Are You Concerned about an Elevated PSA?
Well, you’re a middle age male and have been very healthy. You recently went to the doctor for your annual physical examination. There were no unusual findings on the examination, but lab tests revealed an elevated PSA level. What does an elevated PSA level mean and should you be concerned?
What is the PSA?
PSA is a protein made by the prostate gland. The higher the PSA level the more likely a man has prostate cancer. But, there are other reasons why a PSA level might be elevated. Also, not all men with prostate cancer have an elevated PSA level.
Generally, a PSA level above 4.0 ng/ml is considered abnormal or high, but it is still possible to have prostate cancer with PSA levels below 4.0 ng/ml but less likely.
Causes for an Elevated PSA other than Cancer
The following are the most common reasons for an elevated PSA not the result of prostate cancer.
- Benign prostatic hypertrophy
- Recent ejaculation
- Anything that puts pressure on the prostate gland.
Benign prostatic hypertrophy
Benign prostatic hypertrophy, or BPH, is an enlarged prostate that can produce some urinary flow difficulty for men. It becomes more common as men age is associated with elevated PSA levels as there is more prostate tissue to produce PSA.
Prostatitis represents inflammation of the prostate either caused by a bacterial infection in acute cases. Chronic prostatitis occurs, too, and may be related to a bacteria or non-bacteria cause. Prostatitis caused by bacterial infections is treated with antibiotics. Is prostatitis is felt to be a cause a round of antibiotics is usually prescribed with the PSA level being checked after treatment to see if the level has returned to normal or previous baseline.
Recent sexual activity leading to ejaculation level can cause a mild increase in the PSA level. It’s generally recommend that you avoid sexual activity for 2-3 days before having a PSA level measured.
Pressure on the prostate gland
Anything that puts pressure on the prostate gland can cause an elevated PSA level. This includes pressure related to riding a bike, horseback riding, and pressure from a recent colonoscopy and digital rectal examination.
Elevated PSA: What Happens Next?
What is done after a PSA level is elevated depends on the results of a digital rectal exam and signs or symptoms a man may be experiencing. Sometimes the PSA level is simply repeated to see if it remains elevated. Another blood test can be obtained called the free PSA level. The lower the free PSA the more likely a man has cancer (opposite of what you might think). In other cases a prostate biopsy may be recommended to see if the elevated PSA level is caused by prostate cancer.
Despite recommendations to minimize the use of PSA testing we still advise males to have their PSA level checked annually if normal and more frequently if elevated.