Question: Is the PSA a reliable test for prostate enlargement?

Dr. Hibberd's Answer:

The PSA ( which stands for prostate specific antigen) blood test is sensitive to prostate tissue and increases with an enlarging prostate gland. The PSA will also elevate (sometimes as high as 100 or more) with infection, inflammation, prostatic calculi (stones), and prostatic tumor. While it is a very good marker of prostatic hypertrophy (enlarging of the glandular component of prostate tissue), it is not to be used as a marker of prostatic enlargement without an accompanying rectal examination.

The absence of PSA elevation does not mean there is no cancer present. There are PSA negative prostate tumors that can only be detected initially by rectal examination and diagnosed by directed ultrasound and biopsy confirmation. Men need to have a rectal examination as well as a PSA for proper evaluation of their prostate gland.