Enlarged Prostate and PSA Levels: What You Need to Know

Does an enlarged prostate mean you have prostate cancer? No. The answer is no.

You can have an enlarged prostate, and it has nothing to do with whether you have prostate cancer. What usually happens is that as your prostate gets bigger, it makes more PSA, or prostate-specific antigen. That gets people’s attention and may lead to a prostate biopsy, which could then result in a prostate cancer diagnosis.

But in actuality, when I see a large prostate, I’m often relieved because it may account for the elevated PSA. A smaller prostate should not make as much PSA, so in some ways, it’s the opposite.

Usually, if you have a smaller prostate that’s making just as much PSA, we’re more concerned about it. But no, a large prostate does not mean you have prostate cancer.

At what PSA level should I worry?

At what PSA level should you worry about prostate cancer? “It depends” is the classic answer.

The traditional cutoff is 4.0. That’s when you get your lab test and may see an “H,” meaning the result is considered high. So if you have a PSA of 4.1, that may trigger further evaluation.

That being said, what’s very important is what your PSA was the year before. If your PSA has always been one or two and then this year it’s four, that’s significant. Or let’s say your PSA is 3.5. It may still technically be considered normal, but it could be high for you.

So the first question is: What was it the year before? Usually, I tell people that about three-quarters of a point per year is about the most acceptable rise. In other words, if it was 2.0 last year, it generally shouldn’t be 3.0 this year.

The other thing to consider is your decade of life. Your prostate is a little like a tree. It tends to get bigger with age, and as it gets bigger, it makes more PSA.

The average 40-year-old may have a PSA around 2.5. The average 50-year-old may have a PSA around 3.5. The average 60-year-old may have a PSA around 4.5. So it depends on your age and, again, what your PSA was the year before.

Can I lower my PSA naturally?

I don’t think the goal should be to artificially lower your PSA. That’s almost thinking about it backward.

When you have a PSA blood test, I usually recommend avoiding sex or ejaculation for at least two or three days before the test. The prostate makes PSA, and if it’s stimulated, if you’ve ridden a bike, if you’re having trouble urinating or if you have an infection, your PSA may be temporarily elevated.

So you may be able to keep the number from being artificially high by avoiding those things before the test.

There are medications and supplements that may affect PSA levels. Finasteride, for example, can shrink the prostate and also lower PSA because you’ve made the prostate smaller.

But in the end, you don’t want to simply lower the number artificially because you could potentially mask an underlying problem.

I think what you’re really asking is whether there’s something you can do to minimize your risk of prostate cancer, and that’s a different conversation involving lifestyle, supplements and other factors.

What happens if I don’t treat an enlarged prostate?

If you don’t treat an enlarged prostate, most of the time you may be okay. The bigger question is what happens if the enlarged prostate is causing your bladder not to empty properly.

That can become a serious problem.

One thing that may happen is urinary leakage because the bladder becomes so full that urine has nowhere else to go. If the urine doesn’t come out, the bladder can continue stretching until it no longer contracts normally.

At that point, you can become catheter-dependent. It’s similar to a balloon that has been overinflated. Once it has been stretched too far, it may not return to its original shape or function normally.

As serious as catheter dependence can be, that’s not the worst thing that can happen.

If the bladder cannot empty and pressure continues to build, urine can back up toward both kidneys. That can potentially lead to kidney damage or, in severe cases, kidney failure and dialysis.

So even though it’s called benign prostatic hyperplasia, or BPH, an enlarged prostate can become a serious issue if it’s preventing the bladder from emptying properly. We want to monitor that, treat it when necessary and address the problem before it reaches that point.

What would a typical appointment look like for a patient with an enlarged prostate?

If you come in because you have an enlarged prostate, one of the things I want to evaluate is how well you’re urinating.

We may perform a urine flow test to measure how fast your urine flows, how much urine you pass and how long it takes you to empty your bladder. Depending on the situation, that may be done at the first visit or a follow-up visit.

More importantly, I want to know how much urine is left in your bladder after you urinate. We measure that with what’s called a post-void residual bladder scan.

We may also have you complete a symptom score to evaluate how much your urinary symptoms are bothering you.

So when you come to the appointment, it’s helpful to arrive ready to urinate, whether that’s for a urine sample or a flow test.

After we’ve evaluated your symptoms and how well your bladder is emptying, we can discuss the treatment options that make the most sense for you, including medications or procedural treatments. If you’re concerned about an enlarged prostate, changes in your PSA level or urinary symptoms, Urology Specialists of Austin can help. Schedule an appointment with our urology team at one of our convenient locations in Austin, South Austin, Round Rock or Dripping Springs to discuss your symptoms and the next steps in your care.

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