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Prostate-specific antigen (PSA) is a protein produced by the prostate gland. Besides being a molecule to test for prostate cancer, the PSA molecule has a purpose. The PSA protein molecule breaks down other proteins, which essentially helps the sperm survive for up to 36 hours after ejaculation.
Understanding the causes of elevated PSA levels and their implications can be crucial in managing prostate health.
Although the debate about who and when men should be tested continues, one fact remains irrefutable: the PSA blood test is the only way to detect prostate cancer early. Men have many questions about the PSA blood test, what can affect it, elevated psa treatment and what to do before getting tested. Let’s explore this further.
Because the prostate releases seminal fluid during ejaculation, the prostate simultaneously releases a small amount of the PSA molecule into the bloodstream. Sexual activity, particularly ejaculation, can potentially increase PSA levels, leading to a temporary rise.
Therefore, most physicians recommend patients abstain from sexual activity, including ejaculation, for 24-48 hours before a PSA test to ensure accurate readings and to reduce the potential for overestimated results. Interestingly, however, the digital rectal exam should not increase the PSA.
Numerous studies support this. The only exception is if the physician does a prostate massage immediately before obtaining the blood test. Fortunately, this is no longer a very common procedure for men.😅
While stress and anxiety may not directly cause an enlarged prostate or raise PSA levels, they can exacerbate the symptoms of conditions like prostatitis, which can indeed elevate PSA levels. Therefore, maintaining a balanced, stress-free lifestyle can support overall prostate health.
Prostatitis, inflammation, or a bacterial prostate infection can cause significant increases in PSA levels. In some cases, these conditions can increase PSA levels similar to those seen in prostate cancer, emphasizing the importance of effectively evaluating prostatitis when an elevated PSA level is detected.
It is essential to discuss any Urologic symptoms you have with your Urologist or your provider before obtaining the PSA. Another interesting fact is that the PSA test can have a variability of up to 20% within a few days. This variability is why there’s no true cut-off, although most urologists (including me) use the PSA of 2.5 – 3 as the danger zone.
Many physicians will use a PSA of 4 as the upper limit of normal. Younger men under 55 could still be at risk with a PSA lower than 2.5. The higher the PSA, the higher the risk of prostate cancer. We know that patients with urinary symptoms such as burning with urination, pain with ejaculation, or lower pelvic pain should have that addressed before obtaining a PSA.
A high PSA level can indicate various prostate issues, including cancer. The top 4 conditions that cause an elevated PSA are:
While procedures like a cystoscopy can help detect abnormalities in the urinary tract, the cystoscopy does not help diagnose prostate cancer. Any instrumentation that irritates the prostate, or even a catheter that goes through the middle of the prostate into the bladder, can cause the PSA to rise. There are different elevated PSA treatment options which we discussed later.
Also, there are other causes that may increase the level of PSA like below;
These all need to be considered when obtaining the PSA Screening test. As discussed above, it is prudent to consider a repeat PSA for men who have had recent instrumentation or a catheter, etc., at a later date to understand better whether the blood test is truly elevated.
Suppose I have seen the PSA test normal range rise over the last 6 to 12 months, and patients have not had any significant instrumentation or urinary issues. In that case, I routinely proceed with a prostate MRI or consider other genetic testing to evaluate for prostate cancer.
PSA levels can also be influenced by age. For example, a PSA level of up to 2.5 to 3 ng/mL is generally considered normal for a 60-year-old man. Still, the definition of “normal” can vary based on age, ethnicity, and other factors.
Family history of prostate cancer plays a significant role in addition to a rise in the PSA in the preceding years. While the age-adjusted PSA was utilized in the past, we can use many other tests in modern-day urology to evaluate that patient’s risk of having prostate cancer in addition to the PSA.
If your PSA level is elevated, don’t think about how to lower the PSA; think about what are elevated PSA treatment As discussed above, it could be recent ejaculation, an inflammatory reaction in the prostate, or even a recent urinary tract infection.
I tell my patients to think about the PSA as a warning sign. Before discussing a prostate biopsy, I routinely consider other blood tests and a prostate MRI to evaluate that patient’s risk of having cancer. My medications for high PSA level suggest that, either you should go for natural or surgery treatment options.
In conclusion, while elevated PSA levels can indicate various prostate-related health issues, it’s important to note that they are not a definitive marker of cancer. Lifestyle factors, including sexual activity and prostate inflammation, can influence PSA levels. If you have an elevated PSA, consider all of the factors discussed above before letting panic set in.
At the minimum, sit down with your provider or Urologist and discuss the blood test and next steps. Retired NYPD detective said it best: “Knowledge is power, but knowledge shared is power multiplied.”