Part Two: Benign, Non-Cancerous Reason’s why PSA rises

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Part one: What is PSA and what it does

Part two: Benign reason’s why PSA goes up

Part three: PSA as a screening tool for prostate cancer

Part four: PSA after prostate cancer treatment

 

More often than not, PSA rises for reasons other than cancer. Still, this biomarker continues to stress men all over the world who get tested for it.

Here are non-cancer reasons why PSA goes up:

  • Ejaculating about 48 hours before the blood draw can cause a false increase in PSA by up to 1.3ng/ml.

 

  • PSA may be higher in smokers compared to non-smokers.

 

  • Inflammation of the prostate, or prostatitis, may cause an elevation in PSA. Symptoms of prostatitis include; pain or discomfort in the perineal area (between the scrotum and the anus), feeling of “sitting on a golf ball,” lower abdominal pain, lower back pain, burning, pain or discomfort after urination and/or ejaculation. Urinary frequency and urgency also appear in men with prostatitis. Treating prostatitis lowers PSA by close to 40%.

 

  • A digital rectal exam (DRE) before the PSA blood draw can increase PSA by 0.4ng/ml, which many physicians think it’s not a big deal. However, when a biomarker like PSA cause so much anxiety when elevated, anything you can do to keep the number low is a good idea, don’t you think? Also, the more vigorous the exam, PSA can go higher than 0.4 points.

 

  • Needle biopsy of the prostate raises the PSA level by seven times its normal value and stay elevated for up to 4 weeks.

 

  • Benign Prostatic Hyperplasia (BPH) or enlarged prostate cause an increase in PSA. One of the best methods to determine if PSA is high from BPH and less likely from prostate is by doing a PSA density. This is a simple calculation where the prostate size, best measured by an MRI, second best by ultrasound, is divided over PSA value. If the result of that calculation is higher than 0.15, the elevated PSA is likely from prostate cancer. If the PSA density is less than 0.15, it is likely from an enlarged prostate. PSA density should not be the only determining factor for prostate cancer diagnosis. Lastly, a group of pharmaceutical drugs called, 5-alpha reductase inhibitors (5-ARI), falsely reduces PSA by about 50%, meaning, that one can harbor prostate cancer and have a low PSA when being on these drugs. Finasteride and Dutasteride 5-ARI’s are the two main drugs used for BPH.

 

  • Riding a bicycle for long distance can increase PSA score by up to 10% by putting pressure on the perineum area close to where the prostate is located. Cycling for short distances may not make a difference. Similar to after ejaculating, it is best to abstain from riding for at least 48 hours before the blood draw.

 

  • Any form of vigorous exercise a day or two before a blood draw may result in a false increase in PSA.

Next week you will learn the use of PSA as a screening tool for prostate cancer and uncover the confusion associated with it.

Last 3 Blog Posts:

What is PSA and what it Does

ADT, Apalutamide, Exercise in the treatment of prostate cancer

Traditional Chinese Medicine treatment for Erectile Dysfunction

 

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by Dr. Geo

6 comments… add one
  • John 04/17/2018, 10:22 AM

    Hi Dr. Geo,

    Does age affect PSA? I have read that it creeps up as you get older. And if it does, how?

    Reply
    • Dr. Geo 04/18/2018, 9:19 AM

      Hi John. As men age, all sort of things is occurring in the aging prostate, including an accumulation of cells (hyperplasia, as in benign prostatic hyperplasia (BPH)) which also contributes to leakage of more blood into the bloodstream. This happens even when older men do not experience urinary symptoms from their prostate. Thus the increase in PSA number after a blood test. I hope this helps.

      Reply
  • jim 05/06/2018, 1:29 PM

    I think you are wrong about psa density. If the result of that calculation is higher than 0.15, the elevated PSA is likely from an enlarged prostate. If it’s less than 0.15, it is likely from prostate cancer.
    From what I have read, if density is less the 0.15 cut off , then it is less likely to be prostate cancer . a high PSA density could indicate you have a higher risk of prostate cancer.

    Reply
    • Dr. Geo 05/06/2018, 7:59 PM

      You are right. Fixed now. That was a result of late night writing. 🙂 Thanks for picking that up.

      Reply
  • nick 05/09/2018, 11:23 PM

    do you worry about botanical 5ARi’s from falsely lowering PSA?
    ie serenoa, pygeum. thx

    Reply
    • Dr. Geo 05/16/2018, 3:45 PM

      Hi Nick, Serenoa and pygeum or nettle root do not falsely lower PSA.

      Reply

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