Yes. Benign prostatic hyperplasia (BPH) can cause PSA levels to rise without necessarily indicating prostate cancer. An enlarged prostate is one of the benign causes that can elevate this marker.
Benign prostatic hyperplasia (BPH) is the non-cancerous enlargement of the prostate gland that commonly occurs after age 50. As the gland enlarges, PSA levels in the blood may rise.
To mark European Prostate Health Day, which is celebrated on September 15 , at ROC Clinic we answer one of the most frequently asked questions when it comes to blood tests: what does it mean to have an elevated PSA level when there is benign prostatic hyperplasia?
Why might PSA levels rise with benign prostatic hyperplasia (BPH)?
PSA, or prostate-specific antigen, is a protein produced by the prostate gland. When benign prostatic hyperplasia (BPH) is present, the amount of prostate tissue increases, and the prostate may become larger. As a result, the amount of PSA released into the bloodstream may also increase.
Therefore, a high PSA level is not synonymous with prostate cancer . In addition to benign prostatic hyperplasia (BPH), an infection or inflammation of the prostate can also raise PSA levels. Similarly, recent ejaculation or certain urological procedures can cause temporary increases in PSA.
What PSA values are considered normal with benign prostatic hyperplasia?
There is no PSA value that can be considered "normal" for all patients with BPH.
Although a PSA level of 4 ng/ml has been used as a reference value for years, the result should not be interpreted as a boundary between a benign disease and cancer.
A patient with benign prostatic hyperplasia may have a PSA level of 4 or 5 ng/ml, or even higher, without having prostate cancer. However, it would also be incorrect to assume that any elevation is solely due to prostate enlargement.
Furthermore, there is no single, universally accepted PSA level that is completely normal or abnormal. The risk of prostate cancer increases progressively as PSA levels rise, but cancer can be present even at levels below 4 ng/ml, while higher levels may be free of cancer.
The important thing is to interpret that value taking into account age, prostate size, previous test results, medical history, and other clinical findings.
If I have a high PSA level and an enlarged prostate, how is that interpreted?
One of the aspects a urologist can assess is the relationship between PSA levels and prostate volume. A parameter called PSA density is used to contextualize the result based on prostate size.
In other words, the same PSA level can have a different meaning depending on the characteristics of the prostate and the patient.
It is also important to understand the evolution of the data. A single result provides information, but comparing it with previous measurements can help the specialist decide whether monitoring is sufficient or if further study is warranted.
When should an elevated PSA be investigated?
Having an elevated PSA level does not automatically mean that a biopsy is necessary.
Depending on the individual case, the urologist may recommend repeating the blood test and considering other tests. When indicated, a prostate MRI can provide more information before deciding on the next steps.
Medication should also be taken into account. Some treatments for benign prostatic hyperplasia, such as finasteride or dutasteride, lower PSA levels , so the result should be interpreted considering that the patient is taking them.
High PSA: a data point that needs to be interpreted, not a diagnosis
Benign prostatic hyperplasia is a non-cancerous growth of the prostate and may be one of the reasons why PSA levels increase.
Therefore, when faced with a high result, it is not advisable to draw conclusions solely from one figure.
At ROC Clinic , our Urology specialists jointly assess PSA, prostate size, its evolution, urinary symptoms and risk factors for each patient to determine whether follow-up or further study is necessary.
On the occasion of European Prostate Health Day , we remind you of the importance of consulting a doctor if you experience changes in urination or abnormalities in prostate tests, and of having an individualized assessment of your prostate health.
