It would be ideal that every disease had a blood test to screen patients.
Sometimes you need imaging tests. In other cases, you might require invasive procedures to confirm the diagnosis of a given disease.
That is one of the reasons why PSA testing is so popular as a screening method for prostate cancer.
But this diagnostic test has its limits. It is not entirely accurate and should be compared with other evaluations to increase the predictive value.
But PSA is not only a test to screen for prostate cancer. It detects many other conditions, including benign prostatic hyperplasia.
Anything that increases the size of the prostate gland may also increase your PSA levels.
If that is the case, what is considered normal and abnormal in terms of PSA level if you have BPH?
Is there a reason to worry if your PSA levels are very high? Does it mean you have prostate cancer?
In this article, we will cover this topic and give you some medical insight into how urologists interpret PSA levels in BPH.
What is PSA screening?
PSA screening is a routine diagnostic tool performed in selected patients to rule out prostate cancer. This is a blood test that measures total PSA and free PSA levels in your blood.
PSA is short for Prostate-Specific Antigen. It is an enzyme produced in the prostate and released in the sperm.
A proportion of this enzyme leaks into the circulation via the prostatic blood vessels. Patients with an enlarged prostate gland produce more PSA, which is released at a higher concentration in the blood.
No other tissues in the body create PSA. Thus, a PSA test gives a reliable account of what is happening inside the prostate.
Still, your PSA level not only depends on prostatic growth. Inflammation, prostatic manipulation, and other factors may also come into play.
In benign prostatic hyperplasia, the prostate tissue grows. More prostatic cells are synthesizing PSA.
A higher volume of this enzyme runs into the blood. For all of this, PSA levels in BPH are higher than the average, and this test is helpful to screen for BPH as well as prostate cancer.
As with any other screening method, PSA screening can be used even if you don’t have symptoms of prostate cancer.
For example, patients with very high risk and family history may run a PSA test to rule out the disease. Urologists have a particular set of indications to know if you are a candidate for PSA screening (1).
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Average PSA levels in BPH patients
As noted above, PSA levels in BPH patients are expected to increase. This is because benign prostatic hyperplasia features an increase in PSA production. There is more free PSA in the blood, but that doesn’t mean you also have prostate cancer.
The results of your PSA test depend on your prostate volume. So, if your prostate gland is very large because your BPH is advanced, you’re expected to have a high PSA, too. As such, it is not possible to determine an average value for all patients. Instead, each one should be evaluated and followed up individually.
However, based on previous studies, we can say that PSA levels in BPH can be included in one of three categories (2):
- Low risk: Your risk will be lower if you are diagnosed with BPH with a PSA level of 4 ng/mL or less.
- Gray area: If your PSA level is within the range of 4 to 10 ng/mL, some studies suggest you’re in a gray area. The risk is higher, and you might need close monitoring and other exams.
- High risk: If you have 10 ng/mL, your risk of prostate cancer is very high. You will likely need another procedure to confirm the diagnosis.
Do not take your risk lightly and overlook the problem if your PSA levels are lower than 4 ng/mL. There are different types of prostate cancer, and some are very silent and do not start raising your PSA levels until it is too late. So, trust your doctor and report any change in your BPH symptoms.
Can BPH raise your PSA level?
PSA levels in BPH increase as the prostate gland grows. This happens even if you are not yet diagnosed with prostate problems.
For instance, a man will have a lower PSA level at 30 years old, and it will naturally increase at 45 years. He may even display elevated PSA levels after that age without having prostate cancer.
Why does it happen? Because the prostate volume is expected to increase as we age. It doesn’t matter if you suffer BPH or not; your serum PSA levels will still increase.
If that is true for healthy patients, it is even more evident in benign prostatic hyperplasia. Anything that causes an enlarged prostate can also raise your PSA level.
Just keep in mind that prostate carcinoma is not detected by PSA alone. Thus, instead of trusting blindly in this measure, doctors use several evaluations to determine your risk of prostate cancer.
If you have BPH and a high PSA, should you be worried?
As noted above, PSA levels in BPH are higher than the average. But the same happens with prostate cancer. How can you tell if your elevated PSA corresponds to benign prostatic hyperplasia or prostate cancer?
Urologists have tried to figure out multiple ways to solve this problem and came up with a few solutions (3,4,5):
Categorizing your risk
We can start by comparing your PSA test results to the risk categories mentioned above. If they are in the low-risk category, you are less likely to have prostate cancer. Patients in the gray area may require further workup. Patients with a high risk will probably need further testing.
Considering your PSA velocity
It is useful to have your records of previous PSA testing if you have BPH. Comparing and making a timeline is fundamental in order to see the rate of prostate growth.
This is called PSA velocity. When the elevation of this measure is sudden and does not correspond with the average increase over the years, it can indicate prostate cancer.
Calculating your PSA density
Patients in the gray area should receive multiple evaluations. An ultrasound scan and digital rectal exams are very useful in this regard. They are recommended when doctors can’t ascertain if you have a high risk or not.
Comparing them with your PSA may give your doctor a clue about what is happening in your prostate.
There is also a measure known as PSA density, which joins your prostate volume measured by ultrasound and your PSA results. It helps doctors evaluate if the elevated PSA corresponds to the volume of the prostate.
Considering your symptoms
Sometimes, a change in your symptoms is what alerts the urologist that something is not going right. An elevated BPH with a sudden onset of severe urinary symptoms should receive a prompt evaluation.
In a nutshell, should you worry about high PSA if you have BPH?
You are expected to increase PSA levels as a part of BPH. The rate of PSA increase and correlating with other exams is fundamental to ascertain your risk. The answer to this question should be evaluated individually.
However, you should be aware of sudden and violent increases in PSA and rapidly worsening symptoms and report them to your doctor.
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In our opinion, a far safer and gentler prostate biopsy alternative is our Advanced Prostate Cancer Risk Assessment (APCRA). This consists of non-invasive blood tests and specialized color Doppler scans.
The variety and sophistication of some of these new blood tests make this a very realistic alternative to a prostate biopsy, especially if you have a preference for non-invasive diagnostics and treatments.
After this testing, you will receive a thorough, 3-hour consultation from a Naturopathic Physician who is also a Professor of Urology and a very detailed, written report of your results to be discussed during the appointment.
He will walk you through the results of his assessment and explain every aspect and each option available to you, while also answering any questions that you may have. Your consultation will be like an educational mini-seminar about the real issues facing you as a patient.
Most urologists will have a preference for the particular treatment that they provide. However, the consultant you will see has no agenda and is completely free to offer honest, independent advice.
He will try and help with any information you need in order to arrive at your decision. But he will not try to sway you one way or the other.
Aside from that, the greatest additional benefits of the APCRA are that it is non-invasive, does no damage, and does not close off any avenues for future treatment.
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How to naturally lower your PSA levels
You have probably heard about specific lifestyle factors that increase your PSA levels. For example, smoking, obesity, and inflammation cause alterations in serum PSA.
In such cases, you can naturally lower your PSA through a series of lifestyle modifications:
- Stop smoking and avoid heavy alcohol consumption
- Adopt a few stress coping techniques
- Exercise and try to live a more active lifestyle
- Reduce the burden of obesity by eating healthily
It is also essential not to take a PSA test if you recently had sexual intercourse, after receiving a prostate massage, or if you have a urinary infection. All of these factors raise your PSA level leading to inaccurate results.
How to naturally shrink your prostate
Your PSA level is a useful measure of prostate health. Thus, the best way to normalize high PSA is by reducing inflammation and other elements that harm your prostate gland.
In other words, shrinking the prostate prevents the damage instead of shutting down the alarm.
This is possible through a few natural therapies. For instance (6):
- Curcumin: This is one of the main components of turmeric. It has potent anti-inflammatory properties. Moreover, studies suggest that turmeric may also inhibit cancer cell growth and induce apoptosis.
- Resveratrol: A famous flavonoid found in grapes and wine. It is also found in peanuts, cocoa, and some berries. Besides protecting against oxidative damage, resveratrol may also promote apoptosis.
- Green tea: It contains catechins with many studies on cardiovascular health and cancer. Green tea reduces inflammation and protects against free radicals.
- Lycopene: This substance is found in tomatoes, papaya, guava, and other fruits. It has been found to reduce the risk of aggressive prostate cancer.
PSA levels in BPH are very important to diagnose and treat this condition. Elevated PSA is expected in these patients, and the measure increases gradually as we grow older.
However, it is essential to check on your serum PSA, even if you have benign prostatic hyperplasia. It may alert patients with BPH about prostate cancer.
Every patient should receive an individual interpretation based on their personal history and symptoms. There is a low-risk area when PSA is lower than 4 ng/mL. However, low risk does not mean zero risk, and your doctor may need to consider some extra information before reaching a conclusion.