Causes of High PSA Level – Elevated Prostate Specific Antigen Test Scores

Q: I am a 50 years old male. I am concerned about my high PSA values of 3.467. What may this mean?

Reply:
 
In a healthy male, the PSA level should be less than 4 nanograms per milliliter of blood. Any value higher than 4 is considered high. Your PSA value of 3.467 is borderline.

PSA value is often high in cases of prostate cancer; that’s why people get worried with high levels. However, keep in mind that prostate cancer is only one of many potential causes of an elevated PSA. Virtually any illness that irritates the prostate will cause it to rise. So PSA scores on screening are only suggestive and not diagnostic of prostate cancer. To make a diagnosis, further evaluation in done by performing other tests such as a biopsy or digital rectal exam. 

Causes of an Elevated Prostate Specific Antigen

  1. The most important and most concerning cause of an elevated PSA is prostate cancer. High PSA patients should be further evaluated for it.
  2. Benign Prostatic Hyperplasia (BPH): This benign (non-cancerous) condition presents simply as an enlarged prostate. It is extremely common in older men and, unlike cancer, has no risk of spreading throughout the body. It is a harmless condition. Intervention is required only if the enlargement is big enough to obstruct the passage of urine. 
  3. PSA levels can naturally increase with age. Some elevation in PSA values after 50 years of age is normal.
  4. Prostatitis is a condition where the prostate becomes inflamed due to an infection or another cause. Most cases of this condition are acute. They come and go away over a short period of time. Sometimes it turns into chronic prostatitis. This condition is treated with antibiotics.
  5. After a prostate biopsy- Men who have recently undergone a prostate biopsy will usually have artificially elevated PSA levels. Because of this, most physicians will draw blood for the PSA test before any biopsies are done. After a biopsy, wait a few weeks before taking a repeat PSA level to let the level drop back to a baseline level.
  6. Recent Ejaculation- Ejaculation (the ejecting of semen from the penis) can cause a mild increase in the PSA level. So any sexual activity is avoided for a couple of days before your PSA blood testing.
  7. After Digital Rectal Exam (DRE)- The digital rectal exam may cause a small increase in the PSA level. Therefore, blood for the PSA test is usually drawn prior to this exam.
  8. Strenuous exercises like bicycle riding can mildly elevate the PSA level over the short term.

Management

Patients with high PSA should be further evaluated. Digital rectal exam is the first to be done. If a suspicious lump is detected during a DRE, the doctor may recommend additional tests to determine the nature of the problem. A urine test may be done to check for a urinary tract infection. Imaging tests, such as a transrectal ultrasound, x-rays or cystoscopy can be required. 

If prostate cancer is suspected, prostate biopsy is taken. This test is diagnostic of cancer.

During this procedure, multiple samples of prostate tissue are collected by inserting hollow needles into the prostate and then withdrawing them. Most often, the needles are inserted through the wall of the rectum (transrectal biopsy); however, the needles may also be inserted through the skin between the scrotum and the anus (transperineal biopsy). A pathologist then examines the collected tissue under a microscope. The histopathology report confirms the diagnosis.
Take Care,
Buddy M.D.

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