Very High Prostate Specific Antigen in an Asymptomatic Patient Leading to Diagnosing Metastatic Prostate Cancer in a Primary Health Care Center in Jeddah, Saudi Arabia

Prostate-specific antigen (PSA) is a glycoprotein secreted by both normal and malignant prostate epithelial cells, and its measurement in serum has become a cornerstone in the screening, diagnosis, and monitoring of prostate cancer (PCa) (1). Elevated PSA levels are commonly associated with prostate malignancy, but they may also result from benign conditions such as benign prostatic hyperplasia (BPH), prostatitis, urinary tract infection, or even recent ejaculation or prostate manipulation (2,3).A serum PSA level above 4.0 ng/mL traditionally raises concern for the presence of prostate cancer, although levels between 4.0 and 10.0 ng/mL fall into a "gray zone" where specificity and sensitivity are limited (4). PSA levels greater than 10 ng/mL are generally associated with a significantly increased likelihood of prostate cancer (5). However, PSA levels in the extremely high range (above 100 ng/mL) are unusual and typically suggest advanced or metastatic disease (6). In some cases, extreme PSA elevation has been reported in the absence of confirmed malignancy, raising questions about potential diagnostic pitfalls and the necessity for thorough clinical evaluation (7).