What should be avoided prior to Prostate-Specific Antigen (PSA) blood work?

Pre-PSA Testing Preparation

Avoid vigorous exercise (such as cycling) and ejaculation for 2 days (48 hours) prior to PSA blood work to prevent false positive elevations. 1, 2

Activities and Substances to Avoid

Physical Activity Restrictions

• Refrain from vigorous exercise for 48 hours before testing, particularly cycling or activities that may mechanically stimulate the prostate 1, 2
• Physical activity can release PSA from the prostate gland into blood and increase serum concentrations up to threefold, with effects that are age-dependent 3
• The PSA elevation from exercise is evident in both free and complexed fractions of PSA 3

Sexual Activity Restrictions

• Avoid ejaculation for 2 days (48 hours) before PSA testing to prevent transient PSA elevations 1, 2
• Ejaculation causes both total and free PSA to increase immediately, with total PSA remaining significantly elevated for up to 24 hours 4
• At 24 hours post-ejaculation, 40% of men still have total PSA levels above baseline when accounting for normal biologic variation 4

Medication Considerations

• Be aware that 5-alpha reductase inhibitors (finasteride, dutasteride) can lower PSA levels by approximately 50% 1, 2
• If medically possible, avoid transient medications such as NSAIDs, stimulants, antihistamines, antibiotics, and cold medications for at least 24 hours before testing 1
• Men on regular cardiovascular medications (e.g., beta blockers) should continue their usual intake 1

Medical Conditions to Address

• Confirm there is no active urinary tract infection or prostatitis, as these can artificially elevate PSA 1
• If PSA is initially elevated, it should be confirmed after a few weeks under standardized conditions (no ejaculation, manipulations, or urinary tract infections) in the same laboratory 1

Timing Considerations

When to Schedule Testing

• PSA testing can be performed at any time of day, though early morning is preferred for consistency 1
• No fasting is required for PSA testing 1
• Habitual food and caffeine intake are of no concern and do not need to be restricted 1

Confirmation of Elevated Results

• A limited PSA elevation should be confirmed after a few weeks under standardized conditions before proceeding to further testing such as biopsy 1
• This confirmation test should also follow the same 48-hour restrictions on exercise and ejaculation 1, 2

Common Pitfalls to Avoid

• Do not perform PSA testing within 48 hours of vigorous physical activity, as this is the most common cause of false positive results 1, 2, 3
• Do not test within 48 hours of ejaculation, as PSA levels may remain elevated and lead to unnecessary biopsies 1, 2, 4
• Do not forget to account for 5-alpha reductase inhibitor use, which requires doubling the PSA value to estimate the true level 1
• Avoid testing during or shortly after treatment for urinary tract infections or prostatitis 1