From the Guidelines
If your PSA test is elevated, it is essential to have it repeated within 1-3 months to confirm the result before proceeding with further testing, as PSA measures obtained using different commercial assays are not directly comparable or interchangeable 1. When dealing with an elevated PSA, it is crucial to consider the limitations of PSA as a cancer-specific marker, as most men with elevated PSA levels do not have prostate cancer, with only about 25% of men with PSA in the 4 to 10 ng/mL range having a subsequent positive biopsy 1. To ensure consistency, the repeat test should ideally be done at the same laboratory using the same testing method. Before the repeat test, it is recommended to avoid activities that can artificially raise PSA levels for 48-72 hours, including:
- Ejaculation
- Vigorous exercise (particularly cycling)
- Prostate manipulation during digital rectal exam
- Urinary tract infections or prostatitis If the repeat PSA remains elevated, your doctor will likely recommend additional evaluation such as a digital rectal exam, prostate MRI, or possibly a prostate biopsy depending on your age, risk factors, and PSA level. PSA can be elevated for reasons other than cancer, including:
- Benign prostatic hyperplasia (BPH)
- Prostatitis
- Recent urinary tract procedures The rate of PSA increase over time (PSA velocity) and the ratio of free to total PSA may provide additional information about your risk, as discussed in the NCCN clinical practice guidelines for prostate cancer early detection 1. Regular monitoring is important as PSA trends over time are often more informative than a single elevated result.
From the Research
Elevated PSA Repeat
- A repeat prostate-specific antigen (PSA) test can help discriminate between cancer and non-cancer-related PSA elevation 2.
- Studies have shown that a 20% drop in PSA levels is associated with a lower risk of cancer and high-grade cancer 2, 3.
- The effect of percentage reduction in PSA levels is greater in men aged ≤60 years than in those >60 years 2.
- No level of repeat PSA can confidently predict the absence of cancer 2.
- A reduction of ≥20% in PSA levels significantly reduces the risk of high-grade prostate cancer 3.
Risk Prediction
- Repeat PSA testing within 7 weeks allows for more accurate risk prediction and can assist in decision-making regarding prostate biopsy 2.
- The use of multivariate panels and risk prediction calculators can help clinicians stratify patients with prostate cancer symptoms in primary care 4.
- Biomarkers that differentiate between benign prostatic hyperplasia (BPH) and prostate cancer are being researched, but further validation is needed 4.