The prostate specific antigen test is a blood test that measures a protein that the prostate gland produces. Men with prostate cancer usually have elevated levels of this protein. However, high levels do not always mean cancer.
Other health conditions may also cause prostate specific antigen (PSA) levels to increase. 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 explain these factors to individuals.
They will also decide whether delaying testing or planning additional tests might help them determine the cause of high PSA test results.
In this article, we look at seven noncancerous causes of high PSA levels, plus other symptoms that may indicate prostate cancer.
Besides prostate cancer, other factors might contribute to elevated PSA levels.
A person’s PSA levels tend to increase slowly with age.
People who are more than 50 years of age should talk to their doctor about their risk of developing prostate cancer and the benefits and risks of PSA screening for them.
The United States Prevention Services Task Force (USPSTF) do 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 process of diagnosis and treatment may also provide more harm than benefit for men who are older than 70 years.
Therefore, it is important to discuss screening options with a doctor based on family and personal medical history.
Prostatitis is an 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:
- difficulty and pain when urinating
- pressure in the rectum
- ejaculation problems
- changes in sexual function
3. Benign prostatic hyperplasia
Benign prostatic hyperplasia (BPH) is an enlarged prostate that can raise PSA levels. BPH is a common condition in older men.
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.
4. 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 the insertion of 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 the PSA test.
5. 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.
6. Vigorous exercise
Running and doing other forms of vigorous exercise a day or two before a PSA test may result in a false positive.
It can be helpful to ask a doctor about exercise recommendations before scheduling a PSA test.
7. Ejaculation changes
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.
Rectal pain, abdominal pressure, fever, and signs of an infection may also indicate a prostate issue.
Prostate cancer may not cause symptoms at all. When it does, symptoms may include:
- painful ejaculation
- blood in the semen or urine
- pain in the hip, pelvis, lower back, or thigh
- a weak flow of urine
- problems urinating
- incontinence or increased urges to urinate
- difficulty getting or maintaining an erection
- a burning sensation when urinating
These symptoms are similar to those of many other prostate issues, including prostatitis and BPH.
A person who has symptoms of a prostate problem will typically need additional testing, such as urine screenings for a UTI or a digital rectal exam (DRE), to test for prostate anomalies or growths.
High PSA levels can be a source of extreme anxiety, particularly in males who have to wait several weeks for a follow-up appointment with the doctors. An individual and their doctors will need to consider the risks and benefits of PSA screening carefully.
While regular preventive health checks can be beneficial, some people may choose not to have the PSA test, depending on their age, overall health, and other risk factors.
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 men with prostate cancer have a normal PSA level. Similarly, some men with a higher than average PSA do not have prostate cancer.
These variations mean that a PSA test alone cannot rule out or diagnose prostate cancer. However, the PSA test can identify whether a person has a higher risk of developing the disease.
Initial testing may include both a PSA test and a 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, then the doctor will arrange for a biopsy to confirm the diagnosis.
People should know that detecting prostate cancer early on does not necessarily reduce the risks of dying from the disease.
When a person has a high PSA but no lumps in the prostate, a doctor might perform the test again and recommend continuing to monitor PSA levels. They may also recheck the prostate in a few months.
An individual may wish to discuss the benefits and drawbacks of each approach with a doctor.