What causes Prostate-Specific Antigen (PSA) to rise temporarily?

From the Guidelines

PSA levels can rise temporarily due to various factors, including prostatitis, benign prostatic hyperplasia, urethral or prostatic trauma, and prostate biopsy, as stated in the 2009 update on prostate specific antigen best practice statement 1. When interpreting PSA results, it's essential to consider these factors to avoid misdiagnosis. Some of the key factors that can cause a temporary rise in PSA levels include:

• Prostatitis, which is an inflammation of the prostate gland
• Benign prostatic hyperplasia, a non-cancerous enlargement of the prostate gland
• Urethral or prostatic trauma, which can occur due to procedures like cystoscopy or catheterization
• Prostate biopsy, which can cause substantial elevation of PSA levels and requires postponing PSA testing for at least three to six weeks Additionally, other factors like ejaculation and digital rectal examinations (DRE) may also cause variable or insignificant increases in PSA levels, as reported in the study 1. It's crucial to use the same assay for longitudinal monitoring, as laboratory variability can range from 20-25% depending on the type of standardization used, and PSA assays are not interchangeable 1. To ensure accurate PSA testing, it's advisable to postpone testing if you have symptoms of urinary infection, inform your doctor about any medications you're taking or recent procedures you've undergone that might affect results, and consider confirming an abnormal PSA before proceeding to biopsy, as recommended in the study 1.

From the FDA Drug Label

In clinical trials, dutasteride reduced serum PSA concentration by approximately 50% within 3 to 6 months of treatment. Noncompliance with dutasteride may also affect PSA test results

The FDA drug label does not answer the question.

From the Research

Causes of Temporary PSA Rise

• Prostate-specific antigen (PSA) levels can be affected by various factors, including medications and medical conditions 2, 3, 4, 5, 6
• The use of 5-alpha reductase inhibitors, such as finasteride and dutasteride, can decrease PSA levels by approximately 50% 3, 6
• However, a rise in PSA levels can still occur in men taking these medications, and it may be indicative of prostate cancer 2, 4
• Other factors, such as prostate volume, digital rectal examination results, and American Urological Association symptom score, can also influence PSA levels and prostate cancer risk 5
• It is essential to consider these factors when interpreting PSA results and making decisions about prostate biopsies and cancer diagnosis 2, 4, 5

Medications and PSA Levels

• Finasteride and dutasteride can reduce PSA levels and prostate volume, but may not eliminate the risk of prostate cancer 3, 4, 6
• The effect of these medications on PSA levels can be used to decrease the need for repeat prostate biopsies 3
• However, a rising PSA level in men taking these medications should still be investigated further to rule out prostate cancer 2, 4

Prostate Cancer Risk and PSA Levels

• PSA levels, digital rectal examination results, and prostate volume can be used to assess prostate cancer risk in men receiving finasteride 5
• The number of biopsy cores may not significantly improve risk assessment in men receiving finasteride 5
• A reduction in PSA levels of more than half during treatment with 5-alpha reductase inhibitors may indicate a good response to therapy and reduce the need for surgical intervention 6