Impact of UTIs on PSA Levels

UTIs can cause significant elevations in PSA levels and should be ruled out before making clinical decisions based on PSA results.

Relationship Between UTIs and PSA Elevation

UTIs, particularly prostatitis, can cause false elevations in PSA levels due to inflammation of the prostate gland 1
The American Urological Association recommends repeat PSA testing after resolution of infection, as infection can falsely elevate PSA 1
Inflammatory processes in the prostate associated with UTIs can lead to release of PSA into the bloodstream, resulting in elevated serum PSA values 2
In patients with BPH (benign prostatic hyperplasia), histological prostatitis was associated with significantly higher serum PSA levels (22.8 vs 14.6 ng/mL) compared to those with BPH alone 3

When evaluating an elevated PSA, urinalysis should be performed to rule out UTI before proceeding with further diagnostic workup 2
Urinalysis is a recommended component of the basic evaluation for men presenting with lower urinary tract symptoms and should be used to detect pyuria or other signs of infection 2
If a UTI is detected in a patient with elevated PSA, the infection should be treated first, and PSA should be repeated after complete resolution of the infection 1
The European Association of Urology recommends complete urinalysis and urine culture to confirm infection and assess antibiotic sensitivity in patients with suspected UTI 1

In patients with prostatitis, PSA levels can be significantly elevated, with studies showing that prostatitis with BPH can increase PSA by approximately 56% (from 14.6 to 22.8 ng/mL) 3
The elevation of PSA in UTI can be substantial enough to potentially lead to unnecessary prostate biopsies if the infection is not identified and treated first 2
In patients with adenocarcinoma of the prostate, those with histological prostatitis had significantly lower PSA levels (232.4 vs 1123.4 ng/mL) than those without prostatitis, suggesting complex interactions between inflammation and PSA production in malignancy 3

Urinary alpha-1-microglobulin and serum PSA can be used together to differentiate between upper and lower urinary tract infections, with serum PSA being particularly useful for identifying prostatitis 4
The best discriminative parameter between pyelonephritis and prostatitis was found to be the urinary alpha-1-microglobulin/serum PSA ratio with a sensitivity of 92% and specificity of 88% 4
For accurate PSA interpretation, it's important to wait until UTI has completely resolved, typically at least 4-6 weeks after successful treatment 1

When an elevated PSA is detected, a urinalysis should be performed to rule out UTI before proceeding with prostate biopsy or other invasive procedures 2, 1
If UTI is present, appropriate antibiotic therapy should be initiated based on culture and sensitivity results 2
PSA testing should be repeated no sooner than 4-6 weeks after resolution of UTI symptoms to allow inflammation to subside 1
In patients with recurrent UTIs and BPH, treating the underlying BPH may help reduce UTI recurrence 5
For patients with neurogenic bladder and recurrent UTIs, special attention should be paid to PSA interpretation as these patients are particularly prone to both UTIs and prostatitis 6, 4