Determining the Cause of an Elevated PSA Level: Is it prostatitis, prostate cancer or something else?

ProstatitisMen who are told by their doctors that the level of PSA in their blood is elevated will naturally hope that the cause is no more than a minor case of prostatitis, or perhaps a case of benign prostate enlargement. The last thing they want to find out is that the cause is prostate cancer. How can one be sure? What are the signs of prostatitis?

Signs of Prostatitis

Prostatitis (inflammation of the tissue in the prostate gland), which occurs in more than half of all men at some time in their lives, may be acute or chronic. The condition typically occurs when bacteria enter the prostate. This invasion can trigger an acute inflammatory response. If the infection does not heal sufficiently, the acute inflammatory response may transition into a chronic inflammatory response of lower intensity.


Acute Prostatitis

Blood tests in patients who are suffering from acute prostatitis usually show a sharp spike in the patients’ PSA levels, i.e. the concentration of PSA in their blood is well above the normal range. This PSA spiking is also usually accompanied by a rise in the concentration of other inflammation markers in the blood. In addition to these laboratory results, however, the patients are very likely to experience any of the following symptoms:

Symptoms of Acute Prostatitis

  • Frequent urge to urinate coupled with a diminished urine flow rate
  • Burning sensation while urinating
  • Pain in the area of the bladder
  • Pressure in the area of the perineum
  • Pressure and pain in the pelvis
  • Fever
  • Chills

Treatment for Acute Prostatitis

Doctors usually prescribe antibiotics when treating their patients for prostatitis. Once the treatment regimen is complete, blood testing should show a steep drop in the level of PSA in the patients’ blood (usually to below the normal range), the concentration of other inflammation markers in the blood should return to normal and the above-mentioned symptoms should disappear.

However, if none of these effects are seen – despite the administration of antibiotics – then one may fairly safely rule out acute prostatitis as the cause of the elevated PSA levels and other symptoms. Having learned this much, the thrust of the investigation will focus on the remaining possibilities, including chronic prostatitis, prostate cancer or some other cause.

Chronic Prostatitis

Chronic prostatitis may or may not lead to abnormal PSA levels. Many men with chronic prostatitis show normal PSA levels. Furthermore, chronic prostatitis is often asymptomatic and simply goes unnoticed. While there may have been symptoms of acute prostatitis in the beginning when the bacteria first entered the prostate (e.g. through the urinary tract), these may have disappeared subsequently as the immune system succeeded in holding the infection at bay. However, if a patient’s own defenses fail to clear up the infection entirely, the inflammation in the prostate tissue that is associated with the immune response may persist in the form of chronic prostatitis. Chronic prostatitis may cause scarring in the prostate tissue, with larger areas of scarring leading to impaired prostate function. Just as in the case of acute prostatitis, chronic prostatitis may be associated with certain symptoms, including the following:

Symptoms of Chronic Prostatitis

  • Pressure and pain in the area of the perineum and pubic bone
  • Painful ejaculation
  • Pain in the area of the bladder
  • Pain and a burning sensation during or after urination
  • Pain in the groin
  • Frequent urge to urinate
  • Erectile dysfunction

Treatment for Chronic Prostatitis

Chronic prostatitis is difficult to treat. Even the prolonged administration of antibiotics may fail to bring about the desired effect.

Conventional Urological Examinations

Acute prostatitis often leads to swelling in the prostate gland, a case of inflammatory hyperplasia or enlargement. When carrying out a digital rectal exam, a urologist inserts a finger into the rectum and presses down on the prostate to determine its consistency and whether it is sensitive to pain. A case of acute prostatitis is confirmed if the patient experiences pain during the exam and the urologist determines that the prostate is relatively soft. Using a rectal ultrasound probe, the urologist can also examine the prostate and determine whether it is swollen. The problem with this procedure is that the pressure exerted on the prostate is often quite painful for the patient. Moreover, ultrasound usually does not enable the urologist visualize the changes in the prostate tissue that have been caused by the acute inflammation.

Advantages of MRI of the Prostate

In contrast to the digital rectal examination and the use of a rectal ultrasound probe, magnetic resonance imaging (MRI) does enable the detection of inflamed prostate tissue. This is because the structure of inflamed tissue usually differs from that of healthy tissue. Moreover, the MRI examination does not involve a digital rectal exam and it is not carried out transrectally. This removes the pain factor for the patient.

When attempting to arrive at a reliable diagnosis of prostate disorders, it is important to be able to distinguish between healthy tissue, inflamed tissue and a tumor. The most common cause of elevated PSA levels in men above the age of 50 is indeed prostate cancer.

The Imaging Procedure: MRI of the Prostate

MRI enables your doctor to shed light on the cause of abnormal PSA values, whether the cause is acute prostatitis, chronic prostatitis, prostate cancer or prostate enlargement.

MRI examinations of the prostate can provide crucial information about the cause of abnormal PSA levels and establish a reliable basis for making decisions about the necessity of any further procedures (e.g. prostate biopsy). MRI enables your doctor to detect tiny tissue changes in the prostate, to precisely demarcate diseased or conspicuous tissue from healthy tissue, to measure the size of the prostate as a means of determining whether it is enlarged and to evaluate the state of the prostate capsule and neighboring organs and lymph nodes.

(-> Read more about MRI of the prostate)

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