Conditions and Treatments

Elevated PSA


PSA or prostate-specific antigen is a protein made only by the prostate gland. Very little PSA escapes from a healthy prostate into the bloodstream, but certain prostatic conditions can cause larger amounts of PSA to leak into the blood. One possible cause of a high PSA level is benign (non-cancerous) enlargement of the prostate, or BPH. Inflammation of the prostate, called prostatitis is another common cause of PSA elevation, as is recent ejaculation. Prostate cancer is the most serious possible cause of an elevated PSA level.


Recent data has redefined the way our urologist look at PSA test results and what is considered “normal”. In addition to the PSA value or number, our urologists will review other factors such as your age, the rate at which PSA number changes over a period of time, and percentage of free PSA in the blood.

Men with normal levels of PSA may also have prostate cancer.


On the initial exam, the urologist will take a detailed medical history including family history and risk factors and perform a physical exam which includes a digital rectal or DRE.

A DRE is a simple procedure in which a gloved finger is inserted into the rectum to feel the size, texture and shape of your prostate and to determine the presence of nodules which can be suggestive of prostate conditions such as BPH or prostate cancer.
Your urologist will discuss your PSA test results relative to your digital rectal exam and may recommend further testing including

  • Urinalysis to detect infection or blood in the urine.
  • X-ray
  • Ultra sound examination to look at images of the prostate produced by sound waves.
  • Prostate biopsy, performed under local anesthetic using ultrasound guidance, is a test in which a tiny needle is used to withdraw small amounts of tissue to be examined in the laboratory. The results of the biopsy will show the nature of the prostate condition


Men should consider being screened for prostate cancer with the PSA test and digital rectal exam beginning at age 40, especially if they have risk factors for the disease. Risk factors include:

  • Age 50 years old or older
  • Race, African-Americans are at greater risk
  • Family history, have a father, brother or son who as had prostate cancer.

While some men with prostate cancer exhibit symptoms such as difficulty urinating, frequent urination or blood in the urine or semen, other men with prostate cancer do not exhibit any symptoms at all.


The PSA blood test and digital rectal exam are the recommend first steps in diagnosing prostate cancer. Additional testing has been developed to determine who needs to further treatment for the disease.


Prostate CAncer gene 3 (PCA 3) is a new gene-based test carried out on a urine sample after a digital rectal exam (DRE). PCA3 is highly specific to prostate cancer, and unlike PSA, is not increased by conditions such as benign prostatic hypertrophy (BPH) or inflammation of the prostate. It is currently used both to determine when a biopsy is needed and to follow patients who elect to watch and wait as a treatment choice for known prostate cancer.