Receiving high prostate-specific antigen (PSA) test results can be stressful. But while PSA blood tests are often used to screen for prostate cancer, there are a number of other reasons for elevated levels.
Speak to your healthcare professional if you’re worried about your PSA or concerned you might have prostate cancer. In the meantime, it may be reassuring to review what PSA is and why it can be elevated with other prostate conditions.
What is PSA and how is it used to diagnose prostate health?
PSA is a protein made by the prostate gland. When there’s a problem with the prostate, it typically releases more PSA, which is why this biomarker is used to screen for cancer. However, PSA can change for other reasons, and PSA test results alone can’t diagnose cancer.
What counts as high PSA?
Unfortunately, there’s no universal standard for what counts as high PSA.¹ Generally 4 ng/mL is the typical cutoff used by most healthcare professionals, but around 15% of men with lower results will have prostate cancer, while 75% of men with higher results won’t.²
Some healthcare professionals will monitor changes in PSA over time rather than relying on a single test. They’ll also consider age, family history and general health to decide if you need follow-up tests or treatment.³ Black men or men whose whose father or brother had prostate cancer are at increased risk, and may wish to begin screening in their early to mid-40s.⁴
Although a prostate biopsy is the most definitive test for cancer, it’s likely your doctor will start with something painless and less invasive, like an MRI of the prostate.
Reasons for high PSA that are not cancer
Here are some of the most common non-cancerous reasons for elevated PSA:
PSA levels typically increase with age,⁵ ⁶ ⁷ which is one of the reasons routine PSA screenings aren’t recommended for men over 70.⁸ However, your risk of prostate cancer increases with age, so your doctor will likely rely on other factors to determine if your high PSA is due to aging or something else.
Benign prostatic hyperplasia (BPH)
Benign prostatic hyperplasia, or BPH, is a common condition that enlarges the prostate and can elevate PSA.⁹ Symptoms of BPH or enlarged prostate include urinary discomfort or feeling like you have to pee often.
Inflammation of the prostate (prostatitis)
Prostatitis is inflammation of the prostate and is associated with elevated PSA. It can be caused by a temporary or acute bacterial infection, but often its cause is unknown.¹⁰
Urinary tract infection (UTI)
Urinary tract infections (UTIs), particularly ones that cause fever, are associated with elevated PSA.¹¹ ¹² If you have a urinary tract infection or fever, wait until it is healed before screening for PSA to avoid skewing the results.
Ejaculation is known to temporarily increase PSA levels.¹³ That’s why it’s typically recommended that you avoid ejaculating for a day or two before taking prostate screening tests.¹⁴
Recent digital rectal exam (DRE)
Generally, your healthcare professional will take a blood sample for PSA before performing a digital rectal exam, because this screening test (where a doctor inserts a finger into the rectum to feel for lumps) can temporarily elevate PSA.¹⁵ For the same reason, it’s good idea to avoid any anal penetration or prostate stimulation a few days before taking a PSA test.
Testosterone replacement therapy
A 2016 meta-analysis found that testosterone replacement therapy was associated with a PSA increase of 0.1 ng/mL, but not an increase in prostate cancer.¹⁶ Dr. Andre C. King is a general urologist and prostate cancer specialist who notes that “the effects of testosterone replacement on prostate cancer are uncertain and there are differing opinions among different urologists.”
Elevated PSA is linked to prostate cancer, but it doesn’t diagnose it, so if you’ve got high PSA levels, don’t panic — it could be one of several other benign conditions. Understanding your demographics and risk factors will help your doctor interpret your test results and decide if further screening is necessary. Most healthcare professionals will try to avoid an unnecessary prostate biopsy, and will usually start with painless and and minimally invasive imaging test, like an MRI.