Elevated PSA

PSA, or prostate-specific antigen, is a protein made in the prostate gland. Its levels can be measured with a simple blood test. Although elevated PSA levels are commonly associated with prostate cancer, the relationship is more complex. An elevated PSA does not always mean cancer is present, but it does signal that further evaluation is needed.

The best urologists in the Charlotte, NC area and West Columbia, SC are here to help you understand the cause of your elevated PSA.

The prostate is a small gland found just below the bladder in men. It surrounds part of the urethra, the tube that carries urine out of the body. The prostate’s role is to produce fluid that nourishes and transports sperm. Because of its location, problems with the prostate can affect both urinary and sexual health.

As men age, the prostate naturally changes. Some of these changes are unnoticeable, but others can lead to symptoms such as:

• Difficulty starting or stopping urination
• Needing to urinate often, especially at night
• Pain or burning during urination or ejaculation
• A weak urine stream

Prostate-specific antigen (PSA) is a protein made by both healthy and abnormal prostate cells. Normally, only small amounts of PSA enter the bloodstream. A blood test is used to measure how much of this protein is in your blood.

Normal levels can vary with age and prostate size. Elevated levels suggest that the prostate is under stress, but not always from cancer.

Because PSA levels rise in different conditions, the test is an indication of prostate health, not a diagnosis.

An elevated PSA can happen due to:

• Prostate inflammation, called prostatitis. Infection or irritation can temporarily raise PSA levels.
• Benign prostatic hyperplasia (BPH). A non-cancerous enlargement of the prostate, common with aging, can cause levels to rise.
• Prostate cancer. Cancer cells usually produce more PSA, which is why the test is used as part of cancer screening.
• Recent activity. Ejaculation, certain medical procedures, or even vigorous exercise, like cycling, can raise PSA levels temporarily.

For this reason, one high result is rarely enough to make a diagnosis. Your doctor will look at trends over time and consider other tests to make a diagnosis.

PSA screening usually begins around age 50, or earlier for men who are at increased risk. A blood sample is drawn from your arm and analyzed in a lab. If your result comes back higher than expected, your doctor may suggest:

• Repeating the test to confirm the result
• A digital rectal exam (DRE) to feel for changes in the prostate
• Imaging, such as an MRI, for more detail
• A biopsy, where a small tissue sample is taken from the prostate and checked for cancer

Managing high PSA levels depends entirely on what is causing them.

Infections or prostatitis

When infection or inflammation of the prostate is the cause, treatment often includes a course of antibiotics. Anti-inflammatory medications may also be used to reduce swelling. Once the infection clears, PSA levels often return to normal.

BPH

If BPH is responsible, medications can be taken to relax or shrink the prostate, improving urinary symptoms. In more advanced cases, minimally invasive procedures or surgery may be considered.

Lifestyle changes

Regular exercise and a diet rich in fruits, vegetables, and omega-3 fatty acids may help improve prostate health overall.

Prostate cancer

If detected, the type of treatment will vary depending on the stage and aggressiveness of the cancer. Options may include

• Surgery
• Radiation
• Hormone therapy
• Close monitoring, if the cancer is low-risk

PSA is not a diagnosis by itself, but it is an important warning sign. It means something is affecting your prostate. If you’ve been told your PSA is high, the next step is to meet with a urologist. They can review your history, repeat testing if needed, and perform a full evaluation to determine what’s really happening.

1. Can exercise affect PSA levels?

Vigorous activities that put pressure on the prostate, such as cycling, can cause a temporary rise in PSA levels. Even ejaculation can cause an elevated PSA. For this reason, doctors sometimes recommend avoiding these activities for 24 to 48 hours before testing.

2. If my PSA is high, will I always need a biopsy?

A biopsy is generally recommended when the likelihood of cancer is higher, but it is not automatically required. Sometimes, repeating the PSA, adding imaging tests like an MRI, or monitoring trends over time provides enough information to decide on next steps.

All of our providers treat elevated PSA