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What Does a High PSA Level Mean?

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A prostate-specific antigen (PSA) test is one tool that doctors use to screen for prostate cancer, which is cancer of the prostate gland, the small gland located between the bladder and the penis in men. Healthcare professionals may administer the test if you’re experiencing prostate symptoms, such as an enlarged prostate, dull pain in the lower pelvic area, frequent urination, and pain or difficulty while urinating, according to the Urology Care Foundation.

Depending on your age and risk factors for prostate cancer, your doctor may also recommend a PSA test as part of routine preventive care. A PSA test involves taking a blood sample and measuring the level of prostate-specific antigen, a type of protein both normal and cancerous prostate gland cells produce. The National Cancer Institute (NCI) advises that higher levels may be a sign of prostate cancer in some people.

But the test isn’t perfect — sometimes PSA levels are high when no cancer is present. Keep reading to find out many common reasons besides prostate cancer that PSA levels might be elevated.

Prostate cancer is the second leading cause of cancer death in American men, behind only lung cancer, according to the American Cancer Society (ACS).

 In many cases, prostate cancer grows slowly and remains in the prostate gland where it may not be life-threatening. But 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.

The ACS highlights several risks with a PSA test.

 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. People with false positive results for cancer may have high PSA levels because of other conditions.

Because many prostate cancers are slow-growing and not life-threatening, there’s also a risk of overtreatment — when a person undergoes treatment that can have risks and side effects for a cancer that may not ever have caused problems or shortened their life.

Because of these considerations, the most recent guidelines from the American Urological Association recommend against PSA testing in men under 40 years of age because there hasn’t been evidence of a clear benefit.

The guidelines also recommend against routine screening in men between 40 and 54 years of age. Instead, the person’s healthcare professional should make an individualized decision on PSA screening depending on the person’s prostate cancer risk factors, including:

  • Being over 50 years of age
  • Being African American or Caribbean with African ancestry
  • Having a family history of prostate cancer
Ideally, doctors recommend a PSA test for men who have at least 10 years of life expectancy or who are undergoing evaluation 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 aged 55 to 69 years unless a male has a 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.

 PSA tests are useful in checking for cancer recurrence after treatment.

There isn’t a consensus among the medical community on when to perform prostate cancer screening, 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 choose to take the test, your provider will discuss your results and the next steps.

In some cases, PSA levels could be above normal for reasons other than cancer. Keep reading to find out seven reasons besides prostate cancer why your PSA level could be above normal.

Aging

Even without any prostate problems, your PSA level can increase gradually as you age. “We use age-based cut-offs to determine normal levels,” says Dr. Herati.

He says that doctors consider a PSA score greater than 2.5 to be abnormal for men in their forties and fifties, and above 4 is abnormal for men in their sixties.

“Remember that a PSA can be a normal range but show a fast rise when followed year to year. This would be considered abnormal and prompt additional investigation,” says 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, a professor of urology at the Tulane University School of Medicine in New Orleans.

Prostatitis is inflammation of the prostate gland, and stats from the Prostate Cancer Foundation suggest that about half of all men have it at least once. Symptoms can include pain or discomfort in the prostate gland and pain or burning during urination.

There are several different types of prostatitis, and the treatments can vary according to the type. While antibiotics can treat bacterial prostatitis, the more common type, called nonbacterial prostatitis, can be harder to treat because doctors often do not know the exact cause. It could develop due to a number of factors, including:

  • Inflammation
  • Nerve damage
  • Pelvic muscle infection
  • Viruses
Even stress and emotional problems can contribute to nonbacterial prostatitis, according to MedlinePlus.

Sometimes, complex and personalized treatments are necessary. Even then, nonbacterial prostatitis can become a chronic condition, which means it persists even after treatment. Men should contact their doctor right away if they have symptoms of prostatitis.

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.

But a catheter placed without trauma is unlikely to change the PSA significantly, 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 medical professional places a long, thin, flexible, lighted tube called a cystoscope in the urethra and moves it up into the bladder. According to the University of Rochester Medical Center, this procedure allows your healthcare provider to look at the urinary tract and detect early signs of cancer, infection, narrowing, blockage, and bleeding. A bladder biopsy (which can occur 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.

A man over 50 can 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 attaches to other proteins, and “free PSA,” which does not. Free PSA has links to benign prostate cancer conditions, such as BPH. According to the NCI, your provider may give you a free PSA test to help determine what is causing the higher PSA,

 generally for those with a PSA of 4.0 to 10.0, which suggests a higher risk of prostate cancer.

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.

The Prostate Cancer Foundation recommends waiting until after a diagnosed UTI has cleared up before getting a PSA test.

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.

Continuously high PSA levels are associated with prostate cancer, but several noncancerous factors can cause a temporary increase that leads to inaccurate PSA test results. Aging, an enlarged prostate, infections, and ejaculatuion can increase a person's PSA level.

For some men, the benefits of screening for prostate cancer outweigh the risks, but that’s not always the case, according to the ACS.

 The organization suggests having a conversation about the uncertainties, risks, and potential benefits with your doctor before deciding to get a PSA test.

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