Will epididymitis (inflammation of the epididymis) elevate Prostate-Specific Antigen (PSA) levels?

From the Guidelines

Epididymitis can potentially elevate PSA levels, but this effect is not always consistent and may depend on whether the inflammation spreads to the prostate gland, causing prostatitis, as noted in various studies 1. The relationship between epididymitis and PSA levels is complex, and while some cases may result in elevated PSA due to the spread of inflammation to the prostate, others may not show this effect if the infection remains confined to the epididymis. Key points to consider include:

• The mechanism by which epididymitis could elevate PSA involves the spread of inflammation to the prostate, increasing the permeability of prostate cells and allowing more PSA to leak into the bloodstream.
• Not all cases of epididymitis will result in elevated PSA levels, particularly if the infection does not affect the prostate gland.
• If a patient with epididymitis has an elevated PSA, it is recommended to repeat the PSA test after the infection has been successfully treated, typically 4-6 weeks later, to determine if the elevation was temporary, as suggested by the principles outlined in 1.
• Persistent PSA elevation after resolution of epididymitis might warrant further investigation for other prostate conditions, highlighting the importance of monitoring and follow-up.
• Treatment of epididymitis typically involves antibiotics, such as fluoroquinolones or doxycycline, along with pain management and supportive measures, which can help in resolving the infection and potentially reducing any associated PSA elevation, as would be managed based on guidelines similar to those discussed in 1 and 1.

From the Research

Epididymitis and PSA Levels

• Epididymitis is inflammation of the epididymis, and its etiology and treatment are based on patient age and the likely causative organisms 2.
• There is no direct evidence in the provided studies that epididymitis elevates PSA levels.
• However, studies have shown that prostatitis, which is inflammation of the prostate gland, can cause elevated PSA levels 3.
• A study found that 52% of patients with lower urinary tract symptoms, normal digital rectal examination, and elevated PSA had a decrease in PSA levels after treatment with antibiotics 3.
• Another study found that an abnormal digital rectal examination is a risk factor for high-grade prostate cancer, but it did not investigate the effect of epididymitis on PSA levels 4.
• The relationship between epididymitis and PSA levels is not well understood, and more research is needed to determine if epididymitis can cause elevated PSA levels 5, 6.

Related Conditions and PSA Levels

• Prostatitis, which is a related condition to epididymitis, can cause elevated PSA levels 3.
• A study found that 39% of patients with lower urinary tract symptoms, normal digital rectal examination, and elevated PSA had prostate cancer 3.
• The diagnosis of prostate cancer is typically made based on a combination of PSA levels, digital rectal examination, and biopsy results 4.
• The COVID-19 pandemic has led to changes in the diagnosis and management of prostate cancer, with a greater reliance on PSA measurements and MRI scans 6.

Treatment and Management

• The treatment of epididymitis typically involves antibiotics, and the choice of antibiotic depends on the likely causative organism 2.
• The treatment of prostatitis also typically involves antibiotics, and the choice of antibiotic depends on the likely causative organism 5.
• A study found that treatment with antibiotics can decrease PSA levels in patients with lower urinary tract symptoms and elevated PSA 3.