An elevated Prostate-Specific Antigen (PSA) level is a common finding in men, often causing immediate concern for prostate cancer. While the PSA test is a routine screening tool, a high reading does not automatically signal malignancy, as many benign conditions can cause the level to rise. Inflammation of the prostate, known as prostatitis, is one of the most frequent non-cancerous causes of an elevated PSA reading.
What is Prostate Specific Antigen
Prostate-Specific Antigen (PSA) is a protein made almost exclusively by the cells of the prostate gland. Its primary function is to help liquefy semen following ejaculation, aiding fertility. Although PSA is mostly secreted into seminal fluid, a small amount naturally leaks into the bloodstream, where it is measured via a simple blood test.
The PSA test measures the protein’s concentration in the blood, reported in nanograms per milliliter (ng/mL). Historically, a level above 4.0 ng/mL was considered elevated, prompting investigation. However, the concept of a “normal” range is complex, as PSA levels naturally increase with age. Healthcare providers now consider age-specific ranges and other individual factors when evaluating results.
The Inflammatory Link to Elevated PSA
Inflammation within the prostate gland is a common cause of elevated PSA levels, separate from cancer or mechanical enlargement. The inflammatory process disrupts the normal barrier between the prostate tissue and surrounding blood vessels.
When inflammation damages the cellular structures, the tight junctions between cells loosen. This breakdown allows a greater amount of PSA protein, normally contained within the gland, to escape into the circulatory system. Consequently, the measured concentration of PSA in the bloodstream rises significantly, sometimes temporarily reaching high levels. The extent of the inflammation often correlates with the degree of the PSA elevation.
Specific Inflammatory Conditions That Affect PSA
The most common inflammatory condition leading to a rise in PSA is prostatitis, which is the inflammation or infection of the prostate gland. This condition can be caused by a bacterial infection (acute bacterial prostatitis) or a chronic, non-bacterial inflammatory process. Acute infections cause the most dramatic and rapid increases in PSA, often accompanied by symptoms like fever and painful urination.
Another non-cancerous cause is benign prostatic hyperplasia (BPH), the enlargement of the prostate gland that occurs as men age. While BPH is primarily a mechanical issue due to increased tissue volume producing more PSA, it often involves chronic, low-grade inflammation that contributes to the overall increase.
Temporary rises in PSA are also seen following physical activities that stimulate the prostate, such as vigorous cycling, or after medical procedures like a recent biopsy or catheterization. Ejaculation can also cause a transient elevation.
Next Steps Following an Elevated PSA Result
An elevated PSA result requires careful follow-up, starting with re-testing the level after ruling out temporary causes. A physician typically recommends a waiting period to ensure recovery from recent physical activity, ejaculation, or potential infection. If prostatitis or a urinary tract infection is suspected, a course of antibiotics may be prescribed, and the PSA test is repeated four to six weeks later.
To better distinguish between benign conditions and cancer, other metrics are used, such as percent free PSA and PSA velocity. Percent free PSA measures the proportion of unbound PSA in the blood; a lower percentage suggests a higher probability of cancer, while a higher percentage suggests a benign cause. PSA velocity refers to the rate of change in the PSA level over time. If the PSA remains elevated, a multiparametric Magnetic Resonance Imaging (MRI) scan is often used to identify suspicious areas before a targeted biopsy is considered.