Sometimes PSA readings are elevated because of something benign, such as ejaculating within 24 hours of the test, or because of a problem that needs treatment, such as a urinary tract infection, but that isn’t cancer. Because the test can’t distinguish between serious causes of elevated PSA and other causes, the United States Preventive Services Task Force (USPSTF) has historically recommended against prostate specific antigen (PSA) testing in healthy men — that is, men who have no family history, known risk factors, or symptoms of prostate cancer. In the meantime, here are seven reasons, besides prostate cancer, your PSA level could be above normal.
1. Aging Affects PSA Levels
Even without any prostate problems, your PSA level can go up gradually as you age. “At age 40, a PSA of 2.5 is the normal limit,” says John Milner, MD, a urologist in the Chicago area. “By age 60, the limit is up to 4.5; by age 70, a PSA of 6.5 could be considered normal.”
2. Prostatitis: A Common Problem in Men Under 50
“The PSA test is a good screening tool for prostate cancer, but it is not very specific,” says Erik P. Castle, MD, a urologist and researcher at the Mayo Clinic in Phoenix, Arizona. “Common causes of inflammation in the gland, called prostatitis, can cause high PSA levels.” Prostatitis is the most common prostate problem for men younger than 50. Prostatitis caused by bacteria can be treated with antibiotics. Another, more common type of prostatitis, called nonbacterial prostatitis, can be harder to treat and may last a long time.
3. Medical Procedures Can Cause PSA to Rise
“Anything that traumatically interferes with the architecture around the prostate gland can make PSA go up,” says Dr. Milner. “One of the most common causes of significantly high PSA from this type of trauma is the placing of a catheter into the bladder.” Another cause is a prostate or bladder exam that involves passing a scope or taking a biopsy. “Since it takes about two to three days for PSA to go down by half, you should wait two to three weeks after this type of trauma to do a PSA test,” Milner says.
4. In Men Over 50: BPH May Be the Cause of High PSA
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. BPH is the most common prostate problem in men over age 50. It may not need to be treated unless it’s causing frequent or difficult urination. Your primary care doctor may be able to tell the difference between BPH and prostate cancer by doing a digital rectal exam, but commonly this will require evaluation by a urologist and further testing, such as a biopsy or imaging studies.
5. High PSA Levels From a Urinary Tract Infection
“Any infection near the prostate gland, including a urinary tract infection, can irritate and inflame prostate cells and cause PSA to go up,” says Milner. 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. In men, most urinary tract infections are caused by bacteria and respond well to antibiotics. Having BPH increases your risk for a urinary tract infection.
6. Ejaculation Is a Potential Cause of Mildly Elevated PSA
“Ejaculation can cause a mild elevation of your PSA level, and so can having a digital rectal exam,” says 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.
7. Can Riding Your Bike Raise Your PSA Level?
There have been occasional studies that link prolonged bike riding to an increase in PSA levels, but others haven’t found this connection. “You would probably have to be a Lance Armstrong–type bike rider to worry about bike riding and a significant rise in your PSA,” says Castle.
The Takeaway on the PSA
“The most important thing to know about PSA is that it is still a really important screening test for prostate cancer,” Castle says. Prostate cancer is the third leading cause of cancer death in American men, behind lung and colon cancer, according to the American Cancer Society.
