In some cases, PSA levels could be above normal for reasons other than cancer.
Aging
Even without any prostate problems, your PSA level can increase gradually as you age. “We use age-based cutoffs 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.
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 damage
Viruses
Even stress and emotional problems can contribute to nonbacterial prostatitis.
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. 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. The condition is more common with age, and while benign, it can cause uncomfortable symptoms like frequent urination, a weak urine stream, and urinary tract infections (UTIs).
BPH can also cause elevated PSA levels.
Your doctor may order additional tests, such as a rectal exam, MRI, ultrasound, or further PSA testing to determine if the cause of elevated PSA is a benign condition or something more worrisome.
Urinary Tract Infection
“A urinary tract infection 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.
Because of this, it’s advised to wait until a diagnosed UTI has cleared up before getting a PSA test.
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.
