, the first step will likely be to draw a follow-up PSA. If the repeat PSA is lower, the initial elevation may have been temporary and associated with something other than prostate cancer. If the repeat PSA remains high, Dr. Kasraeian may recommend further studies, including an MRI, prostate biopsy, or another advanced diagnostic test to rule out prostate cancer. While all patients are monitored closely, patients who receive an elevated PSA result can expect to have PSAs drawn more frequently for a period of time.
Urinary Tract Infection Or Irritation
An infection of the urinary tract, as well as irritation caused by medical procedures involving the urethra or bladder, may irritate the prostate and cause it to produce more PSA. If you have experienced any of these, be sure to let your doctor know. Youll need to give the area some time to heal and calm down before running a PSA test.
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What Is A Normal Psa Test Result
There is no specific normal or abnormal level of PSA in the blood, and levels may vary over time in the same man. In the past, most doctors considered PSA levels of 4.0 ng/mL and lower as normal. Therefore, if a man had a PSA level above 4.0 ng/mL, doctors would often recommend a prostate biopsy to determine whether prostate cancer was present.
However, more recent studies have shown that some men with PSA levels below 4.0 ng/mL have prostate cancer and that many men with higher levels do not have prostate cancer . In addition, various factors can cause a mans PSA level to fluctuate. For example, a mans PSA level often rises if he has prostatitis or a urinary tract infection. Prostate biopsies and prostate surgery also increase PSA level. Conversely, some drugsincluding finasteride and dutasteride , which are used to treat BPHlower a mans PSA level. PSA level may also vary somewhat across testing laboratories.
Another complicating factor is that studies to establish the normal range of PSA levels have been conducted primarily in populations of White men. Although expert opinions vary, there is no clear consensus regarding the optimal PSA threshold for recommending a prostate biopsy for men of any racial or ethnic group.
In general, however, the higher a mans PSA level, the more likely it is that he has prostate cancer. Moreover, a continuous rise in a mans PSA level over time may also be a sign of prostate cancer.
A Dozen Things That Can Raise Your Psa That Arent Cancer
Elevated PSA levels dont always spell cancer!
This month was Prostate Cancer Awareness Month. So you went to your doctor for an exam and a Prostate Specific Antigen blood test. If your came Prostate Specific Antigen back 1.0 ng/ml or less, congratulations on a perfectly healthy prostate! However, if you are one of the many men whos Prostate Specific Antigen level is slightly to moderately elevated , not to worry, it doesnt necessarily mean cancer!
There are many things that can contribute to an elevated Prostate Specific Antigen level beside having cancer. Think of PSA as a barometer of overall prostate health. If levels start to rise then its time to take action as something is going awry.
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Significance Of A Rising Psa
Many doctors use PSA levels to determine the diagnosis and treatment of prostate problems. Unfortunately, some urologists subscribe to the theory that almost any rise in a mans PSA value should be followed up with a prostate biopsy.
Men are also led to believe that PSA levels are all-important for diagnosing prostate cancer both by their peers and by the media. However, many situations can significantly rise in PSA that does not indicate cancer or require significant treatment.
Other conditions that can cause increased PSA levels include an enlarged prostate or an inflamed or infected prostate . In addition, PSA values can be temporarily increased by external stress on the prostate, such as bicycle or motorcycle riding as well as sexual activity, especially intense sexual or physical activity.
For older men, the general upper limit that is considered normal is 4.0 ng/mL. However, normal prostates emit a higher level of PSA as a man ages. The PSA level also tends to increase with the size of the prostate, especially with BPH. A CAT scan or an MRI can determine the size of a mans prostate, but such tests may not always be warranted.
Some doctors use rising PSA as a major factor in determining if a man needs a biopsy or further treatment, especially when the PSA rise is showing a steep slope.
High Result In Prostate Specific Antigen Test
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Other Reasons For An Elevated Psa Test
In addition to urinary tract infection and prostatitis, there are other reasons that can cause a high PSA level. These include:
- Benign prostatic hyperplasia Benign prostatic hyperplasia, also known as BPH, is enlargement of the prostate caused by aging. An enlarged prostate can produce higher levels of PSA. There are treatments available for BPH.
- Medical procedures A prostate exam or digital rectal exam can result in inflammation of the prostate and increased PSA levels. A urinary catheter or urethral scope can also cause higher PSA levels. For accurate results, wait a few weeks after having a medical procedure done before having a PSA test.
- Age It is normal for PSA levels to gradually trend up with age. If the rise in your PSA level is slow, and consistent with your age, there is likely no concern.
- Cancer An elevated PSA level does not mean you have cancer but most men with prostate cancer do have an elevated PSA level. If you have an elevated PSA level your doctor may perform a digital rectal exam to check for lumps on the prostate. They will also likely order another PSA test to see if your level continues to rise. They may order imaging tests to check for cancer on the prostate. If you are receiving treatment for prostate cancer, your doctor will likely monitor your PSA level to help determine how effective treatment is. If PSA decreases, it can indicate that treatment is effective.
What You Should Do
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Explore the patient’s concerns and expectations. Find out how much he knows and understands about prostate cancer and prostate specific antigen
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When examining him include the abdomen and external genitalia to exclude other conditions such as urinary retention and epididymitis, which can be associated with urinary infection
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Do a digital rectal examination. An asymmetrical prostate, a nodule, or a hardened area are common abnormal findings. Abnormal findings of digital rectal examination have a positive predictive value of 20% for prostate cancer. Up to 12.5% of men with a prostate specific antigen concentration of < 4 ng/ml and an abnormal finding on digital rectal examination are found to have prostate cancer on biopsy
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Do a urinalysis and urine culture to exclude urinary tract infection. Treat him if the culture is positive, then repeat the prostate specific antigen test if after eight weeks his midstream urine is clear
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Give him written information about prostate specific antigen and prostate cancer if possible
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Refer him to a urologist.
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Is The Psa Test Accurate
PSA test accuracy is questionable because there many factors interfere with the measurement. A false measurement can be misleading and prompt a prostate biopsy. This procedure is useful for detecting prostate cancer. However, it has consequences that affect the quality of life of patients.
A prostate biopsy can cause chronic bleeding and chronic pain. The site of the procedure can become infected and bring along other problems. There would be no point if the result was a false positive, and the patient stays with pain and bleeding for a long period. Thus, PSA accuracy is very important if we want to use PSA screening for prostate cancer.
Since this test can sometimes be misleading, PSA testing is recommended for some patients. If you have urinary symptoms or risk factors for prostate cancer, youre a candidate. However, every patient presents a different case, and you will need the opinion of an expert.
Stil, PSA is beneficial for urologists. Along with the Gleason score, it is used to evaluate how aggressive cancer is. It can help your urologist to decide if hes going to perform a radical prostatectomy. It is also very useful for patients during active surveillance. This is a watch and see approach doctors use in senior patients with non-aggressive cancer .
Causes Of High Psa Levels Without Prostate Cancer
PSA or prostatic specific antigen is a special protein that is secreted by prostate cells. The PSA test determines the serum levels of this protein in the blood. It has been observed that high PSA levels are usually suggestive of prostate disease but high levels of PSA doesnt always mean that the person is suffering from prostate cancer. High PSA levels that are caused by benign conditions returns to normal levels if inciting source is removed.
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What Other Factors Can Influence Psa
Many other factors can influence PSA levels at a higher and measurable rate. You can have a high PSA level in the following cases:
- High levels of parathyroid hormone: Hormonal levels can affect the function of the prostate gland. The parathyroid hormone regulates the balance of calcium in the body. A very high level can also increase the chance of BPH and prostate cancer. Thus, people with a high level of parathyroid hormone are at a higher risk. They may have a higher chance of getting a high PSA reading .
- After ejaculation: Ejaculation and sexual activity directly stimulate the prostate gland. It releases its contents and may also leak PSA to the blood. Thus, it is not appropriate to perform a PSA test after ejaculation or any sexual activity. Remember that during sex, there are also micro ejaculations. These may also affect the results of a PSA test, even if theres no actual climax.
- Medications: Some medications affect your PSA levels. And, ironically, some of them are used to relief prostate symptoms. For example, finasteride is commonly used to improve urinary problems in BPH. This drug will also reduce the level of PSA. The end result is a lower PSA, but not because the problem is getting better. It is a skewed result that may confuse doctors and patients. Thats why your doctor will probably advise to stop finasteride treatment before testing your PSA levels .
When Should I Start Getting My Psa Checked
Most men are encouraged to have regular PSA tests performed starting at around age 45, though men with a positive family history of prostate cancer or certain prostate cancer risk factors, such as being African American, should start sooner. During your initial visit with Dr. Kasraeian, he will thoroughly review your previous records, discuss your health history and family history, perform any necessary lab work or imaging studies, and formulate a customized care schedule that best meets your needs.
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How High Can Psa Levels Go With Prostatitis
PSA levels can vary by age and individual. As mentioned before, there is no standard range for PSA levels, but typically anything greater than 4.0 ng/mL indicates a problem. However, your PSA level can be below 4.0 ng/mL and you can have prostatitis. After antibiotic treatment, an elevated PSA level due to prostatitis should decline.
What Is A High Psa Level
There isnt a particular PSA level thats deemed normal as levels can vary over time. With that said, most medical experts in the past note that PSA levels of 4.0 ng/mL and lower are normal while levels above 4.0 ng/mL may require a prostate biopsy to determine the underlying cause and confirm whether or not prostate cancer is present .
Its important to remember that prostate cancer isnt always the underlying reason for high PSA levels, as previously mentioned, there are many conditions and factors that can cause your levels to fluctuate.
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What Questions Should I Ask My Doctor
You may want to ask your healthcare provider:
- What type of prostatitis do I have?
- What is the best treatment for this type of prostatitis?
- What are the treatment risks and side effects?
- How can I avoid getting prostatitis again?
- What type of follow-up care do I need after treatment?
- Should I look out for signs of complications?
A note from Cleveland Clinic
Prostatitis is a common problem that affects many men. Unfortunately, theres a lot of confusion about the disease. People use the word prostatitis to describe four different conditions. There isnt a one-size-fits-all treatment for prostatitis, which is why an accurate diagnosis is so important.
Can A Rapid Rise In Psa Indicate Prostatitis
Rapid Rise in PSA May Signal Prostatitis. But men with a PSA velocity of 4.0 ng/mL per year or higher were just as likely to have prostatitis as they were to have prostate cancer, said Dr. Eggener, who performed the study with William J. Catalona, MD, Professor of Urology at Northwestern University Fienberg School of Medicine.
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When To See A Doctor
Some of the first symptoms of patients who have an elevated PSA level is difficult or painful urination, pain in the abdomen or pelvic area, and a frequent urge to urinate. These symptoms can be signs of BPH, prostatitis, prostate cancer, and kidney stonesall of which require different treatment. If you are experiencing any of these symptoms, it is important to talk with your doctor. Your doctor will be able to help determine the cause of your problems and provide an individualized treatment plan.
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An Elevated Psa Can Cause Anxiety
Men often worry that an elevated PSA means they may have prostate cancer. Fortunately, only 25-30 percent of men with a PSA between 2.5 and 10 will be diagnosed with prostate cancer, and the majority of those men will have very early-stage cancer.
While some criticize PSA screening, it’s important to know that prostate cancer deaths have declined 44 percent since it was introduced in 1991. Today, it continues to remain the best way to detect prostate cancer.
The PSA is a simple blood test that measures the amount of a specific proteinprostate-specific antigen in a mans bloodstream. PSA is a protein molecule produced not only by prostate cells, but also by prostate cancer cells. PSA protein should remain in the prostate and within ejaculate where it helps liquefy semen and break down other proteins to help sperm live longer after a man ejaculates. A small number of PSA molecules can leak into the bloodstream, but when a PSA level is higher than normal, it may be a sign of something more serious happening in the prostate.
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Medical Procedures Can Cause Psa To Rise
“Anything that traumatically interferes with the architecture around the prostate gland can make PSA go up,” says Dr. Milner. “One of the most common causes of significantly high PSA from this type of trauma is the placing of a catheter into the bladder.”
Another cause is a prostate or bladder exam that involves passing a scope or taking a biopsy.
“Since it takes about two to three days for PSA to go down by half, you should wait two to three weeks after this type of trauma to do a PSA test,” Milner says.