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.
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