Prostate specific antigen (PSA) is a protein produced by cells of the prostate gland in men. A man may have a PSA blood test measuring the level of PSA in a man’s blood with the results reported as nanograms of PSA per milliliter (ng/ml) of blood. A normal PSA level is considered to be between 1.0 and 4.0 ng/ml. If the number is above 4.0, the level is considered abnormal or elevated.
Typically when a man’s PSA blood level is elevated it is associated with prostate cancer. But there can be additional reasons besides prostate cancer influencing a man’s PSA level to rise.
Listed below are some of the more common reasons why a man’s PSA may be elevated that is not due to prostate cancer:
• A man’s age
A man can have an elevated PSA level without having any prostate problems – often due to the PSA levels gradually increasing with a man’s age. For instance, at age 40, a PSA of 2.5 is within the normal limit but by age 60, the limit can go up to 4.5 and by age 70, up to 6.5. These higher levels of PSA can be normal for an older man but a doctor will most likely want to do some other testing just to be sure there is nothing more serious developing.
• Benign prostatic hyperplasia (BPH)
BPH is an enlargement of the prostate gland but is not cancerous or considered to be prostate cancer. More cells are producing PSA making the number increase. Depending on whether a man is having symptoms such as frequent or difficulty urinating, BPH may not need to be treated. For men after the age of 50, BPH is considered to be the most common prostate problem in men.
• Urinary tract infection
An infection such as a urinary tract infection can irritate and inflame prostate cells causing PSA to rise. It is best to wait to have a PSA test until after an infection has cleared up to get a more accurate reading.
• Sex
A man should refrain from sex or ejaculation for at least 24-48 hours before a PSA test as ejaculation can cause a mild increase in the PSA number.
• Digital rectal exam
Having a digital rectal exam can increase PSA levels – a doctor will should always draw blood for a PSA test before doing a rectal exam.
• Prostatitis
Prostatitis is an infection of the prostate causing inflammation of the prostate gland. A man who has this condition should wait until after it is cleared up before having his PSA levels checked.
• Bicycling
A few studies have linked prolonged bike rides to increasing PSA levels. In order to make that happen, most doctors believe that a man would have to be training at the level of Lance Armstrong to be concerned with bicycling raising PSA. Most doctors agree that any man who rides a bike for prolonged periods of time should refrain from this at least 24 to 48 hours and to refrain from ejaculation before having the PSA test done.
What happens if the PSA level is elevated?
Due to the fact there are numerous things that can raise a man’s PSA level besides prostate cancer, it is important to treat each man individually. A biopsy of the prostate gland is not always necessary when a man has an elevated PSA. A man with an elevated PSA however does warrant further investigation into a potential problem.
Whether a man has a biopsy or not, depends on how high the PSA is and how much it has changed from previous readings. When a urologist reviews a man’s health history and physical, then is when he may be able to identify the cause of an elevated PSA. It is at this point when a physician can recommend a biopsy to rule out cancer. Otherwise, if an elevated PSA is high due to an infection, then antibiotics will be given or a scope procedure may be done to evaluate the size of the prostate.
In summary
The most important message for men is to have regular yearly checkups with their physician along with a PSA blood test and DRE starting at age 40. Do not assume right away that a high PSA is automatically prostate cancer. There are many different causes for an elevated PSA. Sorting out what exactly is the cause needs to be determined before assuming it is prostate cancer. Even if it is, when a man receives regular medical care and follows healthy lifestyle habits, he will be in a better position to beat back the cancer and get on with his life.
Dr. Samadi is a board-certified urologic oncologist trained in open and traditional and laparoscopic surgery and is an expert in robotic prostate surgery. He is chairman of urology, chief of robotic surgery at Lenox Hill Hospital. He is a medical correspondent for the Fox News Channel’s Medical A-Team Learn more at roboticoncology.com. Visit Dr. Samadi’s blog at SamadiMD.com. Follow Dr. Samadi on Twitter, Instagram, Pintrest and Facebook.