Hearing that your PSA is raised can be worrying, but many men with a high result do not have prostate cancer. PSA is made by all prostate cells, healthy or not, so anything that makes the prostate larger, inflamed or disturbed can push the level up. Understanding the other causes helps put a result in context.
Benign prostatic enlargement
The most common reason for a raised PSA is an enlarged prostate. As men get older, the prostate usually grows. A larger gland contains more cells, so it makes more PSA.
Doctors can allow for this by working out PSA density, which compares the PSA level with the size of the prostate measured on an MRI scan. A high PSA in a large gland is often less concerning than the same level in a small one. Our page on benign prostatic enlargement explains the condition.
Prostatitis
Prostatitis means inflammation of the prostate. It can be:
- acute: caused by a bacterial infection, often with fever, pain and urinary symptoms
- chronic: longer-lasting, sometimes with pelvic pain and no clear infection
Both types can raise PSA, sometimes sharply. After treatment, PSA usually falls back over several weeks. Your doctor may suggest repeating the test once symptoms have settled, so that the result reflects the true level rather than the effect of inflammation.
Urine infection
A urinary tract infection can irritate the prostate and raise PSA for a while. If you have an infection, a PSA test is usually delayed until it has cleared, often for around six weeks.
Recent activity
Some everyday activities can cause a short-term rise in PSA:
- Ejaculation: within 48 hours of the test.
- Vigorous exercise: particularly cycling, which puts pressure on the prostate.
- Prostate examination: a recent rectal examination may have a small effect.
- Recent procedures: such as a catheter, a cystoscopy or a prostate biopsy.
The NHS page on the PSA test recommends avoiding these before a test.
Urinary retention
Being unable to pass urine properly, with the bladder holding more than it should, can also raise PSA. This needs medical attention in its own right.
How doctors find the cause
When PSA is raised, a urologist will usually:
- repeat the test after a few weeks, avoiding the factors above
- check a urine sample for infection
- examine the prostate
- arrange an MRI scan to look for suspicious areas
If the MRI is normal and the PSA density is low, many men can avoid a biopsy and simply continue monitoring. If there is a concerning area, a targeted biopsy may be recommended so that the tissue can be examined under a microscope.
Medicines that lower PSA
Some medicines used for an enlarged prostate, such as finasteride and dutasteride, lower PSA by around half. If you take one of these, your doctor will take this into account. Always mention all your medicines when you have a PSA test.
Living with a raised PSA
It can be frustrating to have a result that needs watching rather than a clear answer, but careful monitoring is often the safest approach. Your urologist will agree how often PSA should be checked and what change would prompt a further scan. Some men have a PSA that stays above the expected range for years without any sign of cancer. Regular monitoring, with occasional MRI scans, can give reassurance. Our article on PSA anxiety looks at the worry test results can cause and how support helps. Prostate Cancer UK also offers practical advice.
Getting a specialist view
If your PSA is raised and you would like it explained, Professor Prokar Dasgupta can review your results and history at The London Clinic. Our prostate cancer page explains how prostate cancer is diagnosed. Please contact the clinic to arrange a consultation.