From the Guidelines
Elevated PSA levels often do not cause noticeable symptoms on their own, but the underlying conditions that cause elevated PSA may produce symptoms such as difficulty starting urination, weak urine flow, and frequent urination. These symptoms can be associated with various conditions, including prostate cancer, prostatitis, benign prostatic hyperplasia, and urinary tract infections 1. It is essential to note that many non-cancerous conditions can raise PSA levels, and age naturally increases PSA levels as well 1. Some of the symptoms that may be associated with elevated PSA levels include:
- Difficulty starting urination
- Weak urine flow
- Frequent urination (especially at night)
- Urgency to urinate
- Incomplete bladder emptying
- Blood in urine or semen
- Painful ejaculation
- In advanced prostate cancer cases, bone pain, weight loss, or fatigue 1. If you have an elevated PSA, your doctor will likely recommend additional tests to determine the cause rather than relying solely on this blood marker, as PSA elevation alone doesn't necessarily indicate cancer or other serious conditions 1. The decision to perform further testing, such as a prostate biopsy, depends on various factors, including the level of PSA, changes in PSA over time, patient age, and prostate volume 1. It is crucial to consider these factors and discuss the pros and cons of PSA testing with your doctor to make an informed decision about your care 1.
From the Research
Symptoms of Elevated PSA
Elevated Prostate-Specific Antigen (PSA) levels can be an indicator of prostate cancer, but they can also be caused by other factors such as prostatitis or benign prostatic hyperplasia (BPH) 2, 3.
- The symptoms of elevated PSA are not always apparent, but they can include:
- Weak or interrupted flow of urine
- Frequent urination
- Painful or burning urination
- Painful ejaculation
- Blood in the urine or semen
Diagnostic Tests
Digital rectal examination (DRE) and PSA testing are commonly used to diagnose prostate cancer 4, 5.
- DRE involves a doctor inserting a gloved finger into the rectum to feel the prostate gland for any abnormalities.
- PSA testing involves a blood test to measure the level of PSA in the blood.
- Transrectal ultrasonography (TRUS) may also be used to visualize the prostate gland and guide biopsies 3.
Limitations of DRE
Recent studies have questioned the usefulness of DRE as a screening tool for prostate cancer 5, 6.
- DRE has been shown to have a low positive predictive value and cancer detection rate compared to PSA testing.
- The combination of DRE and PSA testing may not significantly improve the detection of prostate cancer.
- Emerging evidence suggests that magnetic resonance imaging (MRI) may be a more effective screening tool than DRE 6.