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What exactly does it mean when a person has a high PSA level?

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Updated July 01, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

High PSA Levels
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Question: What exactly does it mean when a person has a high PSA level?
I had my first PSA test last week, and the doctor said it was a little high. I am having the test done again, but am worried it may be cancer. What exactly does having a high PSA mean?
Answer: The PSA is a test used to measure a protein called prostate specific antigen in the blood. Men with prostate cancer often do have elevated PSA levels, however levels can fluctuate and increase based on a number of factors that are unrelated to cancer. The PSA test is also notorious for producing false positives and negatives.

Due to these variables, the PSA is not considered to be a diagnostic tool or even an effective screening test when used alone. It is coupled with a digital rectal exam for prostate cancer screening, but ultimately, it is a prostate biopsy that either confirms or rules out cancer.

Other Than Cancer, What May Cause High PSA Levels?

Ejaculation -- While your doctor may not recommend avoiding ejaculation prior to having a PSA test, it can slightly elevate your levels. If your PSA level is high and you ejaculated within 48 hours of the test, your doctor may want to conduct a retest and ask that you abstain from sexual activity (or masturbation) before the test.

Enlarged Prostate -- If you have benign prostatic hyperplasia (BPH), your PSA levels may be elevated. BPH is a common non-cancerous condition that occurs as men become older.

Prostatitis:Another common culprit of high PSA levels, prostatitis is the inflammation or infection of the prostate. It can be caused by bacteria, but many times we don't know why some men develop prostatitis.

Age:PSA levels can naturally increase as men grow older.

When Does a High PSA Level Warrant a Prostate Biopsy?

In this excerpt, provided by UpToDate -- an electronic resource used by many patients and their doctors looking for in-depth medical information -- you can see how wary physicians may be to biopsy a prostate based on initial PSA test results:

"Men with abnormal PSA values can also be referred for biopsy, though some experts recommend first repeating the PSA several weeks later, particularly for borderline elevations below 7.0 ng/mL. PSA measurements have considerable short-term variability. A retrospective analysis of stored serum from 972 men found substantial year-to-year fluctuations with 44 percent of men with a PSA above 4.0 ng/mL having normal PSA findings at subsequent annual visits.

"In addition to biological variability, PSA may be transiently elevated due to ejaculation, perineal trauma, or prostatitis. Before repeating a borderline elevated PSA test, patients should be asked to refrain from sexual activity and bike riding for at least 48 hours and, if there is evidence of prostatitis, complete a course of antibiotics."

In most men, repeating a PSA test before undergoing biopsy is important, as many factors influence the level of PSA found in the blood. UpToDate references a study which found that many men who had elevated levels (above 4.0 ng/mL) had normal levels following the abnormal result. While having an elevated PSA result can be concerning, you should not panic. Want to learn more? See UpToDate's topic, "Prostate Cancer Screening," for additional in-depth medical information.

Source:

Hoffman, Richard M. "Prostate cancer screening." UpToDate. Accessed: October 2009.

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