From the Guidelines
Prostate-Specific Antigen (PSA) can be elevated by several factors, including prostate cancer, benign prostatic hyperplasia (BPH), prostatitis, urinary catheterization, and prostatic trauma.
Key Factors that Elevate PSA Levels
- Prostate cancer: a significant cause of elevated PSA levels, as cancer cells can produce more PSA than normal cells 1
- Benign prostatic hyperplasia (BPH): a non-cancerous enlargement of the prostate gland that can increase PSA levels 1
- Prostatitis: inflammation of the prostate gland, which can be caused by infection or other factors, and can elevate PSA levels 1
- Urinary catheterization: particularly traumatic catheterization, can cause PSA levels to rise 1
- Prostatic trauma: any injury to the prostate gland, such as from a biopsy or surgery, can increase PSA levels 1
Other Considerations
- Finasteride and dutasteride: 5α-reductase inhibitors that can lower PSA levels by approximately 50% 1
- Ejaculation and digital rectal examination (DRE): may cause a temporary increase in PSA levels, but the effect is variable and often insignificant 1
- Prostate biopsy: can cause a substantial elevation of PSA levels, and PSA testing should be postponed for at least three to six weeks after the procedure 1
From the Research
Factors that Can Elevate Prostate-Specific Antigen (PSA)
- Prostate volume: A study published in 2 found that prostate volume accounted for 23% of the serum PSA variance, indicating that larger prostates can lead to elevated PSA levels.
- Inflammation: The same study 2 found that inflammation accounted for 7% of the serum PSA variance, and that acute and chronic inflammation was more prevalent in men with elevated PSA levels.
- Prostatic calculi: The study 2 also found that prostatic calculi accounted for 3% of the serum PSA variance.
- Nonisoechoic ultrasound lesions: The study 2 found that nonisoechoic ultrasound lesions accounted for 1% of the serum PSA variance.
- Bacterial prostatitis: A study published in 3 found that PSA levels were elevated during the acute phase of prostatic inflammation, and that the elevated PSA level returned to normal within 14 days after initiation of antimicrobial therapy.
- Benign prostatic hyperplasia: The study 2 found that men with benign prostatic hyperplasia had larger prostates and more subclinical prostatic inflammation, which can lead to elevated PSA levels.
Clinical Implications
- The elevation of PSA due to inflammation can confound the use of PSA kinetics and lead to unnecessary biopsies and treatments 4.
- Repeat PSA measurements after a period of observation or a course of empiric antibiotics may be necessary to exclude prostatic malignant involvement 4.
- The development of new assays that can detect proteins complexed with PSA and other potential markers may improve the sensitivity and specificity of prostate cancer diagnosis 5.