PSA

What a High PSA Level Means if It’s Not Prostate Cancer

The Prostate-Specific Antigen, also known as PSA, is a protein synthesized by the prostate. It works as an enzyme that breaks down other proteins.

More specifically, it makes sperm more fluid to facilitate the movement of sperm cells inside the vagina. It does so by breaking down gel-like proteins called semenogelin.

So, you can say that PSA is not a bad thing by itself. Still, it is beneficial to detect prostate cancer and other prostate abnormalities.

Measuring PSA in the blood is a handy tool to evaluate our prostate health. We can find this enzyme in the sperm, but it also leaks into the blood. The proportion that leaks is usually very small but increases in certain cases. Prostate cancer is one of these cases, so PSA screening is useful to evaluate high-risk patients. It is often the first step to detect prostate tumors.

In normal cases, PSA levels range between 3 and 4 ng/mL. But these levels change throughout our lifetime. Prostate cancer patients usually have very high PSA levels, but other benign conditions have a similar effect. Even manipulating the prostate with medical procedure causes the same result. So, not every high PSA level point out at prostate cancer.

There’s currently an ongoing debate about the role of PSA levels in prostate cancer screening. Some patients with prostate cancer have lower PSA levels than expected. Other patients with very high serum PSA do not have prostate cancer. That’s why this test should be interpreted along with other signs and symptoms.

It is also compared to total PSA, PSA velocity, PSA density, and additional prostate cancer markers. A biopsy is a reliable way to detect prostate cancer and obtain a Gleason score. But they have side effects, and we can’t perform this procedure on every patient.

That’s why a yearly measure is only recommended in patients with risk factors. That way, the number of false-positive reduces the incidence of unnecessary prostate biopsy (1).

It is also important to instruct patients before performing a PSA test. Several factors increase or decrease PSA values. When patients understand this, they can avoid a false positive. Knowing this is also useful to understand why levels of this marker change as we age. And, if you know how to take a PSA sample, you won’t need another confirmation exam with added expenses.

That’s why we’re bringing a useful list of different factors that increase PSA levels. For each one, we’re telling you what is happening and what you can do about it:

Aging

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 example, if you’re younger than 50 years old, your normal PSA levels probably range between 0.5 and 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 (2).

Prostatitis

Prostatitis is the inflammation of the prostate gland. In these cases, inflammation may be associated with a relatively normal size of the prostate. So, why is there an increase in PSA levels in prostatitis?

Because the microcirculation of the prostate changes, and there’s an increase in blood flow. Such an increase in blood flow increases the leaking of PSA protein into the general circulation. Thus, even if you have a small prostate, inflammation raises your PSA levels.

In this case, prostatitis causes a few urinary signs and symptoms. Thus, it is sometimes difficult to differentiate with benign prostatic hyperplasia. But after suspecting a prostate condition, your doctor will perform other tests. A transrectal ultrasound is usually enough to detect prostatitis and rule out prostate cancer and BPH (3).

Medical procedures

The manipulation of the prostate causes an increase in PSA levels. For example, a prostate massage or a medical procedure that involves the prostate.

Other urologic surgeries may also increase PSA levels by creating pressure upon the gland. A digital rectal exam has the same effect. Even riding a bike for a very long time may increase your PSA levels by creating pressure on the pelvic floor. The prostate has PSA and other substances stored throughout the gland.

Manipulating the gland or creating pressure causes a mechanical release of these substances. Thus, they leak into the bloodstream and increase serum PSA. What you need to do in these cases is taking your sample before 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 (4).

BPH

This is one of the most common causes of rising PSA in aging males. As noted above, an increase in the size of the prostate causes an increase in PSA levels. This is commonly seen as we age, but there’s a steep increase over the baseline in BPH. Serum PSA goes up suddenly, but not as violently as in advanced or metastatic prostate cancer.

This is a benign condition that increases the size of the prostate. The number of prostate cells is higher, and the vascularization increases as the prostate grow. Thus, there’s more contact surface with the bloodstream, and the leakage of PSA increases.

In these cases, doctors need to evaluate the magnitude of the problem. Depending on each case, they would recommend using medications or surgery. PSA levels are then evaluated according to a new baseline (5).

Urinary tract infection

Urinary tract infections are not as common in males as they are in females. But they cause a transient increase in BPH levels. Such an increase is even higher when the infection is located near the prostate gland. For example, in a bladder infection, the effect on PSA levels is more dramatic.

In these cases, urinary infection triggers inflammation in the bladder and nearby tissues. The gland is just below the male bladder, and the inflammation of this organ affects the prostate tissue, too. The microcirculation increases, and there’s more contact between the gland and the blood. Thus, the PSA protein travels to the bloodstream and increases its levels.

A urinary tract infection features similar urinary symptoms to those found in BPH. But unlike BPH and prostate cancer, the onset of the disease is usually acute. It is associated with a burning sensation when urinating and fever. That’s why it is not very hard to rule out BPH and prostate cancer. However, it is important to wait for 1 or 2 weeks before taking a PSA sample if you had a recent urinary infection (6).

Ejaculation

Sexual activity is another trigger that increases blood levels of PSA naturally. When a man ejaculates, there’s a contractile tissue in the prostate that activates. This muscle-like tissue creates pressure inside the prostate and releases its fluid.

In doing so, it also increases the proportion of PSA that leaks into the blood. That’s why we can experience a slight increase in serum PSA after sexual activity.

This increase is minimal and nothing compared to that experienced after a prostate massage. However, it is important to abstain from sexual activity or masturbation 24 hours before PSA testing. This way, we can make sure that the test is accurate and can be used to track PSA changes as we age (7).

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. This drug is used to treat inflammation and autoimmune disease.

However, it also triggers the androgen receptor in the prostate gland. By doing so, it stimulates the activity of DNA and creates new PSA proteins. There’s an increase in the concentration of the protein inside the gland despite having the same size. Thus, the proportion of PSA that runs into the blood increases, too.

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). 

How to naturally lower PSA

As noted above, PSA is an enzyme synthesized by the prostate gland. It stays enclosed in the gland waiting for the next ejaculation when it serves to liquefy semen.

However, there’s always a fraction of this enzyme that leaks into the bloodstream. This fraction increases when the gland is larger, and there are more cells and more blood vessels.

It also increases in cases of inflammation, when the gland’s microcirculation increases. Or when androgens and other substances change how the prostate behaves. 

So, if we want to lower PSA levels naturally, we need to take one of four ways:

  • Shrink the prostate gland: An enlarged prostate is a common cause of high serum PSA. If we can reduce the prostate gland’s size with natural remedies, PSA levels will be reduced. It may also help patients control BPH or prostate cancer symptoms.

  • Control inflammation: In cases of prostatitis, inflammation is the main problem. It can be controlled by using over-the-counter medications and natural remedies. 

  • Reducing testosterone’s effect: As noted above, androgens play a significant role in producing more PSA. They may also contribute to the risk of prostate cancer in some cases. Some natural remedies may counter this effect. They reduce PSA levels while providing helpful protection against prostate cancer.

  • Following a healthy lifestyle: We can make lifestyle changes with a significant effect on our PSA levels. They can be reduced with lifestyle modifications, even in patients with prostate cancer.

Based on these routes, we can consider multiple recommendations to reduce our PSA levels. Unlike finasteride, these recommendations do not silence a PSA test or cause false negatives. They contribute to prostate care, improving its structure, metabolism, or both.

  • A healthy diet: First off, it is vital to understand the role of day-to-day habits. Diet is probably the most important. By leading a nutritious diet, we are giving our organism nutrients to modulate prostate structure. Some of them promote apoptosis or cause an arrest in the cell cycle of cancer cells. For example, pomegranate antioxidants and lycopene in tomato. Many other nutrients naturally found in our diet have a similar effect. They reduce PSA levels naturally by solving the problem instead of silencing the alarm (9).

  • Appropriate exercise levels: We don’t need to exercise for hours to improve PSA levels. Also, remember that riding a bike as a part of your exercise might increase the circulating levels by applying pressure on the prostate. In these cases, you can use a prostate-healthy seat to avoid this temporary side effect. But in general, exercise stimulates the immune system and modulates our hormones and metabolism. That’s why studies show that engaging in 3 hours of exercise every week improves the condition of prostate cancer patients (10).

  • Stress management: This is another day-to-day tool we can use to reduce PSA levels naturally. Stress management modulates macro and microcirculation, the immune system, and other aspects that increase PSA levels. Actually, a team of researchers found an improvement in the PSA score, too. The participants in this clinical trial used yoga and other relaxation techniques. There was a control group that did not engage in any of these treatments. The treatment group ended up with a better PSA level (11).

  • Natural supplements: After checking every day-to-day modification, you can further boost your prostate health with natural supplements. One of the most important is green tea due to its high antioxidant profile. Green tea is known to reduce inflammation and control oxidation in the gland. As such, it is an excellent aid if you’re worried about prostate cancer (12). Other supplements include pomegranate, turmeric, and lycopene. They all lower PSA levels naturally (9).

Conclusion

A urologist uses a PSA test result very carefully because different factors can increase a man’s PSA level. So, even if we have high results in a PSA blood test, it does not indicate advanced prostate cancer.

Compared to a prostatic biopsy and a Gleason grade, this test is not entirely accurate. We can have higher PSA levels with a normal prostate in aging men or during a prostate infection. Certain medications and medical procedures can increase our levels of PSA. Even ejaculation has the same effect.

Thus, all of these factors should be evaluated if you have a high PSA level. If one of them is probably affecting your test, it might be appropriate to do it once again. In the meantime, you can always use natural ways to lower PSA levels.

On a day-to-day basis, you can change your exercise levels and diet. Releasing stress and learning to manage a difficult day is also important. And you can further boost these lifestyle modifications through supplements such as green tea, turmeric, lycopene, and pomegranate.

Sources

  1. Baccaglini, W., Cathelineau, X., Araújo, F. G., Medina, L. G., Sotelo, R., Carneiro, A., & Sanchez-Salas, R. (2019). Screening: actual trends on PSA marker. When, who, how?. Archivos espanoles de urologia, 72(2), 98-103.
  2. van Renterghem, K., Van Koeveringe, G., Achten, R., & van Kerrebroeck, P. (2010). A new algorithm in patients with elevated and/or rising prostate-specific antigen level, minor lower urinary tract symptoms, and negative multisite prostate biopsies. International urology and nephrology, 42(1), 29-38.
  3. Pansadoro, V., Emiliozzi, P., Defidio, L., Scarpone, P., Sabatini, G., Brisciani, A., & Lauretti, S. (1996). Prostate-specific antigen and prostatitis in men under fifty. European urology, 30, 24-27.
  4. Chybowski, F. M., Bergstralh, E. J., & Oesterling, J. E. (1992). The effect of digital rectal examination on the serum prostate specific antigen concentration: results of a randomized study. The Journal of urology, 148(1), 83-86.
  5. Carter, H. B., Pearson, J. D., Metter, E. J., Brant, L. J., Chan, D. W., Andres, R., … & Walsh, P. C. (1992). Longitudinal evaluation of prostate-specific antigen levels in men with and without prostate disease. Jama, 267(16), 2215-2220.
  6. Lorente, J. A., Arango, O., Bielsa, O., Cortadellas, R., & Gelabert-Mas, A. (2002). Effect of antibiotic treatment on serum PSA and percent free PSA levels in patients with biochemical criteria for prostate biopsy and previous lower urinary tract infections. The International journal of biological markers, 17(2), 84-89.
  7. Rajaei, M., Momeni, A., Kheiri, S., & Ghaheri, H. (2013). Effect of ejaculation on serum prostate specific antigen level in screening and non-screening population. Journal of research in medical sciences: the official journal of Isfahan University of Medical Sciences, 18(5), 387.
  8. Iguchi, K., Hashimoto, M., Kubota, M., Yamashita, S., Nakamura, M., Usui, S., … & Hirano, K. (2014). Effects of 14 frequently used drugs on prostate‑specific antigen expression in prostate cancer LNCaP cells. Oncology letters, 7(5), 1665-1668.
  9. Khan, N., Adhami, V. M., & Mukhtar, H. (2010). Apoptosis by dietary agents for prevention and treatment of prostate cancer. Endocrine-related cancer, 17(1), R39-R52.
  10. Hackshaw-McGeagh, L., Lane, J. A., Persad, R., Gillatt, D., Holly, J. M., Koupparis, A., … & Abrams, P. (2016). Prostate cancer-evidence of exercise and nutrition trial (PrEvENT): study protocol for a randomised controlled feasibility trial. Trials, 17(1), 1-10.
  11. Ornish, D., Weidner, G., Fair, W. R., Marlin, R., Pettengill, E. B., Raisin, C. J., … & Aronson, W. J. (2005). Intensive lifestyle changes may affect the progression of prostate cancer. The Journal of urology, 174(3), 1065-1070.
  12. Kumar, N. B., Pow-Sang, J., Spiess, P. E., Park, J., Salup, R., Williams, C. R., … & Schell, M. J. (2016). Randomized, placebo-controlled trial evaluating the safety of one-year administration of green tea catechins. Oncotarget, 7(43), 70794.

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