Though prostate cancer can result in a PSA spike, non-cancer causes exist.
Outside of skin cancer, prostate cancer is the most common cancer type in men, with more than 140,000 new cases diagnosed each year. Because the risk for prostate cancer increases as a man ages, annual screening exams are recommended for most men beginning at age 50 and earlier if a family history of this cancer type or other factors involved that increase their risk. The two most essential tests in screening for prostate cancer include a digital rectal examination (DRE) and a prostate-specific antigen (PSA) blood test. Especially for men who are new to prostate cancer screening, it can come as a scare when PSA test results indicate an “elevated” PSA level. And although an elevated PSA level may indicate prostate cancer (a doctor must do further tests to confirm it), other non-cancerous conditions can result in an elevated PSA. So let’s take a closer look.
Benign Prostatic Hyperplasia/Enlarged Prostate
The prostate gland is about the size of a walnut and is located right underneath the bladder in men. The prostate and the seminal vesicles are responsible for producing seminal fluid that nourishes and carries sperm during ejaculation.
This fluid contains a protein called Prostate Specific Antigen, also known as PSA. PSA is responsible for helping sperm cells penetrate a female egg, leading to development of an embryo.
The medical term Benign Prostatic Hyperplasia (BPH) is synonymous with the more mainstream phrase “enlarged prostate.” As the term would suggest, an enlarged prostate means that the gland has grown larger. As the prostate enlarges, it will produce more PSA. Some of the higher level of PSA production eventually makes it into the blood stream in patients with BPH. Therefore, men with enlarged prostate may have an elevated PSA level. Although the precise cause of BPH is unknown, the phenomenon of prostate enlargement happens to most men as they get older. It has been theorized that prolonged exposure to testosterone in some men leads to eventual growth of prostate tissue, thereby causing BPH.
While BPH may be asymptomatic in some men, others will experience changes in their urinary habits. These changes can include an urgent need to urinate and an increased frequency of urination at nighttime. Difficulty starting urination, a weak or disrupted urine stream, dribbling at the end of urination, and the inability to completely empty the bladder are other symptoms some men with BPH experience.
Because BPH is a result of aging, nearly all men will experience prostate enlargement at some point in their lives, with more than 90% of men over 80 experiencing the condition. The good news is, having an enlarged prostate gland, by itself, does not factor into a man’s risk for developing prostate cancer.
Prostate Inflammation/Prostatitis
Inflammation of the prostate gland is another condition that can result in an elevated PSA. When there is inflammation in the prostate, the prostatic blood vessel and capillaries become more porous. This in turn allows for PSA to more easily leak into the capillaries and enter the blood stream, leading to higher PSA readings in patients with prostatitis.
Whereas BPH can occur undetected in a man, or he may experience some less severe symptoms as a result, prostatitis is a different story. Swelling and inflammation of the prostate often cause difficulties with urination, but pain is often present alongside those difficulties. And the differences don’t end there. Though BPH tends to affect men as they get older, prostatitis tends to affect younger men, usually those under 50. Symptoms of prostatitis include pelvic pain, perineal pain, burning with urination, frequency and urgency of urination, urethral discharge, and pressure sensation in the rectal area.
The most common cause of prostatitis is infection. Bacteria can enter the prostate and cause infection this organ, called bacterial prostatitis. Some common risk factors that cause bacterial prostatitis are prolonged sitting, constipation, diarrhea, colitis, bladder infection, enlarged prostate, and immunocompromised states such as cancer and diabetes. Other causes of prostatitis are systemic inflammatory conditions such as inflammatory bowel disease, lupus, arthritis, recent upper respiratory infection like a cold or flu, and propensity to food allergies.
Bacterial prostatitis is the result of a bacterial infection that causes urine to leak into the prostate. Nerve damage because of surgery or trauma can also result in prostate inflammation. In addition to painful urination, prostatitis can also cause a man to experience pelvic pain or painful ejaculation. Especially when the cause of the inflammation is bacterial, early treatment is necessary to help resolve the condition and prevent it from worsening.
Naturally Occurring High PSA Values
There is a subset of patients with elevated PSA who have no cancer, BPH, or prostatitis. These men have higher PSA levels naturally. Their prostate basically produces more PSA protein than the general population. This propensity towards higher PSA values may be genetic, found in brothers and fathers.
Sexual activity and PSA levels
Sexual activity, especially ejaculation, will lead to temporary elevated PSA. In general, PSA levels with increase by 02 to 1.0 level higher than normal PSA after sexual activity and ejaculation. This phenomenon usually last 24 to 72 hours. Therefore, it is suggested that blood draw should be done with about 2 – 3 days of abstinence.
Oral sources of elevated PSA
PSA can also rise in patient with oral conditions. The Salivary Glands produce a very minute amount of this test. Conditions that lead to salivary gland swelling will lead to slight increases to PSA. Recent gum surgery, chronic tooth decay, mumps, salivary gland infection can lead to elevated PSA.
Of course, it bears repeating that annual checkups are good practice for your overall health and well-being no matter your age. Men tend to observe these health screenings less often than women, so it’s essential to take note of your body’s signals. Even if it isn’t yet time for an annual PSA screening, you absolutely should be talking to your doctor about your urologic health at your checkups. And, of course, men should address any symptoms experienced with urination, ejaculation, pelvic pain, or all the above sooner and outside the scope of a “regular” exam. Those symptoms are not of the ”wait and see” or “deal with it later” type. Remember gentleman, your health should always remain at the top of your “To Do List.”
Sources:
https://www.mayoclinic.org/tests-procedures/psa-test/in-depth/prostate-cancer/art-20048087
https://www.roboticcancersurgery.com/contents/conditions-and-treatments/prostate-cancer/overview
https://medlineplus.gov/ency/article/000381.htm
https://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/symptoms-causes/syc-20370087
https://www.mayoclinic.org/diseases-conditions/prostatitis/symptoms-causes/syc-20355766
