First, the urologist will preliminarily assess whether PSA levels are elevated by considering factors such as the patient’s age, medications taken regularly, and the size of the prostate gland.
Additionally, as mentioned earlier (What is Prostate-Specific Antigen (PSA)?), reasons for elevated PSA levels include recent ejaculation, recent prostate digital rectal examination, recent cystoscopy, long-distance cycling, among others. The doctor will take a history to exclude these possibilities.
Next, the doctor will arrange the following tests to determine whether the condition is acute prostatitis, urinary tract infection, or prostate enlargement, etc.
Digital rectal examination: To check for significant pain (suspected acute prostatitis) or hard nodules (suspected prostate cancer).
Blood tests: If acute prostatitis is suspected, blood may be drawn to confirm whether white blood cell count and inflammation markers are elevated.
If the patient’s PSA levels are only slightly elevated (typically 4 to 10 ng/mL), the doctor may draw blood again to confirm “free prostate-specific antigen (free PSA).
Combining PSA with free PSA can help the doctor decide whether the patient should undergo prostate biopsy.
Urinalysis: To check for pyuria or hematuria and to perform bacterial culture and antibiotic sensitivity testing.
Prostate ultrasound: To check for prostate enlargement, prostatic abscess, or suspected lesions indicative of prostate cancer.
Generally, if the doctor has ruled out the aforementioned possible diseases or conditions, the next step is to exclude the possibility of prostate cancer.
Typically, when prostate cancer is suspected, there are two common strategies:
Arranging conventional prostate biopsy: Biopsies are taken from several sites of the prostate guided by transrectal ultrasound, using a biopsy needle to obtain small tissue samples, which are then examined by pathologists for the presence of cancer cells.
Arranging advanced prostate magnetic resonance imaging (MRI): Prostate cancer cells have distinct imaging features on MRI.
If the examination results do not reveal any suspicious lesions, the patient only needs to regularly monitor changes in PSA levels without undergoing prostate biopsy.
If the examination results reveal suspicious lesions, one or more, the patient may then undergo further prostate biopsy guided by MRI imaging.
Through image-guided navigation, urologists can precisely biopsy these suspicious lesions without worrying about missing them with traditional biopsies, thus improving the detection rate.
If the patient is confirmed to have prostate cancer after undergoing biopsy, the doctor will arrange further relevant treatment.
If the biopsy results indicate benign tissue, the patient can simply return for regular follow-up examinations.
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