Myth: An elevated PSA always means cancer

There was an excellent article published on the superb medical website, Medical News Today recently on this very subject. I thought I would give my take on this excellent review.

PSA stands for prostate specific antigen and not prostate cancer antigen. An elevated PSA does not always imply prostate cancer. Thus, there has been significant controversy as to the utility and benefits of a PSA.

PSA is a specific protein produced by the prostate gland. The level of PSA varies with age but typically most men with prostate cancer have a PSA level above 4 ng per ml. Unfortunately, 15% of men with prostate cancer will have a PSA lower than this. It is my experience that the trend of PSA levels is more important than the absolute amount.

The typical screen for prostate cancer is the combination of a PSA level and a subsequent Digital rectal examination(DRE). The problem is that various experts in the area question the validity of both forms of examination and it is difficult to get a healthy consensus.

What are the causes of an elevated PSA other than cancer?

1) The older you are, the higher your PSA. If you examine the prostate glands of all men over 80 you’ll probably find traces of prostate cancer in everyone. The problem is that most people will die with the disease not from the disease. The real issue is who has the more aggressive forms as opposed to the more benign forms of prostate cancer. Many people argue that PSA testing should stop over age 70.

2) Prostatitis — any condition that inflames the prostate gland will also elevate the PSA level. Most people with prostatitis will have symptoms such as problems with urination & often changes with sexual function

3) Benign prostatic hypertrophy — as men age and especially if their sexual function reduces as well, it is very common for the prostate to swell. A man with benign prostatic hypertrophy may also experience significant problems with urination such as frequency, urgency and difficulty passing urine.

4) Medical intervention — having a digital rectal examination will significantly elevate the PSA as will any instrumentation of the urinary tract such as a catheter or cystoscope.

5) Urinary tract infection — although urinary tract infections are more common in women, they can also occur in men and may elevate the PSA levels

6) Vigorous exercise, especially cycling — often the middle-aged men in Lycra experience problems with erectile dysfunction as the bicycle seat can affect the nerves important in achieving an erection but also putting pressure on the prostate gland elevating the PSA. Even high-level activity apart from cycling may raise the PSA.

7) Ejaculation — if you are due for a PSA test, it is important to avoid ejaculation for a 48-hour period prior to the test.

If you have an elevated PSA, my strong advice is not to panic. I would carefully consider the advice given above and have a repeat test at some stage over the next few months once any of the other potential conditions have settled.

There have been a number of studies showing the inverse link between sexual activity and prostate cancer. I have often said that the best cancer prevention technique is to use the organ for what it was designed for. If your PSA is elevated, I would suggest you empty your prostate a few times a week (i.e. sexual activity) and then have the PSA repeated 48 hours after the last episode of the ejaculation and do not perform very vigorous exercise (in particular cycling) in the two days before the test.

If your PSA hasn’t changed, I would suggest referral to a urologist but always obtain a second opinion before a definitive procedure is performed.