What is a PSA Test?

PSA (Prostate Specific Antigen) is a protein produced by cells in the prostate gland. A PSA test measures the level of this protein in the blood.

Small amounts of PSA normally enter the bloodstream. However, higher PSA levels may occur when the prostate is irritated, inflamed, enlarged, or affected by disease.

An elevated PSA does not automatically mean prostate cancer. Many non-cancerous conditions can also cause PSA to rise.

Elevated PSA (Prostate Specific Antigen)

Diagram of the human male reproductive system, showing internal organs including the prostate, bladder, and urethra.

Common Causes of an Elevated PSA

Benign Prostatic Hyperplasia (BPH)

An enlarged prostate is a common cause of increased PSA levels, particularly in older men.
BPH is non-cancerous and occurs as the prostate grows with age.

Symptoms may include:

  • Weak urinary stream

  • Difficulty starting urination

  • Frequent urination, especially at night

  • Feeling that the bladder does not empty fully

Prostatitis (Prostate Inflammation or Infection)

Inflammation or infection of the prostate can cause PSA to rise significantly.

Symptoms may include:

  • Pelvic or perineal pain

  • Painful urination

  • Fever or chills

  • Difficulty urinating

This condition is usually treated with medications such as antibiotics.

Prostate Cancer

Prostate cancer can cause elevated PSA levels. However:

  • Many men with prostate cancer have only mild PSA elevation

  • Many men with high PSA do not have cancer

Further tests are needed to determine whether cancer is present.

Recent Ejaculation

Ejaculation within 24–48 hours before the test can temporarily raise PSA levels.

Doctors often recommend avoiding ejaculation before a PSA blood test.

Prostate Stimulation or Medical Procedures

PSA may increase temporarily after procedures that affect the prostate, including:

  • Digital rectal examination (DRE)

  • Prostate biopsy

  • Catheter insertion

  • Cystoscopy

  • Recent prostate surgery

Urinary Tract Infection (UTI)

Infections involving the urinary tract or bladder may raise PSA levels.

Symptoms may include:

  • Burning when urinating

  • Frequent urination

  • Cloudy or foul-smelling urine

  • Fever

Vigorous Exercise

Certain activities that put pressure on the prostate may increase PSA temporarily, such as:

  • Cycling

  • Horse riding

  • Intense physical activity involving the pelvic area

Age

PSA levels tend to increase gradually with age due to natural prostate enlargement.

For this reason, doctors often interpret PSA results using age-specific reference ranges.

What Happens if PSA is Elevated?

If your PSA level is higher than expected, your doctor may recommend:

  • Repeating the PSA test

  • Treating possible infection first

  • A digital rectal examination (DRE)

  • Imaging tests (such as prostate MRI)

  • Referral to a urologist

  • Prostate biopsy in selected cases

The decision depends on:

  • PSA level

  • Rate of PSA change over time

  • Age and risk factors

  • Examination findings

Important Points to Remember

  • PSA is a screening and monitoring test, not a diagnosis.

  • Many men with elevated PSA do not have prostate cancer.

  • PSA results must always be interpreted in the clinical context.

When to Discuss PSA Testing With Your Doctor

Talk to your doctor about PSA testing if you:

  • Are over 50 years old

  • Are over 45 with a family history of prostate cancer

  • Have urinary symptoms

  • Have previously had an elevated PSA