Elevated PSA: A Guide To Men

Prostate Cancer in New York City – 2020

by Alex Shteynshlyuger MD


If you have any questions, to schedule a consultation, please contact us or call/text: 1-646-663-5515.

We have excellent reviews from patients and their partners.  Information for out-of-state and international patients.  Find out our office hours or directions to our office

We offer affordable appointment prices with or without insurance.  Same-day virtual video appointments and in-person appointments are available.

Dr. Alex Shteynshlyuger is a fellowship-trained urologic oncologist, a robotically-trained surgeon who specializes in all aspects of care for early, advanced, and metastatic prostate cancer. He is a member of the Society for Urologic Oncology and the American Society for Clinical Oncology.


Elevated PSA: How High is High?

It is important to understand that the PSA test, when used for predicting prostate cancer risk, is not a “Yes” or “No” test.

There is no specific cutoff for the PSA test.  Because PSA varies from man to man as a result of age, genetic profile, prostate size, and a number of other variables, the values that are considered elevated are patient-specific.

Prostate Specific antigen

Prostate-Specific antigen

Typically lower values of PSA are considered to be elevated in younger men as they are expected to have much lower values than older men.  So in a 45-year-old man, a PSA of 3.5 would be considered elevated, while in a 75-year-old male, a PSA of 3.5 may not be considered elevated.

The complicating issue is what we call the PSA velocity, which is a rate of change in PSA over time.  Increased PSA velocity can be associated with an increased risk for prostate cancer.  As a result, the same 75-year-old male with a PSA of 3.5 may be considered at high risk for prostate cancer if his PSA went up from 2.5 to 3.5 over a period of 1 year.

The biggest challenge when it comes to PSA values is in the range of PSA values under 10.  With PSA values in the range of 10-20, men are increasingly likely to have prostate cancer; men with PSA over 20 are at particularly high risk. Most men with PSA >20 are eventually diagnosed with prostate cancer, often aggressive.

What is PSA?

PSA stands for prostate-specific antigen. It’s a blood test. Prostate-specific antigen (PSA) is a glycoprotein enzyme produced by both prostate epithelial cells and prostate cancer cells and is the most commonly used serum marker for cancer.

Your doctor will look at your PSA results and must consider your age, your race, family history, medications that you are taking, and many other variables to decide whether your PSA is normal or abnormal.

What You Should Know About PSA

Some commonly used medications for enlarged prostate, called 5-alpha-reductase inhibitors, can cause PSA decrease by about 50%.  This does not decrease the risk of prostate cancer, and the number needs to be doubled in men taking these common medications: Proscar (finasteride), Avodart (dutasteride), Jalyn (dutasteride plus tamsulosin). A man taking Proscar for 6 months with a PSA of 5.6 measured after 6 months has a corrected PSA of 10.2.

PSA levels vary with age. Commonly used normal ranges are as follows:

  • Men below age 50: Normal PSA less than 2.5 ng/mL
  • Men 50 – 59 years: Normal PSA level less than 3.5 ng/mL
  • Men 60 – 69 years: Normal PSA level less than 4.5 ng/mL
  • Men older than 70 years: Normal PSA level less than 6.5 ng/mL

These results may vary between different labs according to different measurements and samples used.

What Other Conditions Can Cause a Rise in PSA?

  • BPH (benign prostatic hyperplasia)
  • UTI (urinary tract infection)
  • Recent prostatic intervention such as a prostate biopsy
  • Recent catheterization or cystoscopy

What are the factors that raise the suspicion of prostate cancer when having an abnormal or Elevated PSA level?

  • Older age
  • Race (prostate cancer has a higher incidence in African-Americans)
  • Presence of urinary symptoms such as hematuria (blood in urine), urinary frequency (wanting to urinate more often even if only a few drops of urine ), urgency (urgent need to urinate), a sensation of incomplete bladder emptying, split urine stream.
  • If you had a PSA test in the past and a subsequent test shows a significant increase even if the value is still in the normal range.
  • If your doctor finds a prostatic lump or nodule during DRE (digital rectal examination)
  • Other risk factors such as a positive family history of prostate cancer or breast cancer

What are the precautions that should be taken before PSA testing:

  • Be sure to tell your doctor about any drugs you are currently on. Some drugs may cause your PSA levels to be falsely low. These include finasteride (Proscar), dutasteride (Avodart), and antiandrogen drugs, such as flutamide, nilutamide, and bicalutamide (Casodex)
  • Be sure to tell your doctor about any anticoagulant therapy you are currently receiving, such as coumadin and aspirin.
  • Digital rectal examination causes a modest increase in PSA, but it is not clinically important.
  • Prostate biopsy causes an immediate elevation in the serum PSA level, which usually returns to a stable baseline level within three weeks. PSA is usually not performed within a month after a prostate biopsy.
  • Recent ejaculation and sexual intercourse can lead to a mild increase in PSA, which is not clinically important.

What are the controversies about PSA screening?

Since the introduction of PSA screening for prostate cancer in 1997, there have been many controversies regarding elevated PSA levels. Misuse of the test for screening has created unnecessary anxiety and increased costs and has led to the significant overdiagnosis and overtreatment of men.

It is necessary only to use a single PSA determination as a baseline and to do a biopsy for those with significant PSA changes over time or for those with clinical manifestations mandating immediate therapy (as urinary symptoms). PSA should also be used to monitor disease progression or recurrence.

What is a prostate biopsy?

It is a minimally invasive procedure that can be done in a urologist’s office. In this procedure, a special biopsy needle is inserted most commonly through the rectum (TRUS) to remove small pieces of tissue from different zones of the prostate (optimally 12 pieces) and then examined under the microscope in a Pathology lab to rule out the presence of prostate cancer.

When should you undergo a prostate biopsy?

  • PSA level > 4 ng/mL for men over age 60
  • High PSA velocity, which is a significant change in PSA level between 2 consecutive results
  • Presence of prostate lump during DRE in correlation with high PSA level
  • When the PSA level is higher than 50 ng/ mL, it is 98.5% accurate in predicting the presence of prostate cancer.

Are there any risks associated with prostate biopsy?

A prostate biopsy is a minimally invasive procedure if done by an experienced urologist. Patients commonly experience hematuria (blood in urine), mild pelvic pain, dysuria (difficult micturition) after the biopsy is done. Infection is one of the serious side effects that can occur after a prostate biopsy, and it can range from mild fever to infection that requires hospitalization.

What are the other tests used in screening for prostate cancer?

Urinary prostate cancer antigen 3 (PCA3)

It is a urinary marker used in predicting the presence of prostate cancer. It offers slightly better predictive power for prostate cancer than PSA, but that is not valuable in an individual patient as the benefit is small.

Prostate Health Index (PHI)

A new PSA isoform called p2PSA was recently identified. The Prostate Health Index (PHI) is a new formula that combines total PSA, free PSA, and p2PSA into a single score that can be used to aid in the diagnosis of prostate cancer. It is equal to (p2PSA/free PSA) × √PSA

PHI significantly improves the prediction of biopsy outcome (whether benign or malignant) over PSA alone. The number of unnecessary biopsies can be reduced by using PHI.

PHI was found to be more accurate than PCA3 for predicting prostate cancer in the initial biopsy and repeated biopsy.

Both Prostate Health Index (PHI) and Prostate Cancer Antigen 3 (PCA3) significantly improve prostate cancer detection at initial biopsy in a total PSA range of 2-10 ng/mL

4KScore Test

This is a new test that was presented at the American Urological Association (AUA) 2014 Annual Scientific Meeting.

The difference between 4KScore Test and PHI test discussed earlier is that it combines 3 PSA measurements (total, free, and intact) with another new prostate-specific measurement called human kallikrein 2 (hK2) in an algorithm.

This algorithm also takes into account the patient’s age, DRE, and previous biopsy results.

The advantage of this test is that it can differentiate between pathologically insignificant and aggressive diseases, and thus it reduces unnecessary biopsies.

References:

  • www.ncbi.nlm.nih.gov
  • NCCN guidelines for Prostate cancer

Did you know? Dr. Shteynshlyuger has performed over 1,000 prostate, penile, and bladder surgeries, including prostate biopsy, prostate removal, penile implants, Urolift, prostate enucleation, correction of Peyronie’s disease, and MRI fusion biopsy.

Where to Get Treatment for Rising PSA in NYC?

At New York Urology Specialists, we offer treatment for men with abnormal PSA and prostate cancer.  Same-day virtual video appointments and in-person appointments are available.

Call/text today: 1-646-663-5515 or make an appointment online.  

We perform procedures such as prostate biopsy, transrectal prostate ultrasound, hydrogel insertion prior to radiation therapy (SpaceOAR), prostate surgery, prostate enucleation for enlarged prostate, and Urolift procedure. We treat prostate cancer, urinary problems, and erection problems and offer comprehensive STD testing for infections. We offer confidential appointments.

Our appointment costs are affordable with or without insurance.  We offer free insurance verification.

Cost of Prostate Cancer Treatment without Insurance

At New York Urology Specialists, we offer affordable treatment for men. Our prices are low for patients without insurance and for those who have high insurance copays, high deductibles, or insurance plans that do not cover treatment costs. 

At New York Urology Specialists, we offer flat-fee ‘all-cost-included’ procedures such as prostate biopsy, hydrogel SpaceOAR insertion, circumcision, no-scalpel vasectomy, testicular implant, vasectomy reversal, hydrocelectomy, varicocelectomy, and many more.  The procedures are performed in our office under local anesthesia or sedation. Men from other states can save thousands of dollars over local hospital fees by coming to New York Urology Specialists for treatment.  Please contact us for current prices and discounts for patients without insurance or with high insurance deductibles.

Cost of Prostate Cancer Treatment and Insurances

Inexpensive Urologist Visit Cost At New York Urology Specialists, we offer affordable treatment for men. Our prices are low for patients without insurance and for those who have high insurance copays, high deductibles, or insurance plans that do not cover treatment costs. 

We accept many health insurance plans.  We would be happy to verify your eligibility and benefits and provide you with detailed information on your health plan’s coverage.  Financing options and credit options are available to help you pay for medical care.

Why Choose New York Urology Specialists for Prostate Cancer Treatment?

  • All treatment is performed by a board-certified urologist experienced in treating men with rising PSA, prostate cancer, enlarged prostate, erectile dysfunction, low testosterone, scrotal and testicular problems, and urinary problems using medical therapy, minimally invasive therapies, lasers, and surgery.  
  • We are one of the few practices in the region to offer a full range of options for the treatment of sexual, urinary, and erection problems in men.
  • We offer treatment options for side effects and complications of prostate cancer treatment including erectile dysfunction, Peyronie’s disease, urinary problems, frequent urination, and overactive bladder in our office.  Office procedures avoid the risks, costs, and recovery from general anesthesia.  
  • We offer diagnostic testing in our office, which avoids hospital costs.
  • Extensive experience: Thousands of men have been treated successfully for elevated PSA, prostate cancer, erection problems, and urinary incontinence.
  • Confidential and Understanding Care. We understand that most of our patients desire privacy.  We see patients with a variety of urological problems. Your reason for visiting us is entirely confidential.
  • We are conveniently located within a 30-60 minute commute to men who are seeking treatment for testicular and penile problems, erectile dysfunction, enlarged prostate, urinary, and cancer treatment in Manhattan, Brooklyn, Queens, Staten Island, Westchester, Long Island, Bronx, and New Jersey.

What do Prostate Cancer Problems Look Like?

You can find pictures of Prostate Cancer as well as before and after treatment images in our image gallery.

Scheduling Appointments for Prostate Cancer Treatment at New York Urology Specialists


If you have any questions, to schedule a consultation, please contact us or call/text: 1-646-663-5515.

We have excellent reviews from patients and their partners.  Information for out-of-state and international patients.  Find out our office hours or directions to our office

We offer affordable appointment prices with or without insurance.  Same-day virtual video appointments and in-person appointments are available.

Dr. Shteynshlyuger MD is a board-certified urologist in NYC who specializes in treating men with elevated PSA, prostate cancer, sexual, testicular, hormonal, urinary, and sexual problems in men.   He has performed hundreds of penile and prostate surgeries, including penile implants, surgery for enlarged prostate, and many other procedures.  


Patients Reviews

Overall Rating:

4

Total Ratings

4

Total Reviews

22

Ratings

Ease of Appointment: Bedside Manner:
Promptness: Spends Time with Me:
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best urology doctor
by on Feb 14, 2021

Dr Alex Shteynshlyuger is the best urology doctor there is. He is attentive, analytical, knowledgeable and skillful. Very confidential with a masterfully professional staff. I would not hesitate in recommending Dr Shteynshlyuger to the world because I am a satisfied patient of his.

solved my problem with ED
by on Jan 29, 2021

Dr. Shteynshlyuger helped to solve my problem with ED

Very Pleased
by on Jan 21, 2021

Very Pleased, I couldn’t have asked for more from Dr. S as well as everyone in the office, The procedure and after was a dream with Dr. S. If you are on the fence, I can tell you, that you will love your experience with Dr. S

highly qualified diagnostician
by on Sep 23, 2020

I have been observed by Dr. Alex for many years and I must say that he is a highly qualified diagnostician, and also several times I have received qualified microsurgical assistance and very useful advice. The only reason I put 4 with a plus is a somewhat long wait for the reception.

successful procedure
by on Aug 20, 2020

To Dr. Shteynshlyuger and your assistants and aids, thank you guys for a successful procedure. I'd refer you to others for your compassionate, knowledgeable, attentive service and indepth follow up care.

very friendly staff
by on Apr 12, 2020

excellent doctor and all very friendly staff

Doctor Shteynshlyuger provided me with the care I needed
by on Mar 11, 2020

The staff is very professional. Doctor Shteynshlyuger provided me with the care I needed. The wait, visits, and instructions were brief. I followed his instructions and my issue was resolved. As a patient exercise patience. Follow the instructions and be honest about your condition and what you hope to accomplish be visiting. Thanks again Doctor.

Recommendation
by on Jul 18, 2019

Therefore I would like to recommend you to anyone who need your services.

Urology Visit
by on Jul 18, 2019

Staff were all very welcoming. Dr. Alex Shteynshlyuger was very knowledgeable and attentive during my time spent with him.

Highly grateful
by on Jun 18, 2019

Dr. Shteynshlyuger is a very patient, understanding and caring doctor. I came to take opinion on my father’s treatment going on in my home country. Highly satisfied from his responses. He even responded to so many of my queries through patient portal . Highly grateful.

First class Surgeon & staff
by on Sep 24, 2018

From the very appointment to the last follow-up visit, I felt I was at the right place and with the right people around me. Dr. Alex Stheynshlyuger and his staff made it easy and confortable. I would recommend them to every man.

Friendly , courteous, effiecient and professional
by on Sep 15, 2018

Wyts Wyts recommends New York Urology Specialists via Facebook. September 15, 2018 · Friendly , courteous, effiecient and professional staff members. This office i highly recommend for any and all Urology matters. Dr Alex Shteynshlyuger is very professional and knowledgable easy to communicate with. Thanks Dr Alex

Satisfied Patient
by on Sep 15, 2018

I am very please and satisfied with everything that has been offorded to me by New York Urology Specialist Office.....Dr Alex

Surgical Procedure
by on Sep 01, 2018

Dr Alex and his staff are through professionals in every sense of the word. From initial diagnosis to a period of evaluating and ruling out options, we decided upon a surgical solution, which appears for the most part to have corrected the issue. Thanks to Ana, and the staff, especially Dr. Alex for treating me so well. Best regards, Lee

urology services
by on Apr 11, 2018

I am very satisfied with the treatment I received at new york urology specialist and would recommend them to other patients.they are the very best.

Review
by on Nov 19, 2017

I am writing to thank dr. Alex. He is thorough, professional, knowledgeable, helpful and friendly. I have seen him for ED and prostate issues, and he has explained all my options clearly, and found solutions that have been a great help. thank you! I highly recommend both Dr. Alex and his staff, which I find to be helpful, friendly, knowledgeable and very professional. They are a pleasure to deal with and all have been a great help.

Dr visit
by on Sep 14, 2017

I am very much thankful for meeting Dr Alex .I had a very serious medical problem I visited many doctors but none could not help me it was very difficult for me until I visited Dr Alex after a couple visits my medical problem is no more I feel very great also I felt almost 20 years younger Dr Alex is second to none fantastic doctor. Thanks again Dr Alex from my family.

Excellent doctor
by on Jul 03, 2014

I am feeling better now after visiting clinic New York urology specialists. Excellent staff and appointment on time.

Thanks to you
by on May 16, 2013

Dear Dr. Alex -On behalf of John and myself – Our thanks to you for the care and concern of your help to Jack with his cancer problems. We will miss you & wish you only the best. Sincerely John & Pat Date: 2013

Thank you for excellent care
by on Jan 07, 2013

Dear Dr. Alex: We want to thank you for the excellent care you provided for George during his emergency operation and the follow up treatment. Your quiet, confident manner was reassuring to us during a very scary time for us. We will never forget you. George Sally R. Date: 2013

We appreciate all that you did to help my dad
by on Sep 17, 2012

Dear Dr. Alex – I just wanted to write you a note to thank you for all of the care you have gave to my father during his illness. We appreciate all that you did to help my dad through his illness. We wanted to be sure to let you know how much it meant to us. Sincerely Joanne R.

We love you!
by on Feb 16, 2012

Dr. Alex Shteynshlyuger and Staff – Thank you so much for taking care of my husband Bob. Dr. Alex: I thank God everyday for you. You were an answer to prayer.

Treatment for Men With Fast Recovery at New York Urology Specialists

Excellence-Urology_Care-banner2At New York Urology Specialists, our urologists are specially trained in the evaluation and treatment of men’s health concerns including high PSA, abnormal 4Kscore, abnormal prostate MRI, and prostate cancer.  We understand the challenges that sexual and urinary problems create for our patients with prostate cancer, their relationships, and their self-esteem.  We help you find a treatment for penile problems and urinary problems, including erectile dysfunction, that fit your needs, lifestyle, and preferences.

Urologists are doctors specializing in the treatment of men with prostate cancer, urinary, and sexual problems that include penis problems, scrotal problems, and erectile dysfunction. By virtue of our experience and skill, we are able to offer an effective treatment option for nearly every man who desires an effective treatment for any problem that affects the penis.  We offer medical and surgical treatment for men’s sexual problems.

We Treat Some of the Most Complex Men’s Health Problems:

Schedule an Appointment with Dr. Shteynshlyuger:

Call/text today: 1-646-663-5515 or make an appointment online

Dr. Shteynshlyuger is a fellowship-trained board-certified urologist with expertise in the evaluation and treatment of prostate problems, including elevated PSA, enlarged prostate, and prostate cancer.  He also treats side effects of prostate treatment, including sexual, urinary, and erection problems in men.  He uses modern, effective, and proven treatment methods.  We offer prostate biopsy, treatment of localized and metastatic prostate cancer with surgery, immunotherapy, radiation therapy, and chemotherapy.  We also offer inflatable penile implant, shockwave therapy for ED, and treatment for Peyronie’s disease. We perform procedures such as hydrogel insertion prior to radiation therapy (SpaceOAR), Rezum for BPH, prostate enucleation for enlarged prostate, and Urolift procedure.  

He has successfully treated hundreds of men with a nodular prostate, elevated PSA, prostate cancer, and erection problems.

He is highly recommended by top primary care physicians in the New York area. If you or someone you know has been experiencing urological symptoms, make an appointment to take advantage of Dr. Shteynshlyuger’s expert advice. Please feel free to contact us with any questions.


If you have any questions, to schedule a consultation, please contact us or call/text: 1-646-663-5515.

We have excellent reviews from patients and their partners.  Information for out-of-state and international patients.  Find out our office hours or directions to our office

We offer affordable appointment prices with or without insurance.  Same-day virtual video appointments and in-person appointments are available.