From the Guidelines
Intercourse can cause a temporary elevation in PSA levels, and it is recommended that patients abstain from ejaculation for 48 hours before a PSA test to ensure reliable results. This is because ejaculation can cause mechanical stimulation of the prostate gland, leading to the release of additional PSA into the bloodstream 1. The increase in PSA levels is usually modest, and these elevated levels generally return to baseline within 24-48 hours after sexual activity.
Key Points to Consider
- Ejaculation can affect PSA test results, and patients should abstain from it for 48 hours before the test 1
- Medications such as finasteride and dutasteride can also impact PSA levels, and patients using these medications should be monitored closely for changes in their PSA levels 1
- Other factors, such as prostate examinations, urinary tract infections, and prostate inflammation, can also cause temporary elevations in PSA levels
- It is essential to consider these factors when interpreting PSA test results to avoid unnecessary concern or additional testing.
Clinical Implications
- Patients should be advised to abstain from sexual activity, including masturbation and intercourse, for 48-72 hours before a PSA blood test to avoid false elevations 1
- Healthcare providers should take a thorough medical history, including medication use and recent sexual activity, when interpreting PSA test results
- Patients with elevated PSA levels should be evaluated further to determine the cause of the elevation and to rule out prostate cancer or other underlying conditions.
From the Research
Effect of Intercourse on PSA Levels
- The relationship between intercourse and PSA levels has been studied in several research papers 2, 3, 4, 5.
- A study published in 1996 found no statistically significant differences in PSA levels before and after ejaculation in 40 patients with symptomatic benign prostatic hyperplasia 2.
- However, another study published in 1997 found that mean total, free, and percent free serum PSA increased 1 hour after ejaculation, with total PSA levels remaining significantly increased 6 and 24 hours after ejaculation 3.
- A 1996 study found that ejaculation causes a significant increase in the serum PSA concentration in men between 49 and 79 years of age, which may persist for up to 48 hours 4.
- A 2014 study found that total PSA value was significantly increased at 1 hour after ejaculation, and mean free PSA level rose after the first hour postejaculation 5.
Clinical Implications
- The increase in PSA levels after ejaculation may lead to an erroneous interpretation of the results of both total and percent free PSA measurements in a small proportion of men 3.
- It is recommended that men abstain from ejaculation for 48 hours prior to having a serum PSA determination 4.
- When the PSA value is borderline with respect to biopsy decisions, the effect of ejaculation on serum PSA levels may be clinically important, and repeated PSA levels should be evaluated 24 hours after ejaculation 5.
Limitations
- The studies had different sample sizes and populations, which may affect the generalizability of the results.
- Further studies are needed to clarify the relationship between complexed PSA and ejaculation 5.