PSA (prostate-specific antigen) is a protein produced by prostate cells.
Prostate cancer cells also produce PSA.
It’s quite normal to have a small amount of PSA in your blood.
But as you get older, the amount rises, and your prostate gets bigger.
The PSA Test is a blood test that measures the amount of prostate-specific antigen (PSA) in your blood.
It is used as a means of early detection of prostate health problems.
A raised PSA level is not always a medical concern but may suggest a problem with your prostate.
A high PSA level can indicate prostate cancer, but there are many other non-cancer causes, which we discuss in this article.
What is a high PSA level?
There is no specific normal or abnormal level of PSA. Factors such as age and ethnicity make it hard for researchers to establish a normal range.
However, most doctors consider PSA levels of 4.0 ng/ml as high and would often recommend a prostate biopsy.
8 non-cancerous causes of high PSA levels
The PSA test alone can’t diagnose any disease. Elevated PSA levels do not always mean that you have prostate cancer or any other prostate problem.
Let’s go into a more detail about the reasons why some men have a high PSA level.
1) Enlarged prostate (BPH)
Benign prostatic hyperplasia (BPH) is not prostate cancer. It simply means that your prostate gland is larger than usual.
In this case, there are more cells in the prostate gland and more cells that produce PSA.
BPH is the most common prostate problem in older men.
Risk factors for having an enlarged prostate include:
- Family history
- Ethnic background
BPH may not need to be treated unless it is causing problems with your urination. Some men go to the toilet more frequently, while some find it hard to pass urine.
In some cases, BPH may cause the bladder to be blocked, which leads to retention of urine, bladder infections, and kidney damage.
In these cases, doctors often recommend invasive surgery along with medications that control inflammation and infection.
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Prostatitis is an inflammation of the prostate gland. Unlike cancer and enlarged prostate, it is often caused by common strains of bacteria.
As microbes enter the urethra, they can travel upwards and spread to the prostate if left untreated.
An inflamed prostate caused by bacteria can be treated with antibiotics. Once they are killed, the inflammation usually subsides, and your prostate gland eventually heals.
However, prostatitis can be long-term and recurring. In this case, it might take more time and effort to treat it.
Nerve damage in the urinary tract might also cause an inflamed prostate. This can be caused by surgery or trauma to the area. HIV/AIDS, catheters, and biopsies can also cause prostate inflammation.
But compared to prostate cancer, prostatitis is more common and easier to treat.
3) Recent sexual activity
Sex can also raise your PSA level. Studies show that frequent sexual activity or a recent ejaculation can cause a mild increase in PSA.
How this works is not fully understood, but high PSA levels due to recent sexual activity are not a big deal. In these cases, PSA levels usually return to normal in two to three days.
This is why men are advised not to ejaculate for 48 hours before a PSA test to avoid a false-positive result.
This way, we can make sure that the test is accurate and can be used to track PSA changes as we age.
4) Urinary tract infection (UTI)
Urinary tract infections irritate and inflame prostate cells. As a result, it could cause PSA levels to go up.
Microbes that enter your urinary tract cause UTIs. In some cases, the invading bacteria spread to the ureters, bladder, and prostate gland.
Your doctor can rule out whether your high PSA levels are caused by UTIs with a simple urine test. And unlike other cases, UTIs can be effectively treated with antibiotics.
Also, if you’re diagnosed with a urinary tract infection, you have to wait until after the infection has cleared up before you have a PSA test.
As we age, the prostate gland increases in size, and the PSA levels go up. In general, everything that increases the size of the prostate increases PSA as well.
Aging is an important factor and one we cannot avoid. That’s why doctors consider your age before looking at your PSA level. They may also need a baseline PSA to create a personalized level range.
For instance, individuals under 50 years old typically have PSA levels ranging from 0.5 to 0.6 ng/mL. But older men can have 1 ng/mL and even 4 ng/mL.
In younger patients, an elevated PSA level should be evaluated carefully. In older patients, they do not represent an alarm sign.
6) Medical procedures or prostate massage
Manipulation of the prostate causes an increase in PSA levels.
- Prostate massage
- A medical procedure that involves the prostate, such as a digital rectal exam
- Riding a bike for a very long time may increase your PSA levels by creating pressure on the pelvic floor
Manipulating the gland or creating pressure causes a mechanical release of these substances. Thus, they leak into the bloodstream and increase serum PSA.
In these cases, you need to get your PSA levels checked before undergoing medical procedures on your prostate.
If you had your prostate examined through a digital rectal exam, it is important to wait 3-7 days before taking a blood sample for PSA.
7) Certain medications
Different medications can cause various effects on our circulating levels of PSA. Some of them reduce PSA levels, but others increase the concentration of this protein in the blood.
For example, we know that finasteride, a drug to treat BPH, reduces PSA levels. This reduction does not have anything to do with a reduction of the prostate gland.
Similarly, recent studies show that certain drugs may also have the opposite effect. For example, betamethasone increases the expression of PSA and the circulating levels of this protein.
A similar drug called dexamethasone has the same effect but to a lower extent. Thus, if you’re taking these drugs to control chronic disease, it is essential to talk to your doctor about it.
But if you can stop taking the medication, it is recommended to do so for 7 days before a PSA test.
8) Parathyroid hormone
The body naturally produces parathyroid hormone to control blood calcium levels. It can potentially stimulate the growth of prostate cancer cells, even in individuals without a prostate cancer diagnosis. Elevated parathyroid hormone levels may consequently contribute to increased PSA levels.
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What is the controversy surrounding PSA screening?
1) Could lead to overtreatment
Using the PSA test to screen for prostate cancer may help to detect small tumors, but many of these tumors do not cause symptoms and will grow so slowly that they are unlikely to be life-threatening.
Overtreatment exposes us to potential complications and adverse effects. These include the inability to control urine flow and erectile dysfunction.
2) Could produce false-positive or false-negative results
Another controversy surrounding prostate cancer screening using the PSA test is that it may give false-positive or false-negative results for prostate cancer.
What that means is you may have an elevated PSA level, but no cancer is actually present.
A false-positive test result will only cause anxiety for you and your family and might lead to unnecessary medical procedures.
One study reveals that only about 25% of men who have a biopsy due to a high PSA level have prostate cancer. If your doctor recommends that you have a biopsy, you need to know all the risk factors involved.
A false-negative PSA test result can also occur. PSA levels can be low even though you actually have prostate cancer. False-negative test results may give you false assurance.
If I choose PSA testing, what are the next steps if you have a raised PSA level?
Instead of quickly jumping to surgery and drugs for a solution, there is another option: active surveillance.
Active surveillance is a non-invasive approach to prostate cancer treatment.
Active surveillance is the better option if your cancer shows all signs of being the “good” kind, i.e., slow-growing, low volume, and not aggressive. In this case, you can treat it without drugs, radiation, or surgery.
A benefit of monitoring low-risk cancer is that you might avoid having unnecessary surgery.
In fact, one study of men undergoing active surveillance found that, 15 years later, less than 1% of men developed metastatic disease. There are also other natural ways to treat prostate cancer.
Watchful waiting is also another option. Watchful waiting is usually used by men experiencing other health problems who may be unable to handle surgery or radiotherapy.
It involves fewer tests than active surveillance and is less intensive, more often than not taking place at a GP surgery than a hospital.
If you do have treatment in the future, it will aim to control the cancer and manage any symptoms rather than to cure it.
Our Advanced Prostate Cancer Risk Assessment (APCRA)
An alternative to traditional prostate biopsy is our Advanced Prostate Cancer Risk Assessment (APCRA). This consists of non-invasive blood tests and specialized color Doppler scans.
The variety and sophistication of some of these new blood tests make this a very realistic alternative to a prostate biopsy, especially if you have a preference for non-invasive diagnostics and treatments.
After this testing, you will receive a thorough, 3-hour consultation from a Naturopathic Physician who will walk you through the results of his assessment and explain every aspect and each option available to you while also answering any questions that you may have.
To book our Advanced Prostate Cancer Risk Assessment, please call our customer service team at +1-888-868-3554, who will be happy to assist you and offer any further information.
A high PSA level doesn’t mean that you have prostate cancer. Around 3 in 4 men with a raised PSA level do not have cancer, and 1 in 7 men with prostate cancer have a normal PSA result.
Before you undergo prostate cancer screening, ask your doctor about the risks. Do your own research and get a second opinion.
There are many causes of a high PSA: an enlarged prostate, prostate inflammation, infection, and recent sexual activity. Therefore, a PSA test is not an accurate indicator of prostate cancer.
But it’s still a good first step to take.
Doing so will help you determine the cause of your prostate problem, along with the right way to resolve it.
For more information on prostate health, check out our Updated & Expanded 10th Edition All About The Prostate…The Definitive Guide To Healing Your Prostate Naturally.