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    wikiprostate.org | Benign Prostatic Hyperplasia. the Symptoms of an Enlarged Prostate
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PROSTATE CANCER SYMPTOMS

Prostate-specific antigen (PSA)

The prostate gland makes a protein called prostate-specific antigen, or PSA. A healthy man without prostate tumor should have a small amount of PSA circulating in his blood.

Some conditions related to the prostate can cause the gland to produce more PSA than normal. These include prostatitis, benign prostatic hyperplasia (enlarged prostate), and prostate tumor.

Prostate-Specific Antigen (PSA) Blood Test

Prostate-specific antigen (PSA) is a substance produced by the prostate gland. Elevated PSA levels may indicate prostate tumor, a non-tumorous condition such as prostatitis, or an enlarged prostate.

Most men have PSA levels under four (ng/mL) and this has traditionally been used as the cutoff for concern about the risk of prostate tumor. Men with prostate tumor often have PSA levels higher than four, although it is a possibility at any PSA level. According to published reports, men who have a prostate gland that feels normal on examination and a PSA less than four have a 15% chance of having prostate tumor. Those with a PSA between four and 10 have a 25% chance of having prostate tumor and if the PSA is higher than 10, the risk increases and can be as high as 67%.

When Should I Have My PSA Levels Tested?

The American tumor Society says men should talk to their physicians about the benefits, risks, and limitations of prostate tumor screening before deciding whether to be tested. The group’s guidelines make it clear that prostate-specific antigen (PSA) blood testing should not occur unless this discussion happens. They recommend that most men at average risk for prostate tumor start the discussion at age 50 and those with higher risk for prostate tumor should start the discussion earlier.

The American Urological Association recommends that men ages 55 to 69 who are considering screening should talk with their physicians about the risks and benefits of testing and proceed based on their personal values and preferences. The group also adds:

  • PSA screening in men under age 40 is not recommended.

  • Routine screening in men between ages 40 and 54 at average risk is not recommended.

  • To reduce the harms of screening, a routine screening interval of two years or more may be preferred over annual screening in those men who have decided on screening after a discussion with their physician. As compared to annual screening, it is expected that screening intervals of two years preserve the majority of the benefits and reduce over diagnosis and false positives.

  • Routine PSA screening is not recommended in men over age 70 or any man with less than a 10-15 year life expectancy.

What Does an Elevated PSA Level Mean?

Elevated PSA levels may indicate prostate tumor or a non-tumorous condition such as prostatitis or an enlarged prostate.

Your PSA level can also be affected by other factors:

Age. Your PSA will normally go up slowly as you age, even if you have no prostate problems.

  • Treatments. Some substances may affect blood PSA levels. Tell your health care provider if you are taking finasteride (Proscar or Propecia) or dutasteride (Avodart). These substances may falsely lower PSA levels typically by half of what it would normally be.

If your PSA level is high, your physician may recommend that you get a prostate biopsy to test for tumors.

Using the PSA Blood Test After Prostate Diagnosis

Although the PSA test is used mainly to screen for prostate tumor, it is valuable in other situations:

  • To guide treatment. Along with a physicians exam and tumor stage, the PSA test can help determine how advanced a prostate tumor is. This may affect treatment options.

  • To determine treatment success. After an operation or radiation, the PSA level can be monitored to help determine if treatment was successful. PSA levels normally fall to very low levels if the treatment removed or destroyed all of the tumor cells. A rising PSA level can mean that prostate tumor cells are present and your tumor has come back.

Staging prostate tumor

Staging of prostate tumor is used to communicate how advanced the disease is and to help plan treatment. Stages range from 1 to 4, with the disease being most advanced in stage 4. There are a number of factors that go into this labeling.

Prostate tumor, like many other tumors, is described based on the American Joint Committee staging system. This staging system is based on the size or extent of the tumor, the number of lymph nodes involved, and whether or not the tumor has spread or metastasized to distant sites or organs. Prognostic groups are further determined based on two additional factors: the PSA level and the Gleason score.

The role of PSA in staging

PSA levels are just one factor used in determining the stage and prognostic groups of prostate tumor.

Some men who have prostate tumor do not exhibit elevated PSA levels, and some non-tumorous conditions, like a prostate infection or benign enlargement, can cause high PSA levels.

Stage 1

Stage 1 prostate tumor is characterized by a Gleason score of less than 6: the tumor is restricted to one half of the prostate with no spreading to surrounding tissues and a PSA level below 10. The Gleason score compares tumor cells to normal cells. The more the cells differ from normal cells, the higher the score and the more aggressive the tumor. Like the PSA level, it is just one piece of the puzzle.

Stage 2a

In stage 2A prostate, the tumor is still restricted to one side of the prostate, but the Gleason score may be up to 7, and the PSA levels are greater than 10 but less than 20 ng/mL.

Stage 2B

By stage 2B, the tumor may have spread to the opposite side of the prostate gland, but it also may still be contained on one side. If the tumor is still restricted to one half of the prostate, a Gleason score of 8 or higher or a PSA level of 20 or greater categorizes the tumor as stage IIB. If the tumor has spread to both sides of the prostate then the stage is IIB regardless of the Gleason score and the PSA level.

Stages 3 and 4

By the time prostate tumor has reached stage 3 or stage 4, the tumor is very advanced. At this point, the stage is determined by the extent of the spread of the tumor, and the PSA level and Gleason score do not factor in the staging. In stage III the tumor has grown through the prostate capsule and may have invaded nearby tissue. By stage 4 the tumor is fixed or immovable and invades nearby structures beyond the seminal vesicles. It may also have spread to distant sites like lymph nodes or bones.

To determine the size and extent of the prostate tumor, physicians use imaging techniques like CT scans, MRIs, PET scans, and biopsies of prostate and other tissue.

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  • 2080 Century Park East Suite 1407,Los Angeles,CA

    Adam Ramin, MD, is board certified in urology, with sub-specialization in Urological Oncology and Robotic Surgery. His considerable medical expertise and surgical skills are enhanced by a true desire to provide a personalized, patient-first approach to medical care at his busy practice thats located in the Century City district of Los Angeles. Dr. Ramin received his medical degree from Mount Sinai School of Medicine in New York and completed his urological surgery residency at Loma Linda University Medical Center in 2000. He subsequently completed fellowship training in urological oncology and laparoscopic urology at City of Hope National Medical Center in Duarte, California. After completing his fellowship training, Dr. Ramin joined the faculty at the City of Hope as Assistant Professor of Surgery. He was among the first few surgeons in the United States to perform robot-assisted laparoscopic prostatectomy using the da Vinci system. Dr. Ramin has since performed more than 2000 laparoscopic and robotic procedures for prostate, kidney, and bladder cancers. He also provides innovative care for men and women experiencing urological issues such as prostatic enlargement, pelvic organ prolapse, erectile dysfunction, and urinary incontinence. As an expert in prostate cancer and robotic laparoscopic prostatectomy, Dr. Ramin has published numerous articles and research papers regarding prostate cancer. He has also trained numerous urologists in the techniques of minimally invasive laparoscopy and robotic surgery. Dr. Ramin is on staff at several prestigious medical institutions, including City of Hope National Medical Center, Cedars Sinai Medical Center in Los Angeles, and Saint John's Health Center in Santa Monica, California. For expert urological care thats provided in a warm and friendly environment where patients come first, schedule a visit with Dr. Ramin.

    (131) 027 - 7292

    10 MI
  • 1360 W. 6th Street Suite 125,San Pedro,CA

    About Advanced Urology Medical Offices  Advanced Urology Medical Offices is a group of top-notch urology practices that has served Greater Los Angeles for over 30 years. With locations in Los Angeles, Redondo Beach, San Pedro, and Culver City, California, patients of all ages and cultural backgrounds come to the clinics to receive high-quality, compassionate treatment for their urological complications.  The clinic specializes in the treatment of urologic conditions and disorders, including kidney stones, erectile dysfunction, urinary tract infections, urinary incontinence, and cancers of the bladder, kidneys, testicles, and prostate.  Some people are hesitant to go into details about issues like these. Thats why the compassionate team of urologists and staff at Advanced Urology Medical Offices strives to provide a trusting, non-judgmental environment where patients feel that they can be open about some of their most personal symptoms. To treat such conditions, the clinics boast some of the most advanced technologies and treatments available in the field today. They frequently perform minimally invasive robotic surgeries using the daVinci® Surgical System, UroLift® implants, and Rezum™ water vapor therapy for enlarged prostates, and testosterone therapy for hormone replacement, to name a few.  For diagnostic purposes, Advanced Urology Medical Offices provides urodynamic testing to review the functioning of your urinary organs and prostate cancer screenings to check middle-aged men for prostate cancer. If youve noticed unusual symptoms related to your urination or your urinary system, dont hesitate to call your nearest Advanced Urology Medical Offices location or use the convenient online booking tool to schedule an appointment discreetly at your convenience. 

    (131) 067 - 0911

    16 MI
  • 200 Medical Plaza Driveway 6th floor CHS,Los Angeles,CA

    Professional Memberships American Urological Association Society of Women in Urology Western Section American Urological Association American Society of Clinical Oncology American Association of Cancer Research Diplomate, American Board of Urology Academic & Medical Staff Appointments Associate Professor, Department of Urology David Geffen, UCLA School of Medicine, September 2005 Isla P. Garraway received her Bachelor of Science degree from Brown University and completed the Medical Scientist (MD-PhD) Training Program at the David Geffen School of Medicine at UCLA with a doctorate in Molecular Biology. Upon completion of the UCLA Urology residency program, she joined the UCLA faculty. She is currently an Associate Professor of Urology and Director of Research, Member of the Jonsson Comprehensive Cancer Center, and Member of the Broad Center for Regenerative Medicine and Stem Cell Research at UCLA. Dr. Garraway is a surgeon-scientist and Principal Investigator of a UCLA basic/translational science laboratory that is focused on characterizing human prostate stem and tumor-initiating cells, as well as biological and microenvironmental interactions that influence metastatic progression. She maintains a clinical practice within the Greater Los Angeles VA Healthcare System, where she also conducts clinical research. Dr. Garraway has received the Donald S. Coffey Career Development, Young Investigator, and Challenge Awards from the Prostate Cancer Foundation. She has also received funding from the National Cancer Institute, the Department of Defense, the Jean Perkins Foundation, the STOP Cancer Foundation, and the Margaret E. Early Foundation. UCLA Academic Appointments:Associate Professor, Department of UrologyDirector of Research, Department of UrologyMember, Jonsson Comprehensive Cancer CenterMember, Broad Stem Cell Center for Regenerative Medicine and Stem Cell Research

    (131) 079 - 4770

    10 MI
  • 1513 S Grand Avenue, Suite 300,Los Angeles,CA

    Dr. Leonard Liang is a leading urologist serving patients in the Greater Los Angeles area. Board-certified by the American Board of Urology, Dr. Liang is experienced in all types of urological disorders and diseases, including kidney and bladder stones, kidney tumors, erectile dysfunction and urinary incontinence. He is a recognized leader in laparoscopic surgical techniques for kidney tumors, minimally invasive procedures for enlarged prostate and prostate cancer and state-of-the-art techniques for kidney transplantation. At his centrally-located private practice on Grand Avenue in downtown Los Angeles, Dr. Liang helps both men and women get the individual attention they need to feel confident in their care. He is committed to ensuring each patient has plenty of time to ask questions and become educated about their care in a comfortable setting where they never feel rushed. Born in Atlanta, Dr. Liang earned his bachelor of science degree in biomedical sciences and his medical degree at the University of Michigan. He completed a six year urology training program at Kaiser Permanente Los Angeles where he was chief resident his final year. Following his urology residency, he did a two year fellowship in kidney transplantation at University of California Los Angeles (UCLA) at the Immunogenetics Center and the Westwood Medical Center. He holds memberships in both the American Urological Association and the American Society of Transplantation. Dr. Liang has been a Plenary Session presenter on prostate cancer and renal transplantation at the American Urologic Association Annual Meeting in 2014. In 2013, Dr. Liang was named 2013 Clinical Faculty of the Year by the UCLA Department of Urology. In addition to his current practice, Dr. Liang maintains affiliations with Good Samaritan Hospital, California Hospital, Pacific Alliance Hospital, and Harbor-UCLA Medical Center. After several years of volunteering his time at Harbor-UCLA, Dr. Liang accepted a part-time attending staff position in 2014. Dr. Liang enjoys teaching residents while doing challenging urologic surgeries and kidney transplants. Dr. Liang speaks fluent English, Spanish and Taiwanese and intermediate Mandarin Chinese.

    (121) 333 - 5676

    15 MI
  • 800 South Fairmount Ave Suite 412,Pasadena,CA

    About HUNTINGTON UROLOGY SPECIALISTS   Huntington Urology Specialists, located in Pasadena, California, is a private urology practice, led by Armen Dikranian, MD, and Ramin Khalili, MD. The team at Huntington Urology Specialists provides individualized care for a wide range of urologic conditions. The skilled and compassionate team of urologists at Huntington Urology Specialists treat conditions ranging from benign prostatic hyperplasia (BPH), incontinence, erectile dysfunction, kidney stones, prostate cancer, urinary tract infections (UTI), and much more. They also provide minimally invasive surgeries, including robotic cancer surgery, robotic reconstructive surgery, complex stone surgery, female prolapse surgery, and treatments for an enlarged prostate. By combining their warm bedside manner with the latest in innovative technology, the team of physicians at Huntington Urology Specialists is able to offer their patients an exceptional experience when they seek out urological care. If you have urological concerns and would like to schedule an appointment with our experts at Huntington Urology Specialists, call the office or request an appointment online today.

    (162) 627 - 5445

    24 MI
  • 2001 Santa Monica Boulevard Suite 460W,Santa Monica,CA

    Meet Dr. Movassaghi Mehran Movassaghi, M.D., is a board-certified, fellowship trained urologist treating patients in Santa Monica California. He has vast experience with endourology and mens health. He provides a variety of treatments for conditions including prostate enlargement and cancer, low testosterone, erectile dysfunction, testicular cancer, kidney stones, and infertility including vasectomies. Before joining St. Johns Physician Partners, Dr. Movassaghi began the first of its kind comprehensive mens health program in the Los Angeles area.   Dr. Movassaghi earned his medical degree at the University of California, Los Angeles, Geffen School of Medicine. He then served his internship at Stanford University Hospital & Clinics and his residencies at Stanford University Hospital & Clinic and USC (University of Southern California). He later completed a prestigious fellowship at Cedars Sinai Medical Center. Dr. Movassaghi is a member of the American Urological Association, the Endourological Society and sits on the board of the American Society for Mens Health. Throughout his tenure, he has published numerous peer-reviewed articles in the areas of endourology, quality of life and integrative medicine. He is the founder of the Los Angeles Prostate Cancer 5K and an avid advocate of prevention for both urologic and other forms of chronic illness. Dr. Movassaghi believes our body is the most complex piece of machinery ever made, and each system is dependent on the other for optimal performance. At every milestone in life, men face different health challenges. Screening, education, and early treatment are the most effective means for longevity and optimal quality of life. He looks forward to welcoming new patients and accepts most major forms of insurance.    

    (131) 058 - 2733

    7 MI