What are the non-cancerous causes of elevated PSA levels. How can age, prostate size, and infections affect PSA test results. When should you be concerned about high PSA levels.

Understanding PSA: The Prostate-Specific Antigen

PSA, or prostate-specific antigen, is a protein produced by cells in the prostate gland. Under normal circumstances, only small amounts of PSA are released into the bloodstream. However, certain conditions can cause PSA levels to rise, prompting concern and further medical investigation.

Why is PSA important? It serves as a key marker for prostate health and is widely used as a screening tool for prostate cancer. However, it’s crucial to understand that elevated PSA levels don’t always indicate cancer.

The PSA Test: A Vital Screening Tool

The PSA test is a simple blood test that measures the amount of prostate-specific antigen in your bloodstream. While it’s an essential tool in the early detection of prostate cancer, it’s not infallible. Various factors can influence PSA levels, leading to what’s known as a “false positive” result.

• Normal PSA levels: Generally below 4 ng/mL
• Borderline PSA levels: 4 to 10 ng/mL
• High PSA levels: Above 10 ng/mL

Is a high PSA level always cause for concern? Not necessarily. While it warrants further investigation, there are several non-cancerous reasons why your PSA might be elevated.

Age and PSA Levels: A Natural Correlation

As men age, their PSA levels tend to naturally increase. This age-related rise is often due to the gradual growth of benign prostatic tissue. It’s one of the reasons why PSA test results are interpreted differently for men of various age groups.

How Age Affects PSA Levels

The relationship between age and PSA levels is well-documented. Generally, older men have higher baseline PSA levels compared to younger men. This natural progression is taken into account when interpreting PSA test results.

1. 40-49 years: PSA less than 2.5 ng/mL is often considered normal
2. 50-59 years: PSA less than 3.5 ng/mL is often considered normal
3. 60-69 years: PSA less than 4.5 ng/mL is often considered normal
4. 70+ years: PSA less than 6.5 ng/mL is often considered normal

Does this mean older men shouldn’t worry about elevated PSA levels? Absolutely not. While age-related increases are normal, significant jumps or consistently rising levels should always be evaluated by a healthcare professional.

Prostate Size and Its Impact on PSA Levels

The size of your prostate can significantly influence your PSA levels. A larger prostate naturally produces more PSA, which can lead to higher readings on the PSA test, even in the absence of cancer or other health issues.

Benign Prostatic Hyperplasia (BPH) and PSA

Benign Prostatic Hyperplasia, or BPH, is a common condition in men over 50. It’s characterized by an enlarged prostate that isn’t cancerous. However, BPH can cause PSA levels to rise, sometimes mimicking the elevation seen in prostate cancer cases.

How does BPH affect PSA levels? As the prostate enlarges, it produces more PSA. This increase can be proportional to the growth of the gland. For instance, a man with a prostate twice the normal size might have a PSA level twice as high as expected, even without any cancerous changes.

• BPH symptoms: Difficulty urinating, frequent urination, incomplete bladder emptying
• BPH diagnosis: Digital rectal exam (DRE), ultrasound, urine flow studies
• BPH treatment: Medications, minimally invasive procedures, surgery in severe cases

Can BPH be mistaken for prostate cancer? Yes, which is why additional tests are often necessary to differentiate between BPH and prostate cancer when PSA levels are elevated.

Prostatitis: Inflammation’s Role in Elevated PSA

Prostatitis, or inflammation of the prostate gland, is another common cause of elevated PSA levels. This condition can be acute or chronic, bacterial or non-bacterial, and each type can affect PSA levels differently.

Types of Prostatitis and Their Effect on PSA

Prostatitis comes in several forms, each with its own characteristics and potential impact on PSA levels:

1. Acute bacterial prostatitis: Can cause a significant spike in PSA levels
2. Chronic bacterial prostatitis: May lead to fluctuating PSA levels
3. Chronic prostatitis/chronic pelvic pain syndrome: Can cause mild to moderate PSA elevation
4. Asymptomatic inflammatory prostatitis: May elevate PSA without other symptoms

How much can prostatitis raise PSA levels? In some cases, prostatitis can cause PSA levels to rise as high as 100 ng/mL or more, especially in acute bacterial infections. However, the elevation is usually more modest in chronic cases.

Does treating prostatitis lower PSA levels? Often, yes. Once the inflammation is under control, PSA levels typically return to the individual’s baseline. This is why it’s crucial to treat any prostate inflammation before relying on PSA tests for cancer screening.

Urinary Tract Infections and PSA Fluctuations

Urinary tract infections (UTIs) can also lead to elevated PSA levels. While UTIs are more common in women, men can develop them too, particularly as they age or if they have an enlarged prostate that interferes with complete bladder emptying.

The Connection Between UTIs and PSA Elevation

When a UTI occurs, it can cause inflammation that extends to the prostate gland. This prostatic involvement can trigger an increase in PSA production, leading to higher levels in the bloodstream.

• UTI symptoms: Frequent urination, burning sensation, cloudy urine
• UTI diagnosis: Urinalysis, urine culture
• UTI treatment: Antibiotics, increased fluid intake

How quickly do PSA levels return to normal after a UTI? In most cases, PSA levels should return to baseline within several weeks after the infection has been successfully treated. However, it’s important to wait at least a month after completing antibiotic treatment before retesting PSA levels to ensure accuracy.

Medical Procedures and Their Impact on PSA Readings

Certain medical procedures, particularly those involving the urinary tract or prostate, can temporarily elevate PSA levels. This is an important consideration when interpreting PSA test results, as recent procedures can lead to false positives.

Common Procedures That Can Affect PSA Levels

Several medical interventions can cause a temporary spike in PSA levels:

1. Digital Rectal Exam (DRE): Can cause a slight elevation in PSA
2. Prostate biopsy: Can significantly increase PSA for several weeks
3. Cystoscopy: May cause a temporary rise in PSA
4. Transurethral resection of the prostate (TURP): Can elevate PSA for several months
5. Catheterization: May lead to a temporary increase in PSA

How long should you wait after a procedure to get an accurate PSA test? The waiting period can vary depending on the procedure. For a DRE, it’s best to wait a few days. For more invasive procedures like a biopsy or TURP, you might need to wait several weeks to a few months for PSA levels to stabilize.

Can you have a PSA test immediately after these procedures? While it’s possible, the results may not be accurate due to the procedure-induced elevation. It’s always best to follow your healthcare provider’s recommendations on when to schedule your next PSA test.

Lifestyle Factors Affecting PSA Levels

Various lifestyle factors and activities can influence PSA levels, sometimes leading to temporary elevations that may cause unnecessary concern. Understanding these factors can help in interpreting PSA test results more accurately.

Sexual Activity and PSA Levels

Sexual activity, particularly ejaculation, can cause a temporary increase in PSA levels. This is because ejaculation can cause the prostate to release more PSA into the bloodstream.

• Ejaculation can raise PSA levels for 24-48 hours
• The increase is usually modest, typically less than 0.5 ng/mL
• PSA levels generally return to baseline within 2-3 days

Should you abstain from sexual activity before a PSA test? Many doctors recommend avoiding ejaculation for 48 hours before a PSA test to ensure the most accurate results.

Exercise and PSA Levels

Certain types of exercise, especially those that put pressure on the prostate area, can temporarily elevate PSA levels. This includes activities like:

1. Cycling
2. Horseback riding
3. Motorcycle riding

How long does exercise affect PSA levels? The effect is usually short-lived, with PSA levels returning to normal within 24-48 hours after the activity.

Should you avoid exercise before a PSA test? It’s generally recommended to avoid strenuous exercise, particularly activities that put pressure on the prostate area, for 48 hours before a PSA test.

Medications and Their Effect on PSA Readings

Certain medications can influence PSA levels, either increasing or decreasing them. This can complicate the interpretation of PSA test results and potentially mask prostate issues if not taken into account.

Medications That Can Lower PSA Levels

Some medications are known to artificially lower PSA levels, which could potentially hide elevated PSA due to prostate cancer or other conditions:

• Finasteride (Proscar, Propecia)
• Dutasteride (Avodart)
• Saw palmetto (a herbal supplement)

How much can these medications lower PSA? They can reduce PSA levels by up to 50%. This effect needs to be considered when interpreting PSA test results in men taking these medications.

Medications That May Increase PSA Levels

Conversely, some medications might cause a slight increase in PSA levels:

1. Testosterone replacement therapy
2. Some diuretics
3. Certain NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)

Should you stop taking medications before a PSA test? Never stop taking prescribed medications without consulting your doctor. Instead, inform your healthcare provider about all medications you’re taking before the PSA test, so they can interpret the results accurately.

Understanding these various factors that can influence PSA levels is crucial for both patients and healthcare providers. While elevated PSA levels can be concerning, it’s important to remember that PSA is just one piece of the puzzle when it comes to prostate health. A comprehensive approach, considering age, prostate size, recent procedures, lifestyle factors, and medications, is essential for accurately interpreting PSA test results and determining the best course of action for each individual.

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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about reasons 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 biopsy of the prostate. 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 cause anxiety or anxiety in the patient. 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.

Before having a PSA blood test, talk to your doctor about the benefits and risks of PSA screening. Find out how soon you can discuss the results of the test, what recommendations you will receive if the results are positive; how often should the analysis be repeated if the results are negative,” – head of the urology department of the Andros clinic,
urologist Alexey Plekhanov.

Should I take a biopsy if my PSA is elevated?

The PSA test is considered the gold standard for diagnosing prostate health. Often, when PSA results are higher than normal, the patient is diagnosed with suspected prostate cancer and sent for a biopsy. However, it is not a fact that a high PSA level is an oncology.

Increased PSA – what to do?

A PSA test, or prostate-specific antigen, makes it possible to suspect the presence of prostate cancer. It must be taken annually by every man after 45 years. In other cases, the analysis is prescribed according to indications: if the results of ultrasound, MRI or CT, digital rectal examination raise doubts about the presence of a tumor.

There is a belief that if the PSA is below 4 ng / ml – this is the norm, in fact it is not. It has been proven that PSA levels vary with age. For men under forty, the lower threshold is 2.5 ng / ml, and for the elderly – 4.5 ng / ml. With age, the prostate enlarges, this is a normal process, and, as a result, the production of PSA increases.

If you have been scheduled for a biopsy, but you want to make sure it was done correctly, you can get a second opinion from the EMC Urology Clinic.

PHI – diagnosis of prostate cancer without biopsy

When a tumor is suspected, but the total PSA is in the range of 2-10 ng/ml, doctors usually opt for expectant management and regular monitoring, or prescribe a biopsy. The best way to clarify the situation in this case is an additional study – a PHI blood test. If the PHI is low, then the doctor may refuse to take a biopsy and continue monitoring. Studies show that up to 75% of biopsies are performed in vain, that is, they could be replaced by a PHI blood test.

Magnetic resonance imaging (MRI)

MRI of the prostate may also help avoid a biopsy. MRI of the prostate, unlike a biopsy, is a non-invasive diagnostic method that does not injure the body and does not expose it to radiation. MRI allows accurate visualization of pathological foci even at the earliest stages of the development of the disease and confirms or refutes the need for a biopsy.

Fusion biopsy – the most accurate way to diagnose cancer

Prostate biopsy is a method of examining prostate tissue for cancer cells. Using a special needle, rectal or urethral punctures are made in the prostate in order to take suspicious tissue for examination.

EMC is one of the few clinics in Russia that does not perform a classic biopsy, but a fusion biopsy. With a classic biopsy, the doctor acts, one might say, blindly, even if the procedure is performed under ultrasound guidance. Fusion biopsy is a procedure carried out under the combined control of ultrasound and MRI. This technology allows you to take the material exactly from the area that is in doubt.

The received material is sent to the laboratory and within a few hours you can get the results. If prostate cancer is confirmed, then the doctor chooses the treatment tactics. As a rule, a radical prostatectomy is performed – the removal of the prostate.