Prostate Specific Antigen (cont.)

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What causes PSA elevation in the blood?

It is believed that elevation of PSA in the blood is due to its liberation into the circulation because of disruption of the prostate cellular architecture (structure). This can occur in the setting of different prostate diseases including prostate cancer. It is important to note that PSA is not specific to prostate cancer but to prostatic tissue and therefore PSA elevations may indicate the presence of any kind of prostate disease. The most common cause of PSA elevation includes benign prostatic hyperplasia (BPH = enlargement of the prostate, secondary to a noncancerous proliferation of prostate gland cells) and prostatitis (inflammation of the prostate). In fact, PSA elevation can also occur with prostate manipulation such as ejaculation, prostate examination, urinary retention or catheter placement, and prostate biopsy. As such, men choosing to undergo PSA testing should be aware of these important factors, which may influence results. Age and prostate volume may also influence PSA test results.

What are normal results for the PSA test?

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The “normal” PSA serum concentration ranges between 1.0 and 4.0 ng/mL. However, since the prostate gland generally increases in size and produces more PSA with increasing age, it is normal to have lower levels in young men and higher levels in older men. The PSA level also depends on ethnicity and family history of prostate cancer. Other than the single reading, the changes in PSA numbers on an annual basis (also referred to as PSA-velocity) also play a role in decision making about the PSA marker. The normal increase of less than 0.75 ng/mL is used to help determine whether levels may be suggestive of disease and to counsel men on management. As such, a man under 50 to 59 years of age with an increase in PSA levels from 0.5 ng/mL to 2.5 ng/mL may cause greater concern despite the “normal” value at that time.

Medically Reviewed by a Doctor on 8/5/2014

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