What Happens If I Have an Elevated PSA Level? What Are My Options?

Dr. Nelson talks about your options if you have an elevated PSA level

462294327 (1)If your doctor thinks prostate cancer might be present, usually because your PSA is elevated or because you have an abnormal exam, you’ll be be sent to urologist.

Typically, if the PSA is elevated, your doctor will recheck it, as all faith isn’t placed in a single test. But if that PSA is definitely elevated, or if it has been arising over a period of time, your doctor will likely proceed to a prostate biopsy.

For more, watch Dr. Nelson in this video.

Video Transcript

Roscoe Nelson MD:  If your doctor thinks prostate cancer might be present and that is usually because your PSA is elevated or because you have an abnormal exam, you are going to be sent to urologist.  Typically, if the PSA is elevated, we are going to recheck it, we are not going to put all our faith in one test, but if that PSA definitely is elevated or if it has been arising over a period of time, we are going to probably proceed to a prostate biopsy.  That procedure is done in the office takes about five minutes, most men do very well with this test. 

There is very small risk of infection and bleeding from it.  If you have been diagnosed with prostate cancer, there are typically five main options that I discussed with my patient.  The first which is under utilised is watchful waiting.  For men who are older and have a low grade small volume prostate cancer, this is often the best option.  It does not mean ignoring the cancer, it means that you are going to actively take part and follow it closely making sure that this is one of those cancers that you are likely to die with and not from. 

If you are younger, have a more aggressive form of prostate cancer, have high volume prostate cancer, and you are healthy and have a life expectancy more than 10 years, we think what are the curative ways, whether it be to remove the prostate surgically either open or with robotics to radiate it either external beam or with brachytherapy seeds, and some people for specific cancers may freeze the cancer.  When the cancer has spread and is not treatable locally, we often use a form of hormonal treatment where we remove testosterone from the patient and this will allow the cancer to quick growing. 

When cancers have stopped responding to hormonal treatment, we go onto some newer developed drugs along with chemotherapy.

Roscoe Nelson
Dr. Roscoe Nelson is certified by the American Board of Urology and a Fellow of the American College of Surgeons. He completed his residency at the University of California, Davis and his doctorate of medicine at the University of California, San Diego. Dr. Nelson is nationally recognized and ranked among the nation’s and Arizona’s top physicians and has won numerous awards including the 2008 through 2012 Patients’ Choice Award.


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