Abstract

Current clinical practices utilize prostate-specific antigen (PSA) as a biomarker for diagnosis of prostatic pathology ranging from malignant to benign conditions. It has a high sensitivity but low specificity but remains an important screening test for prostate cancer. However, there are some instances in which elevations in PSA levels occur with no indications of benign prostatic hyperplasia, tissue injury, or malignancy on biopsy. Spurious elevations in PSA have typically been seen with exercise, older age, digital rectal exams, prostatitis, dysplasia, and some medications such as HMG-CoA reductase inhibitors. Upon histological evaluation in instances of elevated PSA without linkage to any previously described etiologies, an apparent narrowing of vascular structures can be observed. Narrowing occurs, seen in Figure 1, as a result of intimal hyperplasia and medial hypertrophy. This paper investigates intraprostatic vascular narrowing leading to ischemia induced PSA elevation. We believe the elevated PSA is secondary to the stenosis of the vasculature of the prostate.