From the Guidelines
Prostate-Specific Antigen (PSA) can be elevated by several factors, including prostate cancer, urinary catheterization, benign prostatic hyperplasia (BPH), and prostatitis.
Factors that Elevate PSA
- Prostate cancer: a common cause of elevated PSA levels, although not all men with elevated PSA have prostate cancer 1
- Urinary catheterization: particularly traumatic catheterization, can cause a temporary increase in PSA levels 1
- Benign prostatic hyperplasia (BPH): a non-cancerous enlargement of the prostate gland, can also elevate PSA levels 1
- Prostatitis: inflammation of the prostate gland, can cause an increase in PSA levels 1
- Other factors: such as finasteride and other therapies that depress androgen levels or ablate prostatic tissue, can also affect PSA levels 1
Important Considerations
- PSA is not a cancer-specific marker, and most men with elevated PSA levels do not have prostate cancer 1
- The use of 5α-reductase inhibitors, such as finasteride, can lower serum PSA values, and it is recommended to increase the PSA of any man taking these medications by a factor of 2.3 to determine his true PSA value 1
- PSA velocity, or the rate of change of PSA over time, can also be a useful indicator of prostate cancer, particularly in men with PSA levels less than 4 ng/ml 1
From the Research
Factors that Can Elevate Prostate-Specific Antigen (PSA)
- Benign prostatic hyperplasia (BPH) 2, 3: Approximately two-thirds of all elevated PSA values in men over 50 years of age are due to BPH.
- Prostatic inflammation 3, 4, 5, 6: Acute and chronic inflammation can cause elevated PSA levels, with the level returning to normal after antibiotic treatment in cases of acute prostatitis.
- Prostate volume 3: Larger prostates are associated with higher PSA levels.
- Prostatic calculi 3: The presence of calculi can contribute to elevated PSA levels.
- Nonisoechoic ultrasound lesions 3: These lesions can also contribute to elevated PSA levels.
- Bacterial prostatitis 4, 6: Both acute and chronic bacterial prostatitis can lead to elevated PSA levels.
- Asymptomatic inflammation of the prostate 6: This can be a confounding factor in patients with an elevated PSA.