From the Guidelines
Lymphoma is unlikely to cause an abnormal PSA level, as PSA is a protein produced specifically by prostate cells, and its elevation is most commonly associated with prostate conditions. However, in rare cases, lymphoma that directly infiltrates the prostate gland might potentially cause some elevation in PSA levels due to disruption of the prostate tissue, as noted in general medical knowledge. If a patient with lymphoma has an elevated PSA, it's more likely that they have a concurrent prostate condition that is unrelated to their lymphoma, as suggested by 1. Any abnormal PSA result should be evaluated by a urologist, even in patients with known lymphoma, to rule out prostate-specific conditions. The standard PSA threshold for concern is typically above 4.0 ng/mL, though this varies by age and other factors, as discussed in 1 and 1. Key points to consider include:
- PSA is not a cancer-specific marker, and therefore most men with elevated PSA levels do not have prostate cancer, as noted in 1.
- Men with low PSA values have a significant chance of having prostate cancer, as seen in the Prostate Cancer Prevention Trial (PCPT) data analyzed by Thompson et al, referenced in 1.
- Recent population-based prostate cancer screening studies have shown survival benefits using PSA, sometimes in combination with digital rectal examination (DRE) or other ancillary tests, as discussed in 1 and 1.
From the Research
Lymphoma and Abnormal PSA Levels
- Lymphoma can cause abnormal PSA levels, as seen in several case reports and studies 2, 3, 4, 5.
- A study published in the European journal of haematology in 2007 reported a case of a 68-year-old patient with follicular non-Hodgkin's lymphoma that produced PSA, leading to high serum PSA levels 2.
- Another study published in The journal of spinal cord medicine in 1996 reported a case of a 62-year-old male with T-cell lymphoma involving the prostate, which presented as elevated PSA 3.
- A case report published in Urology in 1995 described a patient with non-Hodgkin lymphoma of the kidney who had a significant elevation of serum PSA levels by monoclonal assay in the absence of prostate disease 4.
- A review of serum CA125 and PSA concentrations in patients with lymphoma published in Clinical advances in hematology & oncology in 2008 noted that PSA elevations have been reported in patients with non-Hodgkin lymphoma, although less frequently than CA125 elevations 5.
Mechanisms and Implications
- The mechanisms by which lymphoma causes abnormal PSA levels are not fully understood, but it is thought that some lymphoma cells may produce PSA 2, 5.
- The presence of lymphoma should be considered in the differential diagnosis of patients with elevated PSA levels, especially in those with lymphadenopathy or other symptoms suggestive of lymphoma 2, 3.
- Elevated PSA levels in patients with lymphoma may return to normal after lymphoma-specific treatment, as seen in the case report published in the European journal of haematology 2.