PSA (prostate-specific antigen) is a protein produced by the prostate gland. PSA levels are used to screen for prostate cancer, monitor its progression, and check for recurrence after treatment. Generally, PSA levels below 4 ng/mL are considered normal. However, PSA levels can fluctuate and suddenly spike for reasons unrelated to cancer. A sharp rise in PSA is concerning and warrants medical evaluation to determine the underlying cause.
What is PSA?
PSA is a protein secreted by the epithelial cells lining the prostate gland. It is produced in higher amounts by prostate cancer cells compared to normal prostate cells. Thus, PSA levels correlate with prostate cancer risk and can be used to screen for the disease. PSA testing measures the level of PSA in the blood. Most PSA in the blood is bound to proteins while a small amount is free (unbound). The total PSA level includes both bound and free PSA.
Normal PSA ranges
PSA levels normally increase as men age. Generally, PSA levels below 4.0 ng/mL are considered normal. However, some labs may use different upper limits of normal depending on a man’s age:
- 40-49 years: 0-2.5 ng/mL
- 50-59 years: 0-3.5 ng/mL
- 60-69 years: 0-4.5 ng/mL
- 70-79 years: 0-6.5 ng/mL
Higher PSA levels may indicate an increased risk of prostate cancer. However, other factors like prostate size, inflammation, and infection can also cause elevated PSA.
What is a PSA spike?
A PSA spike refers to a sudden and significant rise in PSA levels over a short period of time. For example, if a man’s PSA increases from 1.5 ng/mL to 5.2 ng/mL over 3 months, this would be considered a spike. Generally, a PSA velocity (rate of change) more than 0.75 ng/mL per year is considered fast rising. A sharp increase in PSA levels is concerning as it may indicate the presence of prostate cancer. However, benign prostate conditions can also cause PSA spikes.
Causes of PSA spikes unrelated to prostate cancer
Several benign prostate conditions can lead to sudden PSA elevations:
Prostatitis
Prostatitis refers to inflammation of the prostate gland. It can be caused by bacterial infection or be non-infectious. Prostatitis leads to PSA elevation by disrupting the prostate tissue architecture and increasing leakage of PSA into the blood. Antibiotics can treat infectious prostatitis and help bring PSA levels down.
Benign prostatic hyperplasia (BPH)
BPH involves proliferation of prostate gland cells resulting in prostate enlargement. Growth of prostate tissue increases production and release of PSA. Pressure on the urethra from the enlarged prostate can also cause inflammation, further raising PSA. BPH medications like alpha-blockers and 5-alpha reductase inhibitors may stabilize or lower PSA levels.
Prostate biopsy
Needle biopsy of the prostate causes temporary trauma to prostate tissue. This results in leakage of PSA from disrupted cells and irritation, increasing PSA for several weeks. PSA levels generally stabilize 6-8 weeks after biopsy.
Ejaculation
Ejaculation causes temporary irritation and inflammation of the prostate. This results in release of PSA into seminal fluid and subsequently in the bloodstream. Thus, PSA levels can spike for a few days after ejaculation before returning to baseline. Abstinence from sexual activity prior to PSA testing can prevent such spikes.
Catheter placement
Insertion of a urinary catheter can irritate the prostate and mechanically disrupt gland tissue. This raises PSA levels which normally improve after catheter removal.
Prostate manipulation
Medical procedures that manipulate or massage the prostate like digital rectal exam, prostate ultrasound, and cystoscopy can cause PSA spikes. This is due to mechanical pressure causing prostate cell damage and inflammation. PSA begins to decline within few days after the procedure.
Intense exercise
Strenuous physical activity like long-distance cycling can transiently increase PSA levels. The exact mechanism is unclear but exercise may affect prostate cell permeability and cause leakage of PSA into the bloodstream. PSA returns to normal after hormone levels stabilize post-exercise.
Other causes of PSA spikes
Besides prostate conditions, the following factors can also cause PSA spikes:
- Urinary tract infection – may irritate prostate cells and raise PSA
- Colonoscopy preparation – dehydration concentrated PSA levels
- Prostate infarction – blocked blood flow damages prostate cells
- Male hormones – testosterone directly stimulates PSA production
- Malignancy elsewhere – cancers not involving the prostate can increase PSA
- Lab error – imprecise test or sample contamination
Evaluating PSA spikes
Sudden PSA rises warrant medical evaluation to determine the cause. Doctors may recommend:
- Repeat PSA test – to confirm spike versus lab error
- PSA kinetics – evaluating velocity and doubling time
- Prostate exam – palpate for enlarged or abnormal prostate
- Urine test – assess for infection
- Imaging – MRI to visualize prostate
- Prostate biopsy – sample tissue to analyze
Based on results, the spike may be attributed to benign causes or warrant continued surveillance for prostate cancer.
Factors affecting PSA spike risk
Certain factors can increase a man’s risk of experiencing a PSA spike:
- Older age – benign prostate conditions become more common with advancing age
- Genetics – family history of prostate enlargement or cancer
- Urinary symptoms – potential indicator of prostate disorder
- Prior biopsy – trauma can cause recurrent spikes
- Infection history – recurrent prostatitis can lead to spikes
- Medications – testosterone supplements increase PSA production
- Obesity – associated with more prostate disease
- Smoking – impairs prostate function and health
Conversely, benign prostate enlargement and PSA spikes become less common after age 80.
Preventing PSA spikes
The following measures may help prevent or reduce PSA spikes:
- Avoid ejaculation and strenuous exercise 2-3 days before PSA test
- Ensure no prior prostate manipulations such as prostate massage, cystoscopy, etc.
- Treat any urinary tract infections prior to testing
- Stabilize benign prostate enlargement with medications if needed
- Allow PSA to stabilize after events like biopsy or catheter placement
- Stay well hydrated before the blood draw
Treating the underlying cause
If a benign cause of the PSA spike is identified, treating the underlying condition can help bring PSA levels down. Options include:
- Antibiotics for prostatitis
- Alpha blockers or 5-ARIs for benign prostate enlargement
- Stopping medications like testosterone affecting PSA levels
- Monitoring PSA after manipulation procedures allow levels to stabilize
Lifestyle measures like diet, exercise, stress reduction, and pelvic floor therapy may also benefit some prostate conditions.
When to consult a doctor
You should consult a doctor if you experience:
- PSA spike to above 4 ng/mL
- Rapid PSA velocity greater than 0.75 ng/mL/year
- PSA doubling time less than 3 years
- Difficulty urinating
- Other urinary symptoms
- Family history of prostate cancer
Evaluation is important even if you have had prior negative biopsies. Persistent elevated PSA requires assessment to rule out prostate cancer.
Monitoring PSA spikes
For PSA spikes attributed to benign causes, doctors may recommend:
- Repeating PSA test in 4-6 weeks
- Continued PSA monitoring every 3-6 months
- Tracking PSA velocity and doubling time
- Prostate biopsy if PSA remains elevated or continues rising despite treatment
Careful monitoring of spikes is key to detect significant changes that may indicate prostate cancer.
Conclusion
In summary, PSA spikes are common and can occur due to various benign prostate conditions. However, prostate cancer remains an important cause that requires evaluation. Thorough medical assessment and close monitoring of spikes is important to determine appropriate management. While spikes due to benign diseases often resolve with time or treatment, persistent elevation requires prompt diagnostic testing and specialty referral to rule out underlying cancer.