Why Your PSA May Be Elevated

November 7, 2015 Updated: November 7, 2015

Is your PSA elevated? PSA stands for prostate-specific antigen, which is a protein that is produced by the prostate gland. The PSA can become elevated in the blood as a result of the prostate cells or gland being disrupted in some way. Because the PSA is not specific for one type of prostate condition, it can be elevated due to a number of different conditions.

A “normal” PSA level is generally between 1.0 and 4.0 nanograms per milliliter (ng/mL). Anything above 4.0 ng/mL is considered abnormal or elevated. The PSA level may differ depending on a man’s age. As men age, the prostate gets larger.

A larger prostate produces more PSA. Therefore, younger men generally have lower PSA levels while older men tend to have higher PSA levels. These variations in PSA levels are not always associated with a prostate condition other than an enlarged prostate. The PSA level may also vary depending on the man’s ethnicity or if he has a family history of prostate cancer.

If you have an elevated PSA, you should see a urologist. A urologist will do a number of tests to determine exactly what is causing the elevated PSA.

Additional tests may include another PSA test, a urinalysis test, a post-void residual urine test, an assessment of your medical and family history, and possibly a prostate biopsy or a cystoscopy, a procedure that examines your bladder.

Common Causes of Elevated PSA

Prostatitis. This also means a prostate infection, which causes inflammation of the prostate gland. Prostatitis is the most common prostate condition in men younger than 50. It can usually be treated with antibiotics.

Age. As men age, their prostate naturally gets bigger. This happens regardless of any medical condition affecting the prostate gland.

Benign Prostatic Hyperplasia (BPH). BPH also means an enlarged prostate gland. This does not mean prostate cancer. BPH is the most common prostate condition men over 50 suffer from. It can often cause urination problems such as frequent urination or difficulty urinating.

Prostate Cancer. An elevated PSA could indicate prostate cancer. If you have an elevated PSA, your doctor will also do a digital rectal exam to see if there are any suspicious lumps present on the prostate gland. If the doctor suspects prostate cancer, a prostate biopsy will be recommended.

It’s also important to monitor any changes in the PSA. If the PSA continues to rise, this may mean prostate cancer. If you continue to have an elevated PSA, but your biopsy is negative, your doctor will most likely recommend follow-up PSA tests and a follow-up biopsy within six months.

Urinary Tract Infection. A urinary tract infection (UTI) can cause irritation and inflammation in the prostate gland, which can cause the PSA to go up. If you have a UTI, a doctor will prescribe antibiotics to treat it.

The PSA should go back to normal after the infection has gone away, so make sure to wait until then to have a PSA test. Men with an enlarged prostate have a higher risk for urinary tract infections.

Certain Medical Procedures. The prostate can sometimes be affected after certain procedures or exams, such as a prostate biopsy or cystoscopy. It can also be affected after having a digital rectal exam.

The PSA can elevate after having any of these procedures because they disturb the prostate gland. The PSA can even rise after having a catheter in place. The PSA should go back to normal within a few days once the prostate has healed.

Intercourse. After sex, or ejaculation, the PSA can go up. The PSA usually only goes up very slightly, so it may not even show a difference. The PSA should go back to normal within a few days.

Dr. David B. Samadi (Courtesy of Dr. Samadi)
Dr. David B. Samadi (Courtesy of Dr. Samadi)



Dr. David Samadi is the chairman of the urology department and chief of robotic surgery at Lenox Hill Hospital. He is a medical correspondent for the Fox News Channel’s Medical A-Team. Learn more at:  RoboticOncology.com 

And visit Dr. Samadi’s blog:  SamadiMD.com. Follow him on Twitter and Facebook.