From the Guidelines
Pushing to urinate is unlikely to significantly affect PSA test results. PSA is a protein produced by the prostate gland, and its levels in blood are measured to screen for prostate cancer and other prostate conditions. While various factors such as prostatitis, benign prostatic hyperplasia, urethral or prostatic trauma, and prostate cancer can be associated with elevated serum PSA levels 1, normal urination—even with some straining—generally does not cause meaningful changes in PSA results. According to the prostate specific antigen best practice statement: 2009 update, factors that can affect PSA levels include prostatitis, benign prostatic hyperplasia, urethral or prostatic trauma, and prostate cancer, but straining during urination is not explicitly mentioned as a significant factor 1.
Some key points to consider when interpreting PSA results include:
- Ejaculation and digital rectal exams have been reported to increase PSA levels, but the effects are variable or insignificant 1
- Prostate biopsy will usually cause substantial elevation of PSA levels, and PSA testing should be postponed for at least three to six weeks 1
- Laboratory variability can range from 20–25% depending upon the type of standardization used, and it is necessary to use the same assay for longitudinal monitoring 1
- Consideration should be given to confirming an abnormal PSA before proceeding to biopsy 1
For the most accurate PSA test results, it's recommended to avoid ejaculation for 48 hours before the test, postpone testing if you have an active urinary tract infection, and inform your healthcare provider about any prostate procedures you've recently undergone. The reason straining during normal urination doesn't typically affect PSA is that this action doesn't usually cause enough trauma or inflammation to the prostate to release additional PSA into the bloodstream.
From the Research
PSA Results and Urination
- The provided studies do not directly address the impact of pushing to urinate on PSA results.
- However, one study 2 investigated the effect of digital rectal examination (DRE) on PSA levels, which may be relevant to the question of whether physical strain, such as pushing to urinate, could affect PSA results.
- The study found that DRE can cause a significant increase in PSA levels, with a mean increase of 0.47 ng/ml, which could potentially lead to changes in clinical decision-making.
- It is possible that pushing to urinate could have a similar effect on PSA levels, although this is speculative and not supported by direct evidence from the provided studies.
Clinical Decision-Making
- The studies suggest that PSA testing is an effective method for detecting prostate cancer, and that DRE can be a useful adjunct to PSA testing in certain cases 3, 4, 5.
- However, the decision to perform a biopsy should be based on a combination of factors, including PSA levels, DRE results, and other clinical indicators 6, 4.
- The studies do not provide direct evidence on the impact of pushing to urinate on PSA results, and therefore do not inform clinical decision-making on this specific issue.
Limitations of the Evidence
- The provided studies do not directly address the question of whether pushing to urinate affects PSA results.
- The studies that investigate the effect of DRE on PSA levels 2 may be relevant to the question, but the results should be interpreted with caution and in the context of the specific study design and population.
- Further research is needed to determine the impact of pushing to urinate on PSA results and to inform clinical decision-making on this issue.