If you are a man, over the age of 50, you will probably have heard of the PSA test.
The PSA test is a valuable biomarker for the detection of prostate cancer, but its usefulness can be limited.
A high PSA level can cause much anxiety. But it is worth being aware that other factors such as age, prostatitis, and BPH has been shown to elevate PSA levels.
Therefore, a high PSA is not always caused by prostate cancer. Thus, it is important to make positive lifestyle changes to help improve your prostate health.
In this article will be discussing what causes PSA to spike, what you can do to lower PSA levels, and whether there is really such a thing as a ‘normal PSA range for men.
What is PSA screening?
PSA is a protease, a group of enzymes that breakdown proteins into smaller peptides or amino acids.
It is released by the prostate gland, promoting the movement of sperm. However, a small amount escapes into the bloodstream and can be used to monitor prostate activity.
Healthy men have low levels of serum PSA but are often elevated in the presence of prostate disorders, including :
Clinical use in prostate cancer diagnosis
The measurement of serum PSA is commonly used for early detection of prostate cancer and monitoring of treatment response.
Further, in negative prostate biopsy for prostate cancer diagnosis, PSA test can be used to determine the need for repeat biopsy. High PSA levels are significantly associated with an increased risk of prostate cancer.
However, serum PSA lacks clinical specificity as it can be elevated by noncancerous conditions.
The methods implemented most often include;
- PSA velocity measures the extent of change in serum PSA over time. Increase of 0.75 ng/ml/y or more has been associated with the presence of prostate cancer (Carter et al., 1992). Unfortunately, this approach is limited by time and multiple measurements.
- PSA density measures PSA levels relative to the prostate volume. It has been shown that PSA density values greater than 0.10 are strongly associated with prostate cancer (Nordström et al., 2018). However, reproducible calculation of prostate volume is a concern and may reduce the usefulness of this method.
- Age-Specific PSA normal ranges use different age-specific cut-offs to interpret the results of PSA tests. However, negative biopsies can still occur even after adjusting for age, especially in men over 70 years of age (Catalona et al., 2000).
- Percentage of free total PSA measures the ratio of the different forms of PSA. For instance, BPH is associated with elevated PSA because BPH occurs predominantly in the inner portion of the prostate with higher PSA levels. In contrast, prostate cancer is commonly within the peripheral zone where pro-PSA is elevated.
What does a high PSA mean?
PSA levels can be affected by several factors and a rise in PSA may indicate:
- prostate inflammation.
- urinary infection.
- prostate cancer.
- recent ejaculation.
Alone, PSA levels are not good measures of prostate health. Your medical team will need to assess other risk factors. They may also perform a DRE to make an accurate diagnosis.
Some of the factors that can cause your PSA levels to be high include;
- Age: PSA levels may increase with age and potential with age-associated BPH.
- BPH: Enlarged prostate, common in older men, can increase the levels of total PSA. The effect of BPH on the bladder and urinary tract can cause inflammation infection (UTI), both of which can increase PSA levels.
- UTI: Urinary tract infection may elevate your PSA levels.
- Prostatitis: Men under the age of 50 often develop prostatitis. Prostatitis-associated inflammation and prostate irritation can also increase PSA levels.
- Recent ejaculation: Some men experience elevated PSA levels after ejaculation. This may persist for 24 hours.
- Prostate injury and surgical procedures: An injury to the groin caused by accident or surgical procedure may spike PSA levels. However, this can be excluded by performing a second PSA test. You should inform your doctor if you had a recent fall, impact or accident.
- Prostate cancer: Prostate cancer often elevates your PSA levels, especially hormone-dependent prostate cancer.
However, digital rectal examination and prostate biopsy are required to make a diagnosis of prostate cancer. High PSA level is likely to be associated with prostate cancer if you have multiple known risk factors of prostate cancer.
- Parathyroid hormone: a hormone that regulates calcium levels may raise PSA levels. Parathyroid hormone has been shown to promote prostate cancer growth, suggesting that its effect on PSA will likely be related to prostate cancer.
Does a high PSA indicate prostate cancer?
It is now established that prostate cancer causes elevated PSA levels in the blood. PSA is not a unique indicator of prostate cancer because PSA screening can be confounded by other prostate conditions.
Difficulty interpreting PSA test results is increased by the shared risk factors between several prostate conditions.
For instance, age does not only increase prostate cancer risk but BPH and urinary tract infection. Thus, patients may present with prostate cancer, BPH, and prostatitis simultaneously.
Both prostate cancer and BPH elevate PSA levels, while prostatitis and trauma may cause fluctuating PSA levels.
Often, levels of PSA gradually return to normal levels with immediate treatment of noncancerous prostate conditions.
What causes PSA levels to rise?
Physiologically, PSA is majorly localized in the prostate epithelial cells and the seminal fluid, but small amounts can enter the circulation.
Prostate cancer, BPH, or prostatitis cause a significant increase in blood PSA.
Prostate cancer cells have been shown to produce more PSA than healthy prostate epithelial cells.
Further, both prostate cancer and BPH increase prostate volume, which can lead to a size-dependent increase in serum PSA levels. These events promote the elevation and escape of PSA into the circulation.
What are “Normal” PSA levels by age?
The definition of physiological PSA levels remains an active debate. 2.5 ng/mL is considered safe. 2.6 to 4 ng/mL is safe in most men but talk with your doctor about other risk factors. 4.0 to 10.0 ng/mL is suspicious. Although this is not always the case. Men with high PSAs do not always have prostate cancer, while men with very low PSAs sometimes DO have prostate cancer. The prostate gland increases in size and produces more PSA as you get older.
Note that the American Urological Association recommends against routine PSA screening in men aged less than 54 years (Carter et al., 2013). If your PSA test result is high for your age or persistently increasing, a prostate biopsy may be recommended.
Your health care provider should consider conditions that can elevate PSA levels before recommending a prostate biopsy.
Is there a safe PSA level?
With the numerous factors associated with PSA levels, it is difficult to determine a safe level confidently.
Some general guidelines are; 0 to 2.5 ng/ml as safe and values 4.0 ng/ml is suspicious that might require further investigations.
How to lower your PSA level
Though you cannot control all the risks factors of the discussed prostate conditions, regular physical activity, healthy diet, and natural supplements can help you maintain a healthy prostate and overall wellbeing.
Lifestyle factors also play a role in aggressive prostate cancer following a prostate cancer diagnosis.
Further, you can make positive choices to avoid the eventual radical treatment like such as radical prostatectomy.
Regular physical activity
Several lines of evidence suggest that regular exercise may reduce PSA levels in men. Weight gain has been linked to the development of BPH, prostate cancer, and prostate inflammation.
Weight gain also increases the levels of estrogen, which has been linked to poor prostate health (Prezioso et al., 2007).
Regular physical activity can help you maintain a healthy prostate and reduce the risk of prostate conditions.
In addition to physical activity, lower daily calorie intake may help to reduce PSA levels. A low-fat diet rich in fruit and vegetables is linked to a healthy prostate.
Consume more plant-based antioxidants
- Tomatoes: Inflammation and oxidative stress play a central role in the development of several prostate conditions. Interestingly, tomatoes cooked in oil release lycopene a potent antioxidant.
- Pomegranate: Pomegranate juice/extract has proven useful in reducing the risk of several prostate conditions through its antioxidant compounds.
A phase II clinical trial involving patients with rising PSA showed, 8 oz of oral pomegranate juice significantly reduced PSA levels (Pantuck et al., 2005).
This positive effect is replicated when pomegranate extract is used in multicomponent food supplements (Paller et al., 2017).
Consider taking natural supplements
It may be challenging to get all your nutritional requirements from dietary sources.
You should talk to your doctor about using supplements to maintain healthy levels of essential nutrients. In addition to dietary sources, vitamin D (Posadzki et al., 2013) and omega-3 fatty acid supplements may help improve your prostate health.
When it comes to screening for prostate cancer and raising awareness, PSA testing has an important role.
A raised PSA level can be a sign of a problem and a PSA blood test can help diagnose that problem.
However, while the test has its benefits, it’s also important to remember that it is not always a reliable indicator and should be followed by other tests, including a rectal exam and multiparametric MRI.
An elevated PSA is not the cause of these prostate conditions, but only an indicator of the underlying disease. However, a low PSA level is a good indicator of a healthy prostate.
Lifestyle changes are still the most effective way to maintain a healthy prostate and lower your PSA level.
If you already have any prostate condition, you should get immediate treatment to avoid disease progression. Natural antioxidants and supplements are also useful in lowering your PSA levels and maintaining a healthy prostate.