Prostate-Specific Antigen (PSA) is a common biomarker used in men’s health to assess the prostate gland. This simple blood test is widely employed as a tool for initial prostate cancer screening and monitoring. Unexpected elevations in PSA levels have been noted in patients experiencing acute systemic illnesses, including the infection caused by SARS-CoV-2. The observation that COVID-19 infection temporarily influences this reading presents a new challenge in interpreting test results. This article explores the scientific evidence connecting COVID-19 infection with transient PSA level increases, providing context for men undergoing routine health screenings.
Understanding the Role of PSA
Prostate-Specific Antigen is a glycoprotein produced primarily by the epithelial cells of the prostate gland. Its normal physiological purpose is to help liquefy semen, ensuring sperm motility after ejaculation. Although the highest concentration is found in seminal fluid, a small amount of PSA naturally escapes into the bloodstream, where it can be measured clinically. This blood measurement serves as a general indicator of prostate health.
Physicians monitor the serum PSA level because disruptions to the prostate tissue can cause more of the protein to leak into the blood. While consistently high levels may signal the presence of prostate cancer, PSA is not a cancer-specific marker. Benign conditions such as Benign Prostatic Hyperplasia or an infection like prostatitis can also lead to elevated readings. Therefore, an elevated PSA level suggests a disturbance within the prostate but does not definitively diagnose malignancy.
The Direct Link: COVID-19 and PSA Elevation
Clinical studies confirmed a direct, temporary correlation between active COVID-19 infection and a significant rise in serum PSA levels. Researchers observed that PSA concentrations measured during the acute phase of the infection were substantially higher compared to levels measured before the illness. In one cohort of men, the average PSA level during active infection rose nearly three-fold from the pre-illness baseline. This acute elevation was seen across different severities of the viral illness.
The increase is typically transient, meaning the PSA level returns to or near its baseline after the patient recovers from the acute infection. The elevated readings observed during the active infection period were found to drop significantly when retested a few months after the viral illness had resolved. These temporary spikes can lead to a “false evaluation,” where the non-cancerous elevation complicates the interpretation of screening results. The medical consensus is that this rise is directly related to the body’s generalized inflammatory response to the virus.
Biological Mechanisms Behind Temporary PSA Spikes
The primary biological explanation for this phenomenon centers on the systemic inflammatory response triggered by the SARS-CoV-2 infection. The body’s widespread reaction includes the release of various inflammatory molecules, known as a cytokine storm in severe cases. This generalized inflammation does not spare the prostate gland, leading to a temporary inflammatory state within the organ. The prostate tissue is affected by this inflammation, which can cause subtle cellular stress and damage.
The virus uses the Angiotensin-Converting Enzyme 2 (ACE2) receptor to gain entry into human cells, and these receptors are notably expressed on prostate tissue. Inflammation or direct cellular stress on the prostate can disrupt the integrity of the blood-prostate barrier. When this barrier is compromised, it allows the PSA protein, which is normally confined within the prostate, to “leak” more readily into the bloodstream. This mechanism is similar to how acute prostatitis causes temporary PSA elevation, making the spike an inflammatory marker rather than an indicator of cancer progression.
Next Steps: Clinical Recommendations for Elevated PSA
The primary recommendation for a patient with an unexpectedly high PSA reading following a recent illness is to wait before undergoing further diagnostic procedures. Healthcare providers are advised to interpret PSA results with caution if the test was performed during or shortly after an acute infection. The temporary nature of the post-viral elevation means that immediate follow-up with invasive procedures like a prostate biopsy may be unnecessary.
The standard clinical guidance is to delay retesting to allow systemic inflammation to fully subside and the PSA level to stabilize. Urologists typically recommend repeating the PSA test approximately four to eight weeks after the patient has completely recovered. Consulting a urologist who is aware of the transient nature of post-viral PSA elevation is important for a differential diagnosis. They will consider other common, non-cancerous causes of elevated PSA before suggesting a course of action, including:
- Recent vigorous exercise
- Urinary tract infections
- Catheterization
- Existing benign conditions