What are Some Other Causes of a High PSA?

First, what does PSA mean?

So you’ve had your PSA test, and it came back high. Your doctor did a DRE and ran a few more tests, and assures you that prostate cancer is very unlikely. Still, you’re worried. What are some other causes of a high PSA?

PSA: prostate specific antigen is a protein made by prostate cells. A healthy prostate releases only small amounts of this protein into the bloodstream, but when some cancer has begun to develop, the affected cells pump out more. A simple blood test can detect PSA and is used as a screening test for prostate cancer.

DRE: digital rectal exam. A prostate in which cancer has begun to grow may change in size and shape. In this exam, a doctor inserts a lubricated, gloved finger about two inches into the rectum and assesses the prostate. Men may be uncomfortable with the idea of this test, but in reality, it takes less than a minute.

The PSA test, and, if needed, the DRE, are your best defense against prostate cancer—which is highly treatable when caught at an early stage.

1. Age

Older men’s normal PSA levels run a little higher than those of younger men. Normal levels also tend to vary a little between different ethnic groups.

Your doctor will evaluate your test results, factor in your age, ethnicity, and any other relevant factors, and let you know whether your results suggest more testing.

2. Prostate size

Because PSA is naturally produced at a very low level by the healthy prostate, a man with a larger-than-usual prostate may have a higher-than-usual PSA level. Your doctor will be able to detect this with a DRE, and will take this into consideration when looking at your PSA test results.

3. Prostatitis

Prostatitis is a painful condition in which the prostate is inflamed, swollen, and tender. It is often caused by a bacterial infection, though sometimes the cause is unknown. In some cases, an elevated PSA level may be another effect of this condition.

4. Benign prostatic hyperplasia (BPH)

Different from simply having a larger-than-usual prostate, BPH is an enlarged prostate. It’s common among men over 50, and it may make urination or ejaculation difficult, which could send you to the doctor to have it checked. Along with the swelling, a prostate with BPH may produce more PSA than usual. Your doctor may recommend additional tests to confirm BPH.

5. Urinary tract infection or irritation

An infection of the urinary tract, as well as irritation caused by medical procedures involving the urethra or bladder, may irritate the prostate and cause it to produce more PSA. If you have experienced any of these, be sure to let your doctor know. You’ll need to give the area some time to heal and calm down before running a PSA test.

6. Prostate stimulation

Any prostate stimulation can trigger the release of extra PSA. This can include ejaculation and vigorous exercise, especially bike riding – but even having a DRE can raise PSA levels. For this reason, doctors usually draw blood before performing the DRE to avoid affecting the PSA test results.

7. Medications

Some medications can artificially lower the PSA, such as finasteride (Proscar or Propecia) or dutasteride (Avodart). Be sure to remind your doctor of any and all medications you may be taking, so they can factor them in when assessing your PSA test results.

PSA levels can fluctuate, and they can be influenced by a number of different factors. Your normal PSA levels might just be a little higher than most men in your demographic category. The important thing is that you’re aware of what’s going on with your body, and that you discuss the possible factors with your doctor. This will help both of you to realistically assess your test results and monitor them over time.

High PSA, No Prostate Cancer: Understand Your Results

You may have elevated PSA levels due to age or certain health conditions, including an enlarged prostate and certain infections.

Prostate-specific antigen (PSA) is a protein produced by prostate gland cells. Elevated levels may indicate prostate cancer, but PSA levels can also be affected by other things, such as enlarged prostate, a urinary tract infection, or recent ejaculation.

On their own, PSA levels aren’t a good indicator of prostate health. Instead, your doctor will look at your PSA levels alongside other risk factors, like age, digital rectal exam results, and family history. Keep reading to learn more about why your PSA levels may be high.

PSA levels may increase as you get older. This normal rise may be caused by the growth of benign, prostatic tissue. Some men also experience an enlarging of their prostate as they age, which may also elevate PSA levels.

BPH, also known as enlarged prostate, is common in older men. BPH can raise PSA levels and affect the bladder and urinary tract. Men with BPH may have difficulty urinating. If left untreated, it may also interfere with kidney function.

Common symptoms include:

• difficulty initiating urination
• weak urine output, which includes dribbling or straining, or stops and starts during urination
• frequent urination
• urgent need to urinate
• Inability to empty bladder completely

The prostate enlarges in many men as they age, possibly as a result of shifting hormonal levels. BPH only requires treatment if symptoms are affecting quality of life or health. Treatments include medications, such as alpha blockers or 5-alpha reductase inhibitors. If your symptoms are severe or do not respond to medication, a minimally-invasive surgical procedure or laser therapy may help to alleviate the problem.

Learn more: Traditional treatment methods for enlarged prostate »

UTIs may spike PSA levels. They are commonly diagnosed through a urine test and treated with antibiotics. Symptoms of a UTI include:

• a constant urge to urinate, which is not always fully relieved after urination
• inability to fully relieve the bladder
• lower back pain, particularly in the flank
• abdominal pain
• a burning sensation or pain during urination
• cloudy, foul smelling, or bloody urine
• fevers or chills

UTIs become more common as you age. Some men are also at greater risk for UTIs. Risk factors include having:

• diabetes
• kidney stones
• an enlarged prostate
• a compromised immune system

Talk to your doctor if you think you have a UTI. They are often treated with antibiotics. If you have high PSA levels and a known UTI, you will need to wait until you’ve recovered from your UTI before repeating the PSA test.

A common condition in men under 50, prostatitis is often the result of a bacterial infection. It causes swelling, inflammation, and irritation of the prostate gland. Symptoms are similar to those of a UTI, and may include:

• lower back or abdominal pain
• pain or discomfort when urinating
• difficulty urinating

If bacterial infection is causing your prostatitis, you may also experience flu-like symptoms and be treated with antibiotics. Nerve damage in the urinary tract may also cause prostatitis. This can occur as a result of injury or as a surgical complication. If no infection is found, anti-inflammatory medication or alpha-blockers may be used to reduce discomfort.

Some studies have looked at the effects of ejaculation on PSA levels. One study published in 2016 found that PSA levels rise in some men after ejaculation. They may remain higher than their typical baseline level for up to 24 hours afterward.

More research is needed to fully understand the effects of ejaculation on PSA levels. However, if you have a PSA test scheduled, consider abstaining from sexual activities that may result in ejaculation for 24 hours before the test.

Parathyroid hormone is naturally occurring hormone produced by the body to regulate calcium levels in the blood. It may also promote prostate cancer cell growth, even in men who do not have prostate cancer. For this reason, high levels of parathyroid hormone may escalate PSA levels.

An injury to the groin, caused by a fall, impact, or accident, may spike PSA levels temporarily. Let your doctor know if you suspect an injury may have affected your PSA levels.

Any procedure that causes temporary bruising or trauma to the groin can have an effect on PSA levels. This can include the insertion of any type of instrument, such as a catheter or surgical scope, into the bladder.

Prostate cancer can cause your PSA levels to increase, so your doctor may recommend that you get a PSA blood test in conjunction with other tests, such as a digital rectal exam, to assess your potential risk. Doctors often recommend PSA testing in men 50 and older. Your doctor may recommend testing your levels at an earlier age if you have known risk factors for prostate cancer, like family history of the disease.

If your PSA levels are high and other diagnostic tests also indicate an increased risk for prostate cancer, your doctor will likely recommend a biopsy to confirm a prostate cancer diagnosis. Ask your doctor about all of the risks associated with biopsy. For some men, holding off on a biopsy and taking a watchful approach is a good option because prostate cancer is generally slow growing. Your doctor will go over all of your options and explain the risks associated with each option.

Second opinion

Getting a second medical opinion can help put your mind at ease about your current care or give you a different perspective, which may help you to decide upon your best options for treatment.

If your current doctor recommends PSA testing or further testing or biopsy after a PSA test, make sure to discuss the benefits versus the risks of each procedure being recommended. Take notes or bring someone with you to your appointment to take notes for you. If you feel the need to discuss this information with another doctor, you absolutely should.

It’s important to remember that elevated PSA levels can mean many things. Prostate cancer is one of those things. If it feels medically necessary to have a biopsy or other testing done, make sure to weigh the benefits versus the risks of each test. Prostate cancer, especially when caught early, is treatable. So are many of the other causes of elevated PSA.

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Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

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General prostate-specific antigen (General PSA)

General prostate-specific antigen – this is the amount in the blood available for determination of the fractions of the substance that is part of the secretion of the prostate gland – serine protease. Prostate-specific antigen is a laboratory marker of the condition of the prostate tissue.

Synonyms Russian

General prostate specific antigen, prostate cancer marker.

Synonyms English

Prostate-specific antigen total, PSA total.

Test method

Immunochemiluminescent assay.

Detection range: 0.006 – 5000 ng/ml.

Units

Ng/mL (nanograms per milliliter).

What biomaterial can be used for research?

Venous blood.

How to properly prepare for an examination?

• Eliminate fatty foods for 24 hours before the test.
• Patients treated with high doses of biotin (> 5 mg/day) should be sampled no sooner than 8 hours after their last dose.
• Avoid physical and emotional stress for 30 minutes prior to examination.
• Do not smoke for 30 minutes before the test.
• Examination should be carried out no earlier than 10 days after prostate massage (obtaining prostate secretion, seminal vesicle massage).

General information about the study

Prostate-specific antigen (PSA) is a protein substance, an enzyme belonging to serine proteases. It is one of the synthesis products of the prostate gland.

The prostate gland consists of muscle tissue and a large number (about 50) of small glands. Muscle tissue is designed to move the fluid that the prostate produces into the internal ducts towards the lumen of the urethra. In addition, intense contractions of the prostate muscles provide the process of ejaculation during intercourse.

The prostate glands produce prostate secretion, which has several functions: it is part of the seminal fluid and serves as an important component of the nutrient medium for spermatozoa. This is a complex composition of biologically active substances that ensure the vital activity of male germ cells. A small part of the secret enters the bloodstream and performs a complex hormonal function – it ensures the normal functioning of the testicles, the functioning of the bladder, regulates sexual desire, affects blood circulation, nervous processes and mental state.

One of the components of prostate secretion is PSA. According to its chemical structure, it is a glycoprotein – a combination of protein and carbohydrates, according to biochemical properties – an enzyme that performs the function of splitting large protein molecules into smaller fragments. Thanks to this ability, it dilutes the seminal fluid. Together with that part of the secretion of the prostate gland that enters the systemic circulation, a small portion of the prostate-specific antigen produced by the prostate also penetrates there. The function of the prostate-specific antigen in the body is unknown, and in laboratory diagnostics it is used to detect diseases of the prostate gland. Some of its fractions have antigenic properties, which makes it possible to identify them using immunochemical laboratory methods. The combination of these properties and determined the name for this substance as “prostate-specific antigen”.

Serum PSA exists in several forms. Two of them are available for determination by immunochemical methods:

1) bound prostate-specific antigen – is in a chemical bond with another compound that blocks its enzymatic function (alpha-1-antichymotrypsin),

2) free prostate-specific antigen – is in free ( unbound) state.

In sum, they reflect the level of the total prostate-specific antigen.

Small fluctuations in total PSA are closely associated with both changes in the functioning of the prostate gland, which are not pathological, and with various diseases of the prostate. For example, PSA levels are influenced by individual differences in prostate mass: a larger prostate produces, correspondingly, more PSA. In addition, the age of patients matters: the amount of PSA gradually increases throughout life. Mechanical effects on the prostate gland, such as massage or cycling, can also cause an increase in this indicator. The same effect has ejaculation.

Total PSA moderately increases with hypertrophy (adenoma) of the prostate, acute and chronic inflammatory diseases of the prostate gland (prostatitis), urinary tract infections, but the main diagnostic value of this analysis is the timely detection of prostate cancer.

Prostate cancer is one of the most common cancers in men. This disease is especially common in men over 50 years of age. In Russia, in almost 70% of patients, it is detected only at the 3-4th stage. Meanwhile, with the timely detection of prostate cancer, the effectiveness of its treatment is very high. But, unfortunately, in the early stages, this disease is asymptomatic. In this regard, during the initial visit to an oncologist, 70% of patients already have tumor spread to surrounding tissues or distant organs. That’s why it’s so important for men to get their PSA checked periodically. The classic methods for detecting prostate cancer – palpation of the prostate gland through the rectal wall in combination with ultrasound – have limited sensitivity and often do not allow timely detection of the tumor, while the PSA test makes it possible to diagnose even early, asymptomatic forms of the disease.

An increase in PSA levels at the beginning of the disease occurs as a result of dysfunction of prostate cells and increased permeability of blood vessels, which stimulates the release of specific substances from prostate cells into the extracellular environment. Tumor cells themselves synthesize prostate-specific antigen in smaller quantities than normal tissues. Thus, this test is highly specific for prostate tissue, but not for prostate tumors. However, with an increase in the total mass of tumor cells, their share in the production of prostate-specific antigen also increases, exerting an increasing influence on the results of laboratory analysis.

The higher the PSA level in the blood, the more certain it is that there is a malignant process in the prostate gland. However, if the total PSA is slightly elevated, the reliability of the diagnosis is doubtful, since the same result can be obtained with other diseases of the prostate, such as benign hypertrophy or prostatitis.

The sensitivity of the PSA indicator increases significantly when simultaneously analyzing the total and free fraction of this substance in the blood and determining the ratio of the results obtained. The proportion of free PSA in the blood serum in prostate cancer is significantly lower compared to its level in any benign process. Due to this, a more accurate distinction between benign and malignant diseases of the prostate is possible with a minimal increase in total PSA.

Early detection of prostate cancer is also carried out through an annual preventive examination. An excessive increase in PSA levels over the year indicates an increased risk of developing the disease.

The total PSA test is also used in the treatment of prostate cancer. This indicator is used to judge the success of therapy: a significant decrease in PSA levels indicates a positive result of therapeutic measures. This analysis is very important for the timely detection of recurrence of the disease after its surgical treatment.

What is research used for?

• For the early diagnosis of adenoma and inflammatory diseases of the prostate.
• For the diagnosis of ischemia or infarction of the prostate.
• For early diagnosis of prostate cancer.
• For the differential diagnosis of prostate cancer and its benign diseases, as well as infectious and inflammatory processes of the urinary tract.
• To evaluate the effectiveness of drug therapy for prostate cancer.
• To monitor the results of surgical treatment of prostate cancer.
• For the timely diagnosis of recurrence of prostate cancer after surgical treatment.
• As part of a preventive screening for the early diagnosis of benign diseases and prostate cancer.

When is the test ordered?

• For prostate symptoms.

• During examination to confirm or rule out prostate cancer.
• In monitoring the effectiveness of drug therapy for prostate cancer.
• When monitoring the patient’s condition after surgery to remove prostate cancer (for the purpose of early detection of a possible recurrence of the disease).
• For preventive examination of the prostate gland.

What do the results mean?

Reference values: 0 – 4 ng/ml.

The amount of total PSA may moderately increase under some conditions not associated with prostate disease, as well as in a number of pathological conditions. The degree of increase in its level is directly proportional to the severity of prostate disease. A low total PSA indicates a low risk of prostate disease or treatment success.

Reasons for increasing total PSA:

• relative increase in prostate mass,
• prostate massage / cycling / ejaculation less than 24 hours before the study,
• infection / inflammation of the urinary tract,
• prostate adenoma,
• prostatitis,
• ischemia / infarction of the prostate,
• prostate cancer.

Reasons for low total PSA:

• low risk of developing prostate disease,
• successful treatment of prostate disease.

Important notes

Also recommended

• Cancer embryonic antigen (CEA)

Who orders the examination?

General practitioner, internist, urologist, oncologist, surgeon.

Literature

1. Andriole GL, Crawford ED, Grubb RL et al. Mortality results from a randomized prostate-cancer screening trial. N Engl J Med 2009;360:1310 – 9.
2. Schroder FH, Hugosson J, Roobol MJ ​​et al. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med 2009;360:1320-8.
3. Osterling JE, Jacobsen SJ, Chute CG et al. Serum prostate-specific antigen in a community-based population of healthy men: establishment of age-specific reference ranges. JAMA 1993;270:860-4.
4. Carter HB, Pearson JD, Metter EJ et al. Longitudinal evaluation of prostate-specific antigen levels in men with and without prostate disease. JAMA 1992;267:2215-20.
5. Beduschi MC, Osterling JE. Percent free prostate specific antigen: the next frontier in prostate-specific antigen testing. Urology 1998;51(Appendix 5A):98 – 109.
6. Modi P, Helfand BT, McVary KT. Modifications and surgical interventions for benign prostatic hyperplasia are potential confounders of prostate-specific antigen. Curr Urol Rep 2010;11:224 – 7.
7. Gleason DF. Histologic grading and staging of prostatic carcinoma. In: Urologic Pathology: The Prostate. Philadelphia, Lea and Febiger 1977, p. 171 – 8.
8. Oesterling JE. Using PSA to eliminate unnecessary diagnostic tests: significant worldwide economic implications. Urology 1995;46(Appendix 3A):26 – 33.
9. Mitchell DM, Swindell R, Elliott T, Wylie JP, Taylor CM, Logue JP. Analysis of prostate-specific bounceafter I(125) permanent seed implant for localized prostate cancer. Radiother Oncol 2008;88:102–7.

about causes article by a urologist-oncologist

If you donate blood for PSA or intend to do so in the near future, most likely you are a mature man at the age of 45 or even older. Your urologist may have ordered this test for you for a number of reasons. For example, you have presented specific complaints that may indicate a possible problem with the prostate gland. Or the doctor found out that your male relatives were diagnosed with prostate cancer during their lifetime.

Keep in mind that a high PSA does not mean you have cancer. A PSA blood test does not provide accurate diagnostic information about the condition of the prostate gland. This is only one of the diagnostic tools that are used in the detection of prostate cancer. Even ultrasound of the prostate in combination with a PSA test does not allow us to speak 100% about the presence of prostate cancer. The final diagnosis can only be made after a prostate biopsy.

How PSA is measured

PSA results are measured in nanograms per milliliter (ng/mL) of blood. For each age group, the normal PSA value, as a rule, differs. For example, for men aged 40-49 years, a level of up to 2.5 ng / ml is considered the norm. As a rule, every 10 years, the PSA level rises by about one. Thus, a PSA level of 6.5 ng / ml for men aged 70 years and older can be considered normal.

PSA age reference range

In addition to age, a number of benign (non-cancerous) prostate conditions can also affect PSA levels. PSA is often elevated in the presence of prostatitis (inflammation of the prostate), a urinary tract infection, or benign prostatic hyperplasia (BPH). Taking certain medications (finasteride, dutasteride and others), as well as obesity, on the contrary, can lower the level of PSA in the blood.

What to do if the test shows an elevated PSA level

If you do not have symptoms associated with prostate cancer, but your PSA level is higher than normal, your doctor may recommend that you repeat the test. If the indicator remains high, it makes sense to track the growth of PSA in dynamics. As part of this monitoring, the doctor will also perform a digital rectal examination of the prostate, which will help track any changes in the prostate over time.

If PSA levels continue to rise or a suspicious lump is found during a digital examination, your doctor may recommend additional tests to determine the nature of the problem, such as transrectal ultrasound of the prostate (TRUS) or magnetic resonance imaging of the prostate.

If prostate cancer is suspected, the doctor recommends a prostate biopsy. During the procedure, tissue samples are taken, most often through the rectum (transrectal biopsy). The pathologist then examines the tissue samples in the laboratory, and the urologist or urologist-oncologist interprets the data for the patient.

Why a PSA test isn’t perfect

Researchers have concluded that many tumors found on PSA screening progress so slowly that they are unlikely to pose a real threat to life. In some cases, PSA screening can do more harm than good. Despite this, many men with low-risk prostate cancer receive aggressive treatment that can cause complications. In particular, radical prostate surgery as well as radiation therapy carry potential side effects, including urinary incontinence, problems with bowel function, erectile dysfunction (impotence), and the risk of wound infection. Therefore, one of the key problems of PSA is overdiagnosis and, as a result, receiving excessive treatment.

In addition, false-positive test results—high PSA levels but no cancer on biopsy—may make the patient anxious or anxious. At the same time, if a man has been diagnosed with a slowly progressing tumor that is not life-threatening, the patient may experience stress just knowing that it is.