Causes of High PSA

Causes of High PSA

Causes of elevated PSA

A blood test that can detect the very initial signs of an enlarged prostate, the PSA (prostate-specific antigen) test is taken by those who are worried they might have prostate cancer. This test can be done at a GP’s surgery and is effective in measuring the level of this specific antigen in a man’s blood. Though the PSA test is a good tool for detecting prostate cancer, yet it is not highly specific. This means that there are other non-cancerous causes of high PSA levels.

Why is the PSA test done? Prostate cancer is common among men and often it is a cause of death due to cancer. In the United States, prostate cancer is the No. 1 non-skin cancer and No. 2 after lung cancer as the cause of cancer death. Early detection is an important tool to get the right and timely treatment.

Once men are diagnosed with prostate cancer, they run the risk of having elevated PSA levels. Though the PSA test detects elevated PSA levels in the blood, it doesn’t provide precise information about the prostate’s condition.

Diagnostic Tools for Prostate Cancer:

Apart from the PSA test to detect prostate cancer, the digital rectal exam is also conducted. In this test, the doctor inserts a gloved finger into the patient’s rectum in order to reach the prostate. By feeling it, the doctor can tell whether it has hard lumps or not.

However, neither of these tests provides sufficient information for the doctor to be sure one suffers from prostate cancer. There could be abnormal results which could force the doctor to suggest a prostate biopsy.

PSA tests are also recommended to judge how good a particular treatment is and to check for the recurrence of cancer.

Elevated PSA Levels:

PSA levels are measured in nanograms of PSA per millilitre of blood (ng/ml). These levels can swing between below 1ng/ml to innumerable ng/ml.

Men aged 50 to 69 have a raised PSA level if it is 3ng/ml or more. If a raised PSA level in the blood is detected, it could mean prostate cancer. However, there are other conditions like an enlarged prostate, urinary infection or prostatitis that can also lead to elevated PSA level.

Who’s at risk? Men are at much higher risk of prostate cancer if they already have a pre-existing history of prostate cancer in the family, or are of black ethnicity, or are overweight.

Pros and Cons of The PSA Test:


  • If the test proves normal, it may reassure you.
  • It gives you an inkling that you may develop cancer before its symptoms begin to develop.
  • It may detect cancer at an early stage, when treatment could prevent its spread.
  • Patients of prostate cancer have a lowered risk of dying from prostate cancer to the extent of 21%.
  • Successful treatment means you avoid getting the advanced stages of this cancer.
  • When advanced cancer is diagnosed, successful treatment gives a longer lease of life.


  • This test can miss detecting cancer and therefore negate the possibility of being struck with it.
  • If cancer is not detected, it could lead to unnecessary anxiety and worry, apart from medical tests.
  • It is limited in its scope to the extent that it cannot differentiate between slow-developing and fast-galloping cancer.
  • If patients find slow-growing cancer that does not cause any prostate cancer symptoms, it could be worrisome.

Before undergoing the test: If you're due to undergo a PSA test, ensure that you do not:

  • Have a urinary infection
  • Ejaculate in the last 48 hours
  • Exercise heavily over the last 48 hours
  • Have a prostate biopsy in the last six weeks

Each of these may give a faulty PSA reading.

After the Test: Completing a PSA Test Means Three Options for the Patient:

He May Have a Normal PSA Level:

If his PSA level is not elevated, he will not be diagnosed with cancer.

He May Have a Slightly Raised PSA Level:

If the patient’s PSA level is slightly higher than normal, he won’t be diagnosed with cancer but will need further PSA tests.

He Has a Definite Elevated PSA Level:

The incidence of men having prostate cancer is 1:4 where all four men have raised PSA levels. The higher the PSA level, the greater the chances of developing prostate cancer.

A PSA test alone is only the first test that detects prostate cancer. The digital rectal examination (DRE) is another.

4 top Non-Cancerous Reasons for High PSA Levels:


Though the PSA test is a good tool for detecting prostate cancer, yet it is not highly specific. This means that other reasons could also lead to elevated PSA levels, such as prostatitis or inflammation in the gland.

Catheter in the Bladder:

Elevated PSA can also result when a foreign body interferes with the body framework in the region of the prostate gland.One example is by placing a catheter in the bladder. Another reason is a prostate exam, that means taking a biopsy. Usually, it takes three days for an elevated PSA reading to reduce by half. So, a PSA test should be done three weeks after a prostate test is done.

Benign Prostatic Hyperplasia (BPH):

This condition points to an enlarged prostate gland, though not prostate cancer. BPH refers to more cells, which means an excess of cells make PSA. However, BPH may not require treatment unless it causes difficulty in urination. It is commonly experienced as a prostate issue among men over 50 years of age. Lastly, BPH leads to abnormal PSA tests in the range of 4 to 10.

Urinary Tract Infection:

If there’s an infection near the prostate gland, such as a urinary tract infection, it can irritate and inflame the prostate cells. This can cause the PSA to rise. If the patient has been diagnosed with urinary tract infection, he should wait until the infection clears up before going in for a PSA test.

Once treatment of prostate cancer begins, patients should remain positive, and not get disheartened. Prostate cancer is treatable and survivors lead a normal life, so apart from chemotherapy, patients might like to follow a healthy lifestyle of eating nutritious food and keeping cheerful.

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Reviewed By:

Dr. Kaushal M. Bhavsar (MBBS, MD)

Assistant Professor in Pulmonary Medicine, GMERS Medical College, Ahmedabad