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.
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:
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 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.
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.
Why is a PSA test used as a diagnostic tool for prostate cancer when the results can indicate so many other conditions? Is there another test I should request instead?
PSA is commonly used because of its noninvasive nature (it’s just a blood test). However, because elevated PSA levels can be seen in other conditions that are not prostate cancer, it has to be used and interpreted carefully. Having a low PSA value is very useful in determining the lack of cancer. It is also useful in monitoring the status of prostate cancer that has been treated, to detect any recurrence. Although there are other tests that can more accurately diagnose prostate cancer, such as an MRI or a biopsy, the ease of PSA testing means it’s still used as a first step in screening, along with other physical exam findings.Seunggu Han, MDAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.