Brenda Spriggs, MD, MPH, MBA
Receiving a lab result of elevated prostate specific antigen, or PSA, can be unsettling because of the known link between this finding and a diagnosis of prostate cancer. In fact, the PSA test is a very sensitive test for prostate cancer. This means the PSA levels will be elevated in most cases of prostate cancer. Unfortunately, the PSA test is not very specific to cancer. This means elevated PSA levels can be caused by a number of conditions other than cancer, including prostatitis, benign prostatic hypertrophy and some forms of exercise.
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About the Test
PSA is a protein produced by the prostate gland. The PSA test simply measures the concentration of this protein in the bloodstream. According to the National Cancer Institute, the FDA initially approved PSA testing as a means of monitoring the status of men already diagnosed with prostate cancer. Since levels of PSA tend to increase or decrease depending on the progression or regression of the disease, the test serves as a convenient method of determining whether treatment is helping. In 1994, the FDA expanded the approved use of the PSA test as part of the initial diagnosis for prostate cancer. For a number of reasons, including its lack of specificity for cancer, routine use of the PSA test to screen for cancer has subsequently fallen under scrutiny.
Benign Prostatic Hypertrophy
As men age, many experience a non-cancerous enlargement of the prostate gland. This condition, known as benign prostatic hypertrophy (BPH) can cause constriction around the urethra, compromising the free flow of urine out of the bladder. Symptoms can range from frequent urination to difficulty initiating urination to urinary retention and secondary bladder infections. BPH can elevate the PSA and may require treatment, but it is not life-threatening. Along with increasing age and a family history of the condition, obesity and lack of physical activity can increase your risk of developing BPH.
Inflammation of the prostate, or prostatitis, can increase the level of PSA in the blood. According to the Urology Care Foundation, there is no association between having prostatitis and any increased risk of developing prostate cancer. Prostatitis is believed to be related to any of several forms of bacterial infection and can be acute or chronic in nature. Treatment may include antibiotics and various measures to control the associated symptoms.
Physical activity has been implicated as a potential factor in elevating PSA levels. Bicycling has received the most scrutiny. The location of the prostate in relation to the narrow saddle of most bicycles provides a plausible mechanism for mechanical irritation of the gland with cycling activities. Although research findings are inconsistent, research published in the German journal "Der Urologe" found an average increase in PSA levels of 25 percent following a cycling exercise test. Even treadmill exercise caused small increases in PSA. These levels normalized after 48 hours, prompting the authors to recommend abstaining from vigorous exercise within two days of PSA testing.