What does PSA level of 20.6 indicate?
it's very high
20.6 is a very high reading. There are a lot of potential causes, including cancer, urine retention, prostatitis, etc. Since cancer is the most important of the aforementioned causes, it should be excluded with appropriate testing. A digital rectal examination, an ultrasound scan and biopsy of the prostate are good ways to detect it. A visit to a urologist would be the most appropriate next step.
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PSA increases mostly in diseases of the prostate gland
The PSA rises in various prostatic diseases. Colon cancer may raise the PSA levels but not as much. Only a slight elevation can be justified. Sildenafil is not supposed to cause any rise but sexual contact is. A 20 is too high for this kind of etiologies though.
many causes of PSA elevation
All conditions in and around the prostate may raise the PSA including prostate cancer, prostatitis, acute urinary retention, benign prostatic hyperplasia, prostatic ischemia, prostatic massage (digital examination, intense bicycling, etc), prostatic biopsy, indwelling catheter, etc.
Other conditions (unrelated to the prostate) may also raise the PSA, including tumors (colon tumor is one of them), drugs (testosterone for example but no sildenafil), acute renal failure, circadian rhythm, etc
You can't lower the PSA. You can only manage the underlying condition. If the underlying condition is properly managed then the PSA may get lower.
Other tests include the digital rectal examination and radiological tests (ultrasound scan and MRI).
investigation is required
Whether it's wise or not depends on the underlying condition. If it's just a prostatitis for example, a course of antibiotics will do very good to him. If it's tumor on the prostate then it all depends on the tumor's aggressiveness. Only a biopsy may give the urologist this information.
You can't judge by the age only. A slow growing tumor could be left alone or with conservative treatment only. Having an aggressive tumor though might be a good reason to do more than that.
So in conclusion, unless there is a certain diagnosis, nobody can tell you what's better for him.