Editing Prostate Cancer: Diagnosis and evaluation (section)

===== Causes of elevated PSA =====
# '''<span style="color:#ff0000">Prostate disease</span> (BPH, prostatitis, prostate cancer, etc.)'''
# '''<span style="color:#ff0000">Prostate manipulation</span> (prostate massage, biopsy, etc.)'''
* '''<span style="color:#ff0000">Prostate Disease</span>'''
**'''<span style="color:#ff0000">Prostate cancer</span>'''
***'''<span style="color:#ff0000">Prostate cancer cells produce less PSA than normal prostatic tissue</span>'''
***'''<span style="color:#ff0000">PSA becomes elevated in prostate cancer due to disruption of cellular architecture within the prostate gland</span>'''
**** '''<span style="color:#ff0000">Prostate cancer lacks basal cells</span>, resulting in the disruption of the basement membrane and normal lumen architecture'''
*** '''<span style="color:#ff0000">PSA levels are inversely correlated with risks of</span>''' 
****'''<span style="color:#ff0000">Pathologically organ-confined (pT2) disease</span>'''
***** '''<span style="color:#ff0000">PSA < 4.0 ng/mL: 80%</span>'''
***** '''<span style="color:#ff0000">PSA 4-10 ng/mL: 66%</span>'''
***** '''<span style="color:#ff0000">PSA > 10.0 ng/mL: <50%</span>'''
**** '''<span style="color:#ff0000">Pelvic lymph node involvement</span>'''
***** '''PSA >20 ng/ml: 20%'''
***** '''PSA >50 ng/mL: 75%'''
*'''<span style="color:#ff0000">Prostate manipulation</span>'''
**'''<span style="color:#ff0000">May influence PSA in a clinically meaningful way[https://pubmed.ncbi.nlm.nih.gov/23659877/]</span>'''
**#'''<span style="color:#ff0000">Urinary tract infections</span>'''
**#'''<span style="color:#ff0000">Instrumentation (e.g., prostate biopsy, cystoscopy, urinary retention, recent bladder catheterization)</span>'''
**##'''<span style="color:#ff0000">Biopsy</span>[https://pubmed.ncbi.nlm.nih.gov/7691013/][https://pubmed.ncbi.nlm.nih.gov/10376076/]'''
**##*'''Results in immediate elevation in the serum PSA level, with a median increase of 6-8 ng/mL'''
**##*'''Usually returns to a stable, baseline level within 2-3 weeks'''
**##'''<span style="color:#ff0000">Cystoscopy</span>[https://pubmed.ncbi.nlm.nih.gov/7691013/][https://pubmed.ncbi.nlm.nih.gov/10376076/]'''
**##*Studies have found that cystoscopy results in small (0.05-0.15 ng/mL) increase in PSA and have suggested that serum PSA determination after either a flexible or a rigid cystoscopy is accurate and reliable
**##'''<span style="color:#ff0000">TURP</span>[https://pubmed.ncbi.nlm.nih.gov/7691013/][https://pubmed.ncbi.nlm.nih.gov/10376076/]'''
**##*'''Results in immediate elevation in the serum PSA level, with a median increase of 6-13 ng/mL[https://pubmed.ncbi.nlm.nih.gov/7691013/]'''
**##*'''Usually returns to a stable, baseline level within 2-3 weeks[https://pubmed.ncbi.nlm.nih.gov/7691013/]'''
**##'''<span style="color:#ff0000">Recent bladder catheterization</span>'''
**##*One study found very little effect on PSA level at day 1 and 3 after catheterization and suggested that routine evaluation PSA in patients with recent catheterization.[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5393098/]
**'''<span style="color:#ff0000">Unlikely to influence PSA in a clinically meaningful way[https://pubmed.ncbi.nlm.nih.gov/23659877/]'''
**#'''<span style="color:#ff0000">DRE</span>''' 
**#*'''Can lead to slight increases in serum PSA level; however, the resultant change in PSA values falls within the error of the assay and''' '''<span style="color:#ff0000">rarely causes false-positive test results</span>'''
**#'''<span style="color:#ff0000">Bicycle riding</span>'''
**#*With long-distance (> 55km) bicycle rides, PSA levels increasing by ≈10%
**#'''<span style="color:#ff0000">Ejaculation</span>'''
**#*'''Studies examining the effect of ejaculation on serum PSA have reported conflicting results.'''
**#**Most controlled studies evaluating ejaculation suggest it either does not significantly impact or modestly increases (~10%) PSA. 
**#*'''<span style="color:#ff0000">A repeat PSA test after 48 hours of sexual abstinence may be helpful for interpreting serum PSA levels that are minimally elevated or newly elevated.</span>'''
**#'''<span style="color:#ff0000">TRUS</span>[https://pubmed.ncbi.nlm.nih.gov/10376076/]'''
**#*'''Results in small (0.3 ng/mL) increase in PSA'''
**#*'''Serum PSA determination after TRUS without biopsy is accurate and reliable'''
**'''Most of the rise in total PSA after prostate manipulation is contributed by the free (non-bound) component.'''
*** '''In general, complexed PSA is the most stable component and relatively little rise occurs following prostate manipulation.'''