The prostate-specific antigen (PSA) test is a blood test that measures a protein that the prostate gland produces. People with prostate cancer usually have elevated levels of this protein. However, high levels do not always mean a person has cancer.

Other health conditions may also cause an increase in PSA levels. In some cases, an elevated PSA is temporary and not a sign of a health problem.

Health conditions, lifestyle factors, and testing inconsistencies can all contribute to high PSA test results. A doctor can further discuss the reasons for elevated PSA levels with a person.

They will also decide whether delaying testing or planning additional tests might help them determine the cause of high PSA test results.

This article discusses eight noncancerous causes of high PSA levels, plus other symptoms that may indicate prostate cancer.

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

Image of a plastic container with red liquid in itShare on Pinterest
VICTOR TORRES/Stocksy

Cells in the prostate gland produce PSA, and levels typically remain below 4 nanograms per milliliter (ng/ml).

Most individuals with prostate cancer have PSA levels above 4 ng/ml. However, some people with the disease have expected PSA levels. Similarly, some with a higher than average PSA may not have prostate cancer.

These variations mean that a PSA test alone cannot rule out or diagnose prostate cancer. However, this test can identify whether a person has a higher risk of developing the disease.

Initial testing may include both a PSA test and a digital rectal exam (DRE).

During a DRE examination, a doctor inserts a finger into the rectum to check the prostate for anomalies.

If both of these tests suggest prostate cancer, the doctor will arrange for a biopsy to confirm the diagnosis.

To discover more evidence-based information and resources for cancer, visit our dedicated hub.

According to a 2021 review, elevated PSA is a symptom of various health conditions. The review did not suggest that elevated levels of PSA can be harmful or cause any symptoms themselves.

If a person has elevated PSA levels due to an underlying health problem, they may experience other symptoms. With this in mind, people should discuss high PSA levels with a healthcare professional.

Share on Pinterest
Infographic by Sophia Smith

Besides prostate cancer, other factors might contribute to high PSA levels.

Age

A person’s PSA levels tend to increase slowly with age.

People who are more than 50 years of age should speak with their doctor about their risk of developing prostate cancer. They can also discuss the benefits and risks of PSA screening for them.

Urologists commonly use age adjustment to put an elevated PSA in perspective for an older individual. For example, they consider a PSA of 4 as elevated for a 40-year-old individual but typical for someone who is 80 years old.

Additionally, the Prevention Services Task Force does not recommend prostate cancer screening for people above 70 years of age. Some data suggest that screening does not improve cancer survival rates and may result in false-positive results.

The diagnosis and treatment process may also lead to more negative effects than benefits for males older than 70 years.

Therefore, it is important for a person to discuss screening options with a doctor according to their family and personal medical history.

Prostatitis

Prostatitis involves the inflammation of the prostate and can be a chronic problem. The condition may sometimes occur due to a bacterial infection.

People with prostatitis may show elevated PSA numbers in test results.

Someone with prostatitis may experience the following symptoms alongside elevated PSA levels:

Benign prostatic hyperplasia

Benign prostatic hyperplasia (BPH) is an enlarged prostate that can raise PSA levels. BPH is a common condition in older adults.

BPH does not increase the risk of cancer, but the symptoms can be similar to prostate cancer. A person with BPH will often experience irritation while urinating.

Medical procedures

Medical procedures on the prostate can elevate PSA levels.

A recent prostate exam can cause false positives on a PSA test. Likewise, this can occur after inserting a urinary catheter or scope into the urethra.

For the most accurate results, a person should wait a few weeks after a medical procedure before undergoing PSA testing. Alternatively, they can have the PSA test before the procedure.

Urinary tract infection

A urinary tract infection (UTI) is an infection of the urethra or bladder that can cause PSA levels to rise.

Having a UTI can cause pain during urination, blood in the urine, or an inability to urinate. In most cases, a simple urine test can accurately diagnose a UTI.

Learn more about UTIs in males.

Vigorous exercise

Cycling and doing other forms of vigorous exercise 1–2 days before a PSA test may result in higher PSA levels.

A person may consider asking a doctor about exercise recommendations before scheduling a PSA test.

Ejaculation changes

Ejaculation may cause PSA levels to rise for a short time.

People who have scheduled a PSA test should tell their doctors about any prostate symptoms they may be experiencing. Changes in ejaculation or urination often indicate a problem with the prostate.

The following symptoms could indicate a prostate issue:

Learn more about whether frequent ejaculation can reduce a person’s risk of developing prostate cancer.

Prostate stimulation

A person’s PSA levels may rise if their prostate experiences stimulation during sex or if they receive anal sex. A healthcare professional may recommend avoiding sexual activity for around a week before having a PSA test.

A 2017 study noted that people who knew they had high PSA levels experienced feelings of uncertainty, anxiety, and depression. If a person is feeling uncertain about their health, they may feel negative emotions more frequently.

People who know that their PSA levels are high may find it helpful to seek the advice of a healthcare professional for further advice.

There is evidence that prostate cancer can lead to elevated blood PSA levels.

However, a 2021 review stated that many factors besides prostate cancer can raise the level of PSA in a person’s blood. Among individuals with high levels of blood PSA, only 2% will have a form of prostate cancer requiring medical intervention.

Prostate cancer may not cause any symptoms. However, symptoms may include:

These symptoms are similar to those of other prostate conditions, including prostatitis and BPH.

A person with symptoms of a prostate issue will typically need additional testing to help with diagnosis.

Several factors can cause a person to have elevated PSA levels, including age, health conditions, certain medical procedures, and sexual activity.

Individuals should speak with a doctor if they are experiencing symptoms of prostate cancer or if they wish to find out more about PSA testing.

Q:

Can any of the above conditions become prostate cancer over time?

A:

Out of everything listed in this article as causes of elevated PSA levels, only a few of them may increase the risk of prostate cancer.

Older age correlates with increased risk for prostate cancer, with the incidence peaking at age 65–74 years old. For prostatitis, the current data suggest that there is an increased risk for prostate cancer, but the studies are of low quality.

It is unclear how exercise affects a person’s risk, but some studies suggest a decrease in risk with exercise. Most experts believe BPH is not a risk factor for prostate cancer. However, the data is conflicting.

Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.