Does A Rapid Rise in PSA Indicate Prostatitis?

Prostatitis is swelling and inflammation of the male prostate gland, located just below the bladder.

The gland produces a fluid stored in the seminal vesicles and sperm cells produced by the testicles. The combined prostatic fluid and sperm cells are known as semen. 

Since the prostate surrounds the male urethra, inflammation, or swelling of the prostate often causes lower urinary tract symptoms, such as; painful or difficult urination. Severe prostatitis can cause pelvic pain, urinary retention, erectile dysfunction, and other issues. 

Prostatitis can occur suddenly or become a chronic condition. It often occurs in older men with an enlarged prostate, but physical stress in or around the pelvic region can trigger it in younger men. 

There are two main types of prostatitis. The most common form, especially among older men, is chronic prostatitis. This is an unpredictable swelling or inflammation of the gland, where symptoms come and go over time. It can be caused by a low-level infection in the prostate and is difficult to resolve completely.

Chronic prostatitis may be caused by a bacterial infection but is often of unknown origin. 

The second type is acute prostatitis, which causes more severe symptoms. The symptoms are usually intense and appear suddenly. This type is rarer and may be initiated by a bacterial infection in the prostate and, occasionally, spillover to the prostate from an active bacterial urinary tract infection. In severe cases, it can be life-threatening and requires immediate treatment. 1 

Recent studies indicate that a rapid rise in PSA levels may signal prostatitis. This article will discuss PSA levels and what they can signify, as well as prostatitis and its treatment options.

PSA (Prostate-Specific Antigen) Testing

Most men age 50 or older are familiar with the Prostate Specific Antigen (PSA) blood test that doctors typically order at routine examinations. PSA is a chemical released by, and unique to, the male prostate gland. Due to prostate enlargement, infection, or the presence of cancer, a larger gland can increase PSA results. 

The PSA test measures the total amount of PSA in the blood. Levels above the generally recognized limit of four might suggest the possibility of prostate cancer and often result in a recommendation for a prostate biopsy—a procedure that has its own set of risks, such as bleeding and infection.

Since the addition of prostate-specific antigen (PSA) testing to routine blood work for men over fifty, a man’s risk to be diagnosed with prostate cancer has increased substantially. Such a diagnosis usually results in extreme psychological duress and is often coupled with an emotional need for immediate treatment to “fix” or “remove” the problem.

However, since many cancers found via routine PSA testing are clinically insignificant, aggressive treatment can be more damaging than helpful—especially to a man’s quality of life. 

Men diagnosed with prostate cancer are frequently scheduled for aggressive treatment shortly after their diagnosis. This immediate rush to treatment has received considerable momentum from both the media and the medical community. Much of this is due to misinformation on the part of the patient.

Secondly, it is the result of a failure of the clinician to fully and truthfully explain the risk/benefit ratio to the patient. It is often easier to satisfy a patient′s emotional need for immediate treatment than it is to explain to a panicky patient and his wife that his cancer may never cause symptoms or become life-threatening. 

It is significant to note that a high PSA reading does not automatically indicate a man has prostate cancer, although some urologists foster that belief in their practice. Many men diagnosed with prostate cancer may never suffer any symptoms or debility from the disease. Thus, through a routine PSA test, a man can easily receive a diagnosis of prostate cancer, along with a recommendation for surgery to remove his prostate. 

What is not considered in the diagnosis or the surgery recommendation is the possibility that his prostate cancer may be of an indolent type that will likely never develop advanced or life-threatening symptoms. Thus, without further study and analysis, the man can be subjected to a major surgery that will have serious side effects for the rest of his life. 2 

Compounding this, urologists that typically make recommendations in this manner also tend to minimize the side effects of their treatment as well as the success rate in either avoiding such side effects or minimizing them. 

Thus, an unwary man accepts the treatment and then suffers through the myriad of serious side effects, often praising his doctor for “curing” his prostate cancer. 

Other tests can help determine if a PSA reading is significant or not. A free PSA test measures the percentage of unbound (or free) PSA in the blood instead of the usual total PSA reading. Benign Prostate Hypertrophy (BPH) tends to produce a higher free PSA percentage than a cancerous prostate. 

The free PSA test does not require a separate blood draw. It is done in conjunction with the total PSA test. 

Significance of a Rising PSA

Many doctors use PSA levels to determine the diagnosis and treatment of prostate problems. Unfortunately, some urologists subscribe to the theory that almost any rise in a man′s PSA value should be followed up with a prostate biopsy. 

Men are also led to believe that PSA levels are all-important for diagnosing prostate cancer both by their peers and by the media. However, many situations can significantly rise in PSA that does not indicate cancer or require significant treatment. 

Other conditions that can cause increased PSA levels include an enlarged prostate (benign prostatic hyperplasia, BPH) or an inflamed or infected prostate (prostatitis). In addition, PSA values can be temporarily increased by external stress on the prostate, such as; bicycle or motorcycle riding as well as sexual activity, especially intense sexual or physical activity. 

For older men, the general upper limit that is considered normal is 4.0 ng/mL. However, normal prostates emit a higher level of PSA as a man ages. The PSA level also tends to increase with the size of the prostate, especially with BPH. A CAT scan or an MRI can determine the size of a man′s prostate, but such tests may not always be warranted. 

Some doctors use rising PSA as a major factor in determining if a man needs a biopsy or further treatment, especially when the PSA rise is showing a steep slope. 

One measurement criteria used is called the PSA velocity. This represents the rate of rising PSA levels over a period of time. In the past, a rapid rise in PSA was thought to indicate the presence of cancer or an aggressive form of cancer. However, studies have cast doubt on this hypothesis, and reports suggest that a rapid rise in PSA is not always linked to cancer. Recent studies indicate that a rapid rise in PSA levels may signal prostatitis 3 

While a sudden significant rise in PSA value is cause for concern and should be checked, it is unlikely that the cause of the rise in prostate cancer. However, men with a normal digital rectal exam and an elevated PSA should schedule a repeat PSA test within 30 to 60 days test to confirm the elevated value before any further evaluation, or a treatment plan is initiated. 

A PSA rise is like a warning signal. It generally means that the prostate is unhappy and warrants attention. However, it does not mean that something is dramatically wrong. A sudden, significant jump in PSA level may mean an infection or a temporary upset in the prostate. 

In men that have already been found to have localized prostate cancer, a sudden rise in PSA may signal cancer has turned aggressive with the potential to metastasize. In any case, it is appropriate to further check it out. 

If an infection is present, a repeat PSA can be scheduled after the infection is cleared. If evidence suggests the rise is due to an external event, the PSA test can be repeated in 30 to 60 days. A biopsy to rule out cancer is not warranted simply because of a rise in PSA.

Treating Prostatitis

Prostatitis is not always treatable. In fact, one of the most common types is a chronic condition that is not due to bacterial infection or any other obvious identifiable cause. The medical community has called it chronic nonbacterial prostatitis or chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). It is a long-term condition marked by pelvic pain and various lower urinary tract symptoms

To date, there is no known cause for the CP/CPPS condition. Laboratory examinations do not indicate any bacterial involvement. Symptoms tend to stay about the same over time or go through cycles of being more or less severe. Unless symptoms are severe or debilitating, treatment is usually unneeded. Some urologists recommend removal of the prostate, but the long term side effects of the surgery usually rule out this approach. 

Bacterial infections of the prostate can be either acute or chronic. Acute prostatitis generally starts suddenly and causes pelvic pain and/or flu-like signs and symptoms, such as fever, chills, nausea, and vomiting. This type of prostatitis is usually caused by common strains of bacteria from either the urinary tract or the rectum and is treated with antibiotics. If left untreated, it can cause serious life-threatening infections. 

Chronic bacterial prostatitis is more common and a less severe infection than the acute version. Both are conditions where bacteria is found to have caused the infection. Antibiotics are usually used in this case as well but may have trouble reaching and killing bacteria deep in the prostate. 

For acute prostatitis, a short course of antibiotics (usually Cipro) for one week to ten days is often prescribed. This short-term treatment may resolve the prostatitis problem if it is randomly caused by a bacterial infection like a spillover from a urinary tract infection.

Short-term antibiotic treatment is unlikely to affect long-term chronic prostatitis. This condition is often treated with antibiotics for longer periods of time, typically 4 to 8 weeks. 

When antibiotics don’t eliminate the bacteria causing prostatitis, or, if they eliminate them temporarily, a difficult-to-treat recurring infection may ensue over the long term. Symptoms may disappear for a while, only to reoccur later on. 

Conclusions

Some urologists treat a rapid rise in a routine PSA test as an immediate indicator for a prostate biopsy. Fortunately, the number of urologists following this obsolete view is dwindling.

A biopsy is an invasive procedure that often results in unnecessary pain, risk, and possibly additional unneeded treatments. While such a rise in PSA levels may indicate prostate cancer, it can also indicate prostatitis or other conditions.

Acute prostatitis is usually the result of an infection spilling over from either the urinary tract or fecal material transferred to the prostate inadvertently. Treatment with antibiotics is usually successful in clearing the infection. When the prostatitis is chronic, antibiotics may work, but in many cases, it is likely the infection will return after a period of time.  

The prostate is an organ that contains many small vessels and capillaries. This makes it harder for antibiotics to get into prostate tissue to treat prostatitis. Chronic prostate infections typically are treated with a long course of antibiotics, usually several months. Additionally, many men undergo multiple short courses of antibiotic treatment as well as longer courses for chronic prostatitis. 

In acute cases, the infection may be cleared, but success is spotty in chronic cases. Since long-term antibiotic treatment has numerous undesired side effects, savvy doctors often enlist naturopathic doctors or herbalists to treat chronic prostate infections naturally. 

Herbal remedies or other natural prostatitis treatments can typically help reduce the infection without the use of powerful antibiotics. Additionally, herbal and/or natural remedies typically do not have debilitating side effects, making them the prime choice for this type of condition.

Some unconscionable urologists tend to order a biopsy for almost every man that enters their office with a prostate problem. A prostate biopsy is one of many methods for examining the prostate gland in the hunt for cancerous growth. Prostatitis is NOT cancer, and any doctor that reflexively orders a prostate biopsy due to out-of-range PSA levels is not putting the best interests of their patient first. 4 

Next Up

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Sources

  1. Dr Alberto Parra, Prostatitis vs BPH: How to Tell the Difference, Bens Natural Health Blog, March 6, 2020
  2. Medicalxpress News, Surgery unnecessary for many prostate cancer patients, December 13, 2018, Uppsala University
  3.  Laino, Charlene, Rapid Rise in PSA May Signal Prostatitis, Oncology Times: May 25th, 2006 – Vol 28, No 10  p 27
  4. James Occhiogrosso, ND, Natural Treatment for Prostatitis, Bens Natural Health Blog, Sept, 18, 2020
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Dr. James Occhiogrosso

James Occhiogrosso is a qualified naturopathic doctor (N.D.) and health practitioner, as well as author of several books including “Your Prostate, Your Libido, Your Life,” He has authored hundreds of articles, and is a frequent guest on numerous radio and TV shows.

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