Historically speaking, elevated prostate specific antigen, or PSA, levels were seen as a definitive sign of possible prostate cancer.
Men with a PSA level about four (ng/mL) were automatically considered to be at a high risk of prostate cancer.
However, this attitude began changing early in this decade. In 2012, the United States Preventive Services Task Force (USPSTF) released guidelines that not only recommended against using PSA testing in healthy men with no known risk factors — such as a family history of prostate cancer – but also warned that assumptions about PSA levels may in fact be causing harm to patients. The USPSTF noted in their guidelines that relying on PSA levels to determine if a patient had prostate cancer was leading to overdiagnosis and overtreatment, and this overtreatment was in turn leading to unnecessary complications for patients such as impotence and incontinence.
Possible prostate cancer is not the only possible cause for elevated PSA levels. In fact, there are a number of other far more benign causes for elevated PSA levels.
For men under 50, the most common cause is prostatitis, or a bacterial infection of the prostate gland. While many cases of bacterial prostatitis can be cured by the application of antibiotics, the most common form of the infection — non-bacterial prostatitis — does not respond to antibiotics and may require years of treatment to cure.
Another common cause of elevated PSA levels is a medical procedure. For instance, catheterization can cause a significant jump in PSA levels, as can a simple prostate exam. In the case of a prostate exam, it may take as long as two weeks for PSA to return to pre-exam levels.
Benign prostate hyperplasia, or enlarged prostate, will also raise PSA levels. This occurs simply because a larger prostate can produce more PSA. An enlarged, non-cancerous prostate is not generally considered cause for concern unless it is causing difficulty urinating or too-frequent urination.
Something as simple as a urinary tract infection can also irritate the prostate and cause PSA levels to rise, as can daily stress.
Finally, simply getting older can cause increased PSA levels. A PSA level of 2.5 is considered normal for a 40-year-old, while a PSA of 4.5 is considered normal for a 60-year-old. For a 70-year-old, a level as high a 6.5 would not be considered a call for concern.
While an elevated PSA levels may be useful indicator for certain conditions, it is far from the only factor that should taken into consideration.
If you have any questions or concerns about PSA levels and your prostate health, contact our office for an appointment.