In the early stages of the disease, most patients have no difficulties. An elevated prostate-specific antigen (PSA) level or subjective complaints usually alert us to the presence of the disease. PSA is a protein produced by prostate cells. Its level is not only elevated in prostate cancer, but in other prostate diseases – benign hyperplasia (in 25% of patients) and prostatitis. Although PSA is not a directly specific marker, most patients with prostate cancer have elevated levels.
Normally, your PSA level would be below 4 ng/ml which is the internationally recognised dividing line between normal and raised PSA levels. The difficulty in diagnosing prostate cancer through the PSA test is that up to 20% of patients with cancer have a PSA level below 4 ng/ml and at the same time, far from every patient with a PSA level of 4-10 ng/ml has prostate cancer. Only 25% of patients in this diagnostic grey zone have prostate cancer.
The patient’s age plays an important role in the PSA testing. We know that with increasing age, the PSA level gradually increases so this age-specific PSA is nowadays usually considered when making a diagnosis:
For men aged 40-49 years, an upper limit of PSA of 2.5 ng/ml has been proposed,
In advanced prostate cancer, the patient may experience similar difficulties as in benign prostatic enlargement (benign prostatic hyperplasia). In most cases, these are problems with urination, which can be difficult and frequent. More rarely, the tumour is manifested by the presence of blood in the urine (haematuria).
Signs of ‘generalised disease’ (advanced) are caused by the presence of distant tumour metastases. Most commonly, the tumour spreads to the bone. One of the most prominent symptoms at this stage is pain. Sometimes, the disease can cause a pathological fracture (bone fracture without an apparent injury).
*Source: https://urosante.cz/urologie/prostaticky-specificky-antigen/
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