From the Guidelines
A PSA level of 17 ng/mL is significantly elevated and warrants immediate urological evaluation and a prostate MRI, as it falls into the high-risk category for prostate cancer, with a recommended consultation with a urologist and a multiparametric MRI of the prostate within the next 1-2 weeks. The normal PSA range is typically below 4 ng/mL, with levels between 4-10 ng/mL considered moderately elevated and levels above 10 ng/mL suggesting a higher risk of prostate cancer 1. A PSA of 17 ng/mL indicates a need for further investigation to determine the cause of the elevation, which could be prostate cancer or benign conditions like prostatitis or benign prostatic hyperplasia.
The multiparametric MRI will help identify suspicious lesions in the prostate that may require targeted biopsy, as studies have shown that MRI-guided biopsy can improve the detection of clinically significant prostate cancer, especially in men with prior negative biopsies and elevated PSA 1. The urologist will likely recommend a prostate biopsy based on the MRI findings to determine if cancer is present. Key points to consider include:
- The importance of avoiding activities that can artificially raise PSA levels, such as ejaculation, vigorous exercise, or prostate manipulation, for 48 hours before any follow-up PSA test.
- The role of multiparametric MRI in identifying suspicious lesions and guiding targeted biopsy.
- The potential for false-positive and false-negative PSA test results, highlighting the need for a comprehensive evaluation including MRI and urological assessment.
While waiting for these appointments, no specific medication is needed, but it is essential to follow the urologist's recommendations for further testing and evaluation to determine the cause of the elevated PSA level and to develop an appropriate treatment plan if prostate cancer is diagnosed. The goal of this approach is to prioritize morbidity, mortality, and quality of life outcomes by accurately diagnosing and managing prostate cancer, if present, while also considering the potential risks and benefits of further testing and treatment.
From the Research
Prostate-Specific Antigen (PSA) 17 and Prostate MRI
- The relationship between PSA levels and prostate MRI is crucial in diagnosing and managing prostate cancer 2, 3.
- A PSA level of 17 may indicate the need for further evaluation, including a prostate MRI, to determine the presence and aggressiveness of prostate cancer 3.
- Prostate MRI can help identify high-grade and high-volume tumors, which are more likely to progress and require treatment 2.
Role of MRI in Active Surveillance
- MRI is recommended prior to enrollment in active surveillance programs to accurately classify risk and predict progression to treatment 2, 4.
- Serial evaluation with MRI can help monitor patients on active surveillance and reduce the burden of unnecessary examinations 2, 5.
- MRI-guided biopsies can improve the characterization of prostate pathologic results and reduce the risk of pathologic disease upgrading 4.
PSA Dynamics and MRI Scans
- PSA dynamics, such as PSA velocity, can be associated with subsequent progression in patients with negative initial MRI scans 5.
- Repeat MRI scans can help detect changes in tumor visibility and guide treatment decisions 5.
- The combination of PSA monitoring and MRI scans can allow for the omission of protocol biopsies in some patients on active surveillance 5.
Re-evaluating Active Surveillance Inclusion Criteria
- The introduction of MRI into the diagnostic pathway may have led to risk inflation, resulting in men being labeled ineligible for active surveillance 6.
- The improved accuracy of MRI-targeted biopsies may permit the widening of active surveillance inclusion and follow-up criteria 6.
- Dynamic and individual risk-based approaches to active surveillance may be necessary to reduce overtreatment and improve patient outcomes 6.