Based on PubMed | What does a high PSA level indicate in the evaluation of suspected testicular cancer?

A high PSA level does not indicate testicular cancer; it is primarily a marker of prostate conditions. PSA (prostate‑specific antigen) is a protein produced by the prostate, and elevated levels are most commonly associated with prostate cancer, benign prostate enlargement (BPH), prostate inflammation (prostatitis), or recent prostate manipulation. ^[1] Elevated PSA is therefore interpreted as a sign of a prostate issue rather than a testicular tumor when evaluating a scrotal mass or suspected testicular cancer. ^[2] In short, PSA is not a diagnostic or staging marker for testicular cancer. ^[3]

What PSA Measures

PSA is made by prostatic epithelial cells and circulates at low concentrations in adult men. ^[2] When PSA rises, it suggests a higher likelihood of a prostate disorder, including but not limited to prostate cancer. ^[1] Many noncancer factors can raise PSA, such as age-related prostate enlargement, infections, urinary instrumentation, ejaculation, or recent exams and procedures involving the prostate. ^[2] Because of these influences, PSA alone cannot confirm prostate cancer and must be interpreted in clinical context. ^[1]

Tumor Markers for Testicular Cancer

Testicular germ cell tumors use a different set of blood markers: beta‑human chorionic gonadotropin (β‑hCG), alpha‑fetoprotein (AFP), and lactate dehydrogenase (LDH). ^[4] These markers help with diagnosis, staging, prognosis, treatment monitoring, and surveillance of testicular cancer. ^[5] Clinical guidelines recommend AFP, β‑hCG, and LDH for testicular cancer across diagnosis and management; PSA is not used for this purpose. ^[3] In practice, ultrasound of the testis plus AFP, β‑hCG, and LDH form the core workup for suspected testicular cancer, not PSA. ^[6]

Why PSA Is Not Relevant in Testicular Cancer Evaluation

PSA is prostate‑specific and has established roles in detecting and monitoring prostate cancer, not testicular tumors. ^[1] A high PSA during a testicular cancer workup usually points toward an unrelated prostate condition that may need separate evaluation. ^[2] PSA is not included in the TNM staging or risk groups for testicular germ cell tumors, which instead incorporate AFP, β‑hCG, and LDH. ^[5] Therefore, elevated PSA should not be used to diagnose, stage, or monitor testicular cancer. ^[3]

Rare Exceptions and Clinical Nuance

Although PSA is “prostate‑specific,” low‑level PSA expression has been detected in certain non‑prostatic tumors and tissues, but this finding is uncommon and not clinically useful for testicular cancer management. ^[7] Reports of testicular germ cell tumors metastasizing to the prostate are extremely rare, and PSA does not become a reliable indicator of such spread. ^[8] In these rare scenarios, diagnosis hinges on imaging, histology, and germ cell tumor markers rather than PSA. ^[4] Even when testicular cancer spreads, clinicians still rely on AFP, β‑hCG, LDH, and imaging not PSA to guide care. ^[5]

Practical Takeaways for Clinicians and Patients

• If you suspect testicular cancer, order AFP, β‑hCG, and LDH rather than PSA. ^[3]
• Use scrotal ultrasound to characterize the testicular lesion (intratesticular masses are more likely malignant). ^[6]
• If PSA is high, consider parallel evaluation for prostate disease (e.g., prostatitis, BPH, or prostate cancer), because this finding typically reflects a prostate issue. ^{[2] [1]}
• Reserve PSA for its established roles in prostate cancer screening discussions, monitoring, and recurrence detection, acknowledging its limitations and non‑cancer causes of elevation. ^{[1] [9]}

Summary

PSA is a prostate marker and does not serve as a diagnostic or staging marker for testicular cancer; elevated PSA should prompt assessment for prostate conditions rather than reinforce suspicion of a testicular germ cell tumor. ^[3] The correct tumor markers for testicular cancer are AFP, β‑hCG, and LDH, alongside testicular ultrasound and appropriate imaging. ^[4] Aligning tests with the organ of origin ensures accurate diagnosis and avoids misleading interpretations during a testicular cancer workup. ^[5]