High PSA

Last Modified: November 30, 2003

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Dear OncoLink "Ask The Experts,"
My husbands PSA is 50. A DRE indicated an enlarged and hardened prostate with nodules. A biopsy is scheduled. What are the implications of a PSA of 50? Can I assume from this score that he has cancer and that the cancer has spread? 


Alan J. Wein, MD, Professor and Chair of the Division of Urology at the University of Pennsylvania School of Medicine, responds:

In the absence of infection, a PSA of 50 generally indicates prostate cancer. Unfortunately, if cancer, this high of a PSA generally indicates advanced disease-- not necessarily metastatic, maybe just advanced local disease. With a physical exam such as the one described, I would say the most likely possibility is prostate malignancy. Have the biopsy done as soon as practical, with ultrasound guidance preferably.

Under and Over Imaging Suspected in Prostate CA Care

Apr 22, 2015 - For men with nonmetastatic castration resistant prostate cancer who have a negative bone scan after diagnosis, factors associated with a second bone scan include higher prostate-specific antigen (PSA), shorter PSA doubling time, and faster PSA velocity; however, there may be under imaging in those at high risk and over imaging in those at low risk, according to a study published in the April issue of the The Journal of Urology.

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