Prostate specific antigen (PSA) – WHAT IT IS

An elevated PSA does not necessarily indicate prostate cancer. It can mean other conditions are present. Do not rush into a conventional prostate biopsy because multiparametric MRI can reveal whether or not there is a prostate cancer tumor. If so, a real-time MRI guided, targeted biopsy gives the most accurate diagnosis.

Antigens are proteins produced from a cell’s DNA. Proteins have many functions in the cell, in the body, and the immune system. They can stay within the cell, become a part of the cell surface, or even leave it.

PSA is a type of cell surface protein made from the DNA of prostate cells. Its purpose is to help keep semen liquefied so sperm can move freely. Because it is a surface protein, small amounts get into the bloodstream, which allows them to be detected and measured by the PSA blood test.

Prostate activity releases higher-than-normal amounts of PSA into the blood. When the prostate gland is stimulated by orgasm or pressure (e.g. digital rectal exam, bike riding, etc.) a blood test may show a temporary elevation in PSA. This is why a digital rectal exam should be done ONLY after blood is drawn for the blood test. After such activity, PSA will return to baseline. But there are other kinds of stimulation, caused by some ongoing activity within the gland itself. Infection or prostatitis, BPH (aging-related gland enlargement), and prostate cancer can also release more antigens into the bloodstream.

Prostate specific antigen (PSA) – WHAT IT IS NOT

Many men think that an elevated or rising PSA is a sign or biomarker of prostate cancer. It is not. PSA is only a sign of prostate activity. However, most patients who have prostate cancer will also have a higher than normal or rising PSA blood test because of cancer’s growth activity. For this reason, prostate cancer becomes “the usual suspect.” This is why doctors want to rule cancer in or out as quickly as possible.

NOTE: The U.S. Government Task Force recommends against routine PSA screening for otherwise healthy men who have no known prostate cancer risk factors. The reasoning behind this was based on the fact that too many men with suspicious PSA were rushed into having a TRUS prostate biopsy, a procedure with known risks. Due to the flaws of TRUS biopsy, many cases of significant prostate cancer were missed, while many insignificant prostate cancers were overtreated. That pathway looks like: PSA/DRE ? TRUS biopsy ? Positive PCa diagnosis ? Decision to treat or not

Elevated or rising PSA – A NEW APPROACH BEFORE BIOPSY

The Sperling Prostate Center upholds the position that PSA screening has value, thanks to new technologies that allow a better, minimal-to-noninvasive diagnostic pathway. Today’s multiparametric MRI and better biomarker tests (also called genomics or molecular testing) means that need for a biopsy can be ruled in or out. Furthermore, if a biopsy is indicated, a real-time MRI guided (in-bore) targeted biopsy uses the minimum number of needles for the most accurate results – especially when accompanied by molecular information about the prostate cancer cells. This pathway looks like:
HIGH PSA ? 3TmpMRI ? MRI-guided biopsy if needed + biomarker tests ? Decision to treat or not

When should you act?

The Sperling Prostate Center recommends that following a suspicious PSA blood test result, do the following:

  1. Wait at least six weeks and have a second test. Sometimes an abnormally high PSA was the result of earlier activity (having sex, riding a bike, etc.) or laboratory error
  2. If a second PSA test remains high, or has become even higher, arrange as soon as possible to have a multiparametric MRI (mpMRI) of the prostate (with and without contrast) done on a powerful 3T magnet. When performed and interpreted by an experienced radiologist, 3TmpMRI can clearly distinguish healthy tissue, prostate inflammation, BPH, and cancer
  3. If your mpMRI was done at another center, ask for a copy of your image CD. Our Center will help you arrange for a complimentary second opinion from Dr. Sperling personally
  4. If at least two readers agree that there is a suspicious lesion, arrange as soon as possible to have a real-time MRI guided (in-bore) targeted biopsy
  5. Recommended: Arrange to have your slides submitted to a genomic analysis (our Center uses several tests depending on the case)

If you have prostate cancer, these steps allow you to have the most accurate and detailed portrait of your disease, including

  • Your most recent PSA
  • Tumor size, shape and location (result of mpMRI)
  • Tumor aggression (combined result of mpMRI, biopsy, genomics)
  • Tumor stage

These clinical factors allow you to make a treatment decision that best matches your disease. Treatment options include radical (whole gland) surgery or radiation, partial gland ablation, focal treatment such as Focal Laser Ablation that spares urinary and sexual function, or Active Surveillance. Because there is no single treatment that is right for everyone, only a thorough diagnosis offers the peace of mind that comes when you know you have chosen the right treatment for you.

Questions patients ask us

Q: My PSA is high. Should I try a course of antibiotics to see if it comes down?
A: Antibiotics are for bacterial infections. Not all prostate infections are caused by bacteria, and taking antibiotics can affect healthy intestinal organisms needed for proper digestion. We suggest a 3T mpMRI scan first. A prostate imaging expert can tell the difference between prostate cancer and infection or inflammation. We recommend finding out as directly as possible if a suspicious lesion exists.

Q: I have a family history of prostate cancer, but my PSA has always been below 2.3 Does this mean I don’t have prostate cancer?
A: A low PSA does not mean absence of cancer. There are many different prostate cancer cell lines. About 15% of them are highly aggressive but in early stages do not raise PSA. For men with a first degree relative (father, brother, son) with prostate cancer, or a mother with breast cancer (yes, men who carry certain breast cancer genes are at increased risk for prostate cancer) we encourage an annual 3TmpMRI, which studies have shown to be better than PSA for screening.

The latest news

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Sperling Prostate Center Joins MR-Guided Focused Ultrasound Clinical Study. Find out more »

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New article co-authored by Dan Sperling, M.D., on Focal Laser Ablation for prostate cancer with powerful clinical trial results. Read it now »