What Causes High PSA Levels Besides Cancer?
[ad_1]
But the test isn’t perfect — sometimes PSA levels are elevated when no cancer is actually present. Keep reading to find out many common reasons besides prostate cancer that PSA levels might be elevated.
Prostate Cancer: The Main Reason Doctors Order a PSA Test
Prostate cancer is the second leading cause of cancer death in American men, behind only lung cancer, according to the American Cancer Society. In many cases, prostate cancer grows slowly and is confined to the prostate gland, where it may not be life-threatening. However, some types of prostate cancer can be aggressive and deadly.
Prostate cancer may not have any obvious symptoms in the early stages, which is one reason why screening can be useful. Diagnosing the cancer before it’s had the chance to spread to other parts of the body means it will be easier to treat and potentially cure.
But there are risks associated with the PSA test, according to the American Cancer Society. In general, the higher a person’s PSA, the more likely it is that they have cancer. But a low PSA blood level isn’t a guarantee that you don’t have prostate cancer, and a higher level is not definitive proof of cancer, according to MedlinePlus. What’s more, the test can appear abnormal, even when there is no cancer, a phenomenon known as false-positive.
Because many prostate cancers are slow growing and not life-threatening, there’s also a risk of overtreatment — a person undergoes treatment that can have risks and side effects for a cancer that may not have ever caused problems or shortened his life.
Because of these considerations, the most recent guidelines from the American Urological Association recommend against PSA testing in men under 40 because there hasn’t been evidence of a clear benefit.
The guidelines also recommend against routine screening in men between the ages of 40 and 54. Instead, an individualized decision on PSA screening should be made based on the person’s risk factors.
Ideally, a PSA test that is used for men who have at least 10 years of life expectancy or are being evaluated for metastatic prostate cancer, says Amin Herati, MD, an assistant professor of urology and the director of male infertility and men’s health at Johns Hopkins Medicine in Baltimore. “In general, we recommend screening men ages 55 to 69 unless a male has higher risk of prostate cancer (a family history, being of African American descent), in which case we screen at age 50,” he says. This aligns with guidelines from the U.S. Preventive Task Force, an independent panel of national experts under the U.S. Agency for Healthcare Research and Quality.
There isn’t a consensus among the medical community on when prostate cancer screening should be performed, and recommendations can change over time. It’s important to discuss the risks and benefits of prostate cancer screening with your doctor before you have a PSA test, according to the American Cancer Society.
For men who elect to take the test, your provider will discuss what your results indicate and what the next steps should be.
Why Would a PSA Test Result Be High Other Than Prostate Cancer?
In some cases, PSA levels could be above normal for reasons other than cancer. Keep reading to find out seven reasons besides prostate cancer that your PSA level could be above normal.
Aging
Even without any prostate problems, your PSA level can go up gradually as you age. “We use age-based cut-offs to determine normal levels,” says Herati.
For men in their forties and fifties, a PSA score greater than 2.5 is considered abnormal. In men in their sixties, PSA above 4 is considered abnormal, he says.
“Keep in mind that a PSA can be a normal range but exhibit a fast rise when followed year to year. This would be considered abnormal and prompt additional investigation,” says Dr. Herati.
Prostatitis
One culprit for higher PSA levels can be a type of inflammation in the gland called prostatitis, a common problem in men under 50, says Erik Castle, MD, professor of urology at the Tulane University School of Medicine in New Orleans.
Prostatitis (PLS) is inflammation of the prostate gland, and about half of all men have it at least once, according to the Prostate Cancer Foundation. Symptoms can include pain or discomfort in the prostate gland and pain or burning during urination. There are several different types of PLS and the treatments can vary according to the type. While bacterial PLS can be treated with antibiotics, the more common type, called nonbacterial prostatitis, can be harder to treat because the exact cause is often unknown — it could be due to a number of factors, including inflammation, nerve damage, pelvic muscle infection, or viruses. Even stress and emotional problems can contribute to nonbacterial prostatitis, according to MedlinePlus.
Sometimes complex and personalized treatments are needed, and even then, nonbacterial PLS can become a chronic condition, which means it persists even after treatment. Men should contact their doctor right away if they have symptoms of PLS.
Medical Procedures
“Anything that traumatically interferes with the architecture around the prostate gland can make PSA go up,” says John Milner, MD, a urologist in the Chicago area. “One of the most common causes of significantly high PSA from this type of trauma is the placing of a catheter into the bladder.” A catheter might be placed before surgical procedures or because of urinary issues.
However, a catheter placed without trauma is unlikely to significantly change the PSA, says Herati. “A three-day period is often sufficient time for a transient increase to dissipate,” he adds.
Another cause of elevated PSA levels is a cystoscopy, a procedure in which a long, thin, flexible, lighted tube called a cystoscope is placed in the urethra and moved up into the bladder. This procedure allows your healthcare provider to look at the urinary tract to detect early signs of cancer, infection, narrowing, blockage, and bleeding, according to University of Rochester Medical Center. A bladder biopsy (which can be performed as part of a cystoscopy) may also cause PSA levels to rise.
Benign Prostatic Hyperplasia
Benign prostatic hyperplasia (BPH) is an enlargement of the prostate gland, but it’s not prostate cancer. “BPH means more cells, so that means more cells making PSA,” explains Dr. Castle.
It’s possible for a man over 50 to have an elevated PSA due to an enlarged prostate, says Herati. “From my experience, men with a large prostate will exhibit higher PSAs,” he says.
Your doctor may be able to tell whether BPH is triggering a high PSA result. There are two types of PSA: “bound PSA,” which is attached to other proteins, and “free PSA,” which is not bound. Free PSA is linked to benign prostate cancer conditions, such as BPH. Your provider may give you a free PSA test to help determine what is causing the higher PSA, according to the National Cancer Institute.
Urinary Tract Infection
“A urinary tract infection (UTI) can cause higher than normal PSA levels,” says Herati. The reason that the levels rise is not clear, but infections may cause the membranes that separate the prostate from the blood supply to be more permeable, he says.
If you’ve been diagnosed with a urinary tract infection, be sure to wait until after the infection has cleared up before you get a PSA test, advises the Prostate Cancer Association.
Having BPH increases your risk for a urinary tract infection, according to a paper published in the Journal of Infection and Chemotherapy.
Ejaculation
“Ejaculation can cause a mild elevation of your PSA level, and so can having a digital rectal exam,” says Dr. Milner. “These types of PSA elevations are usually not enough to make a significant difference unless your PSA is borderline. PSA should return to normal in two to three days.”
To avoid this type of elevation, doctors will usually draw blood for a person’s PSA level before doing a rectal exam. Ask your doctor if you should avoid ejaculation for a few days before a PSA test.
Biking
There have been occasional studies that link prolonged bike riding to an increase in PSA levels. A study published in PLoS One found that long distance bicycle riding caused PSA levels to increase by an average of 9.5 percent. “The perineal pressure of the bike seat can cause higher PSA levels,” says Herati.
The Bottom Line on PSA Levels and Prostate Cancer Screening
For some men, the benefits of getting screened for prostate cancer outweigh the risks, but that’s not always the case, according to the American Cancer Society. The organization suggests having a conversation about the uncertainties, risks, and potential benefits with your doctor before making a decision on whether to have your PSA levels tested.
Several organizations provide decision making tools for you to read ahead of time, including the Centers for Disease Control and Prevention and the American Cancer Society (PDF).
Additional reporting by Becky Upham.
[ad_2]
