An elevated prostate specific antigen (PSA) begins the process. Your doctor will want to know how rapidly your PSA is increasing, called PSA velocity, and also PSA doubling time.

Some men with prostate cancer do not experience any symptoms of the disease and don’t discover they have it until a screening test returns with a suspicious result, leading to a search for a diagnosis. Other men may experience significant symptoms of prostate cancer, prompting them to seek medical attention. These symptoms may include:

• Slow start to urination: Some men will find they have trouble initiating urination despite the urge to urinate.
• Painful urination: Some men may experience pain when they urinate, called dysuria. The pain may be similar to what you feel when you have a bladder infection.
• Weak urine stream: You may notice that your urine stream is weaker than it used to be or that you “dribble” urine.
• Difficulty emptying bladder: You may find that despite taking your time to urinate, you feel as though you are unable to completely empty your bladder.
• Blood in urine: Some men may notice blood in their urine, called hematuria.
• Blood in semen: Noticing blood in your semen may be a sign of prostate cancer.
• Pain with ejaculation: Painful ejaculation can occur in some men with prostate cancer.
• Bone pain: Prostate cancer most commonly spreads or metastasizes to bone so pain in the bones, particularly those of the pelvis, hips, and spine, can occur with metastatic prostate cancer.

The Ups and Downs of the PSA Test

PSA is a protein produced by the prostate gland that can be detected in the blood. A PSA result can be elevated in men who may have prostate cancer, but many other conditions can cause a rise beyond normal PSA levels; among them are benign prostatic hyperplasia (BPH) and inflammation of the prostate (prostatitis).

The PSA test was originally approved to monitor men who had previously been diagnosed with prostate cancer; however, beginning in the 1990s, doctors started using it along with a digital rectal exam (DRE) to screen asymptomatic men for prostate cancer. This was typically done on an annual basis for all men starting at the age of 50. Evidence has shown, however, that many men may be over-diagnosed and over-treated as a result of having an elevated PSA test, leading to some controversy over its use for routine screening.

If PSA Test Result Is Elevated, What Comes Next?

If you have no history of prostate cancer, are asymptomatic, and have a normal DRE, your doctor may chose to follow-up with PSAs and DREs at regular intervals. If you have been previously diagnosed and/or treated for prostate cancer and your normal PSA levels begin to increase, your doctor may recommend additional testing. This may also be the case if you are symptomatic or at increased risk of having prostate cancer.

• Urinalysis: A urinalysis can rule out a urinary tract infection as the cause of an elevated PSA.
• Transrectal Ultrasound: An ultrasound can help identify irregularities in the prostate gland.
• Biopsy: The only way to definitively diagnose prostate cancer is performing a biopsy on prostate tissue.