From the Guidelines
Rigorous exercise can temporarily increase PSA levels, and men should avoid vigorous physical activity for 48-72 hours before a PSA blood test to ensure accurate results. The relationship between physical activity and PSA levels is complex, with some studies suggesting that acute exercise may increase serum prostate-specific antigen (PSA) concentration 1. This increase is thought to be due to trauma to the prostate gland and surrounding tissues, releasing more PSA into the bloodstream. According to the physical activity and cancer control (pacc) framework, physical activity, especially acute exercise, may increase serum PSA concentration 1. However, habitual physical activity may be associated with lower PSA concentration 1.
Some key points to consider:
- The elevation in PSA levels due to exercise is typically short-lived, with levels returning to baseline within 24-48 hours after exercise cessation.
- Activities that put direct pressure on the perineum, such as cycling, may cause more significant increases in PSA levels.
- Age and existing prostate conditions may influence the magnitude of this effect, with older men or those with prostate issues potentially experiencing more pronounced elevations.
- The temporary increase in PSA levels due to exercise is not indicative of prostate cancer but can lead to false-positive test results if not accounted for when scheduling PSA screening.
It is essential to note that the current evidence is based on observational and intervention studies, and more research is needed to fully understand the relationship between physical activity and PSA levels 1. Nevertheless, avoiding vigorous physical activity for 48-72 hours before a PSA blood test is a reasonable precaution to ensure accurate results.
From the Research
Effect of Rigorous Exercise on PSA Levels
- The effect of physical activity on PSA concentration in serum is controversial, with some studies showing an increase in PSA levels after exercise 2, 3, 4.
- A study published in 1996 found that serum PSA concentrations increased by as much as threefold immediately after 15 minutes of exercise on a bicycle ergometer 2.
- Another study published in 2011 found that the average increase in total PSA (tPSA) after a 1-hour cycling test was 1.9 ± 1.7 ng/ml (25%) 3.
- A 2022 study found a significant average increase in tPSA after exercise (1.14 ± 1.11 ng/ml to 1.24 ± 1.26 ng/ml [mean, +8.8%]) after both cycling and rowing 4.
- However, not all studies have found a significant increase in PSA levels after exercise, with one study published in 2003 finding no statistically significant changes in average total or free PSA concentrations after a marathon 5.
Factors Influencing the Increase in PSA Levels
- The increase in PSA levels after exercise may be age-dependent, with one study finding that the exercise-induced increase in PSA concentration affected participants aged ≥50 years, but not those aged <50 years 4.
- The type of exercise may also influence the increase in PSA levels, with cycling appearing to have a greater effect than rowing or treadmill exercise 3, 4.
- The duration and intensity of exercise may also play a role, with one study finding that a 1-hour cycling test resulted in a significant increase in PSA levels 3.
Clinical Implications
- The increase in PSA levels after exercise may be clinically relevant in some individuals, particularly those with elevated PSA levels or a history of prostate cancer 2, 3.
- However, other studies have found that the effect of exercise on PSA levels is generally clinically irrelevant, and that men do not need to abstain from exercise before PSA sampling 4.
- Further research is needed to fully understand the relationship between exercise and PSA levels, and to determine the clinical implications of this relationship 6.