Does a persistently high PSA level (above 11) mean prostate cancer?

This question has recently drawn public attention after former Secretary for Constitutional and Mainland Affairs Erick Tsang mentioned his case. Dr. Ma Wai-kit, Urology Specialist at Hong Kong Adventist Hospital – Stubbs Road, explained that PSA (Prostate-Specific Antigen) is a protein produced by prostate cells. Elevated PSA levels in blood tests are indeed an important indicator of prostate health, but they do not equate to a confirmed cancer diagnosis.

Dr. Ma noted that when PSA levels fall between 4 and 10, there is about a 25% chance of prostate cancer. Once the level exceeds 10, the risk rises to one-third or higher. A reading of 11 is considered high risk and warrants further investigation. However, PSA is essentially a screening marker, and elevated levels may also result from benign conditions such as urinary tract inflammation or benign prostatic hyperplasia (BPH). He explained: “Hyperplasia causes the prostate tissue to release more antigen proteins, which in turn raises PSA levels.”

When faced with elevated PSA, doctors typically recommend further tests, including MRI scans to detect suspicious shadows in the prostate. If abnormalities are found, a biopsy is required to obtain tissue samples for confirmation. It is reported that the public figure in question has already undergone ultrasound, MRI, and biopsy, which Dr. Ma believes are sufficient to determine whether prostate cancer is present.

Benign prostatic hyperplasia is a common age-related condition. Statistics show that about 55% of men over 50 experience hyperplasia, and the prevalence rises to 80% among men over 70. Hyperplasia compresses the urethra, leading to difficulty urinating. Initial treatment usually involves medication to relax the muscles of the prostate and bladder outlet, improving urinary symptoms, though medication generally does not lower PSA levels. If symptoms severely affect quality of life or medication proves ineffective, minimally invasive surgery to widen the urethra may be considered.

The causes of prostate cancer are more complex, potentially linked to family history, chronic stress, smoking, and excessive intake of red meat. Importantly, prostate cancer may present no symptoms in its early stages, making regular screening essential. Dr. Ma recommends that men over 50 consider annual blood tests. Early detection and treatment can result in a 10-year survival rate of over 90%, whereas late-stage diagnosis may reduce survival to 50% or lower.

According to the latest cancer statistics in Hong Kong, prostate cancer is the third most common cancer among men, with over 3,000 new cases in 2023. Among these patients, about 35% had PSA levels above 20, and nearly 20% had levels between 10 and 20. These figures remind the public that while PSA is an important indicator, only professional and comprehensive examinations can provide an accurate assessment of prostate health and enable timely intervention.