Prostate Cancer Diagnosis

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Having a high level of PSA in the blood is not a cancer diagnosis. There are a number of factors that can cause damage to the prostate which may result in the release of high levels of PSA into the bloodstream. The following can cause damage to the prostate to release high levels of PSA in the blood:

  • Some medical conditions
  • Medications
  • Enlarged prostate
  • Prostate infection

The PSA test is useful but it is worth noting that other seemingly harmless daily activities prior to the test can affect the PSA levels too.

  • Ejaculation within the last 48 hours
  • Having your prostate stimulated during sex within the last week
  • Having a digital rectal examination before the PSA blood test
  • Doing vigorous exercise, such as cycling within the last 48 hours
  • Having had a prostate biopsy in the last 6 weeks

Another important point to note is that under normal circumstances black men produce higher levels of PSA than men of other races.
The normal ranges of PSA vary for different race groups but have shown higher readings for men of all ages who are of African descent, shown below.

Age Group Normal range(ng/ml) 
40-49 0-2.0
50-59 4.0
60-69 4.5
70-79 5.5

If your level of PSA is higher than the normal range for your age group your doctor will take other factors into consideration to determine if a biopsy is needed.
The PSA reading alone does not indicate you have prostate cancer. Factors such as DRE, PSA, predisposition, health are among the factors to consider.


Only a prostate biopsy can determine if you have prostate cancer.
A sedative is usually given to the patient prior to the procedure, and samples of tissue are taken and sent to the lab. As side effects, prostate biopsy can result in:

  • Pain
  • Blood in the urine or ejaculate
  • Infection


The doctor assesses a patient’s situation based on the Gleason Score provided by the pathologist. The Gleason Score indicates the degree of change that is noted in the cells. The lower the score, the less likely the cancer is to spread.

Stage I: Tumor is confined to one side of the prostate gland and cannot be felt. It is slow-growing. Levels of Prostate-Specific Antigen (PSA) are low in the blood, and microscopically, cancer cells look like healthy cells. 

Stage II: Cancer may or may not be detected on physical examination. It is confined to the prostate, and PSA levels are low or medium. Although cancer at this stage is small, it has a greater potential to grow and spread.

  • Stage IIA means that cancer involves only half of the prostate gland and cannot be felt on physical examination. PSA levels are medium, and cancer cells are well-differentiated, just like the healthy cells. A large tumor with well-differentiated cells is also labeled as stage IIA.
  • Stage IIB means that cancer is present only inside the gland, and one may be able to feel it physically. The level of PSA is still medium, but cancer cells are no longer well-differentiated. They are only moderately differentiated.
  • Stage IIC is the same as that of stage IIB except that cancer cells are poorly differentiated.

Stage III: Cancer has spread from the prostate gland to the nearby regions, like bladder and rectum. PSA levels are high, and a locally advanced stage of cancer is there.

  • Stage IIIA means that cancer has spread outside the outer layer of the prostate gland and has seeded the nearby tissue.
  • Stage IIIB means that cancer has grown further and has invaded the adjacent organs, such as rectum or bladder.
  • Stage IIIC means that cancer cells are very poorly differentiated across all parts of the tumor.

Stage IV: Cancer has spread to distant parts of the body.

  • Stage IVA means that cancer has spread to the regional lymph nodes.
  • Stage IVB means that cancer has spread to distant lymph nodes, or bones, or  other organs of the body, such as lungs and liver.

Staging helps the healthcare provider to determine your individual treatment plan.

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