Prostate cancer: Does PSA level affect prognosis?

I read an article that said that prostate cancer may grow slowly because PSA keeps it in check. So, men with higher PSA levels have a better prognosis for prostate cancer than do men with lower PSA levels. Can you explain this?

- Herbert / No state given

Mayo Clinic urologist Erik Castle, M.D., and colleagues answer select questions from readers.

Answer

Prostate-specific antigen (PSA) is a protein made by your prostate tissue. Men with prostate cancer often have elevated PSA levels because the cancer cells make excessive amounts of this protein.

At the time of your initial diagnosis of prostate cancer, your PSA level helps determine how likely it is that your cancer has spread (metastasized). It also determines how likely your cancer will be cured with treatment such as radiation or surgery. Generally, the higher your PSA level and the higher the speed at which it increases, the more prostate cancer cells you have in your body.

But this isn't always the case. In some cases, the PSA level may not be elevated, despite the prostate cancer. These cancer cells often have more genetic mutations than other cancer cells do, and they don't have the ability to make PSA. This type of prostate cancer is usually more aggressive and doesn't respond well to treatment. Some scientists believe that genetic mutations in these cancer cells may allow such cancers to grow and spread more quickly.

Prostate cancer often grows very slowly. The reasons for this aren't clear. Some research suggests that PSA may inhibit the formation of new blood vessels (angiogenesis) that contribute to the growth of cancer. This could explain why prostate cancers that don't produce PSA tend to grow and spread more rapidly than prostate cancers that do produce PSA. Still, you shouldn't immediately interpret a high PSA level to be protective against prostate cancer. You should discuss the results of your PSA test with your doctor before doing further tests or treatments.

Research on PSA levels and prostate cancer is ongoing. If you're concerned about your prostate cancer risk, ask your doctor what additional tests might benefit you.

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