What Causes an Elevated PSA?

What is a PSA test?

PSA stands for prostate specific antigen. It is a protein produced by cells in the prostate gland. A PSA test is a simple blood test that measures how much PSA there is in a man’s blood. This type of test is most often done by a urologist when men turn a certain age or when men possess certain symptoms or risk factors relating to prostate conditions. The blood test is then sent to a laboratory to be analyzed. The results of the PSA are often reported in ng/mL, which means nanograms per milliliter.


PSA is a protein produced by the prostate gland. It is secreted by the prostate in the semen, where it liquefies the semen after ejaculation. Most of the PSA that the prostate produces is released from the body in the semen. However, some of the PSA remains in the blood. Men with a healthy prostate usually have a low amount of PSA in their blood. carried out of the body in semen, but a very small amount escapes into the blood stream, so PSA is normally found in low amounts (nanograms per milliliter or ng/mL) in the blood.

What is a normal PSA level?        

A “normal” PSA level is generally between 1.0 and 4.0 ng/mL. Anything above 4.0ng/mL is considered “abnormal” or elevated. The PSA level may differ depending on a man’s age. As men age, the prostate gets larger. A larger prostate produces more PSA. Therefore, younger men generally have lower PSA levels while older men tend to have higher PSA levels. These variations in PSA levels are not always associated with a prostate condition, other than an enlarged prostate. The PSA level may also vary depending on the man’s ethnicity or if they have a family history of prostate cancer.

What causes the PSA to elevate?

The PSA elevates in the blood as a result of the prostate cells or gland being disrupted in some way. Because the PSA is not specific for one type of prostate condition, it can be elevated due to a number of different conditions. Most common causes of elevated PSA:

Benign prostatic hyperplasia (BPH)

BPH also means an enlarged prostate gland. This does not mean prostate cancer. BPH is the most common prostate condition men over 50 suffer from. It can often cause urination problems such as frequent urination or difficulty urinating.


Prostatitis also means a prostate infection, which causes inflammation of the prostate gland. Prostatitis is the most common prostate condition in men younger than 50. It can usually be treated with antibiotics.

Prostate cancer

An elevated PSA could indicate prostate cancer. If you have an elevated PSA, your doctor will also do a digital rectal exam to see if there are any suspicious lumps present on the prostate gland. If they suspect prostate cancer, a prostate biopsy will be recommended. It’s also important to monitor any changes in the PSA; if the PSA continues to rise, this may mean prostate cancer. If you continue to have an elevated PSA, but your biopsy is negative, your doctor will most likely recommend follow-up PSA tests and a follow-up biopsy within six months.


As men age, their prostate naturally gets bigger. This happens regardless of any medical condition affecting the prostate gland.

Having certain medical procedures or exams

The prostate can sometimes be affected after certain procedures, such as a prostate biopsy or cystoscopy. It can also be affected after having a digital rectal exam. The PSA can elevate after having any of these done because they disturb the prostate gland. It can even rise after having a catheter in place. The PSA should go back to normal within a few days once the prostate has healed.

After sex

After sex, or ejaculation, the PSA can go up. The PSA usually only goes up very slightly, so it may not even show a difference. The PSA should go back to normal within a few days.

Urinary tract infection

A urinary tract infection can cause irritation and inflammation in the prostate gland, which can cause the PSA to go up. If you have a UTI, a doctor will prescribe antibiotics to treat it. The PSA should go back to normal after the infection has gone away so make sure to wait until then to have a PSA test. Men with an enlarged prostate have a higher risk for urinary tract infections.

What to do if you have an elevated PSA

If you have an elevated PSA, you should see a urologist. A urologist will do a number of tests to determine exactly what is causing the elevated PSA. Additional tests may include another PSA test, a urinalysis test, post-void residual, assessment of medical history and family history, and possibly a prostate biopsy or cystoscopy.

If you do not have any prostate cancer symptoms and your PSA remains elevated after all other prostate conditions have been ruled out, your urologist will recommend having follow-up PSA tests, digital rectal exams to monitor for any changes. If your urologist suspect you may have prostate cancer, such as by finding a nodule during a DRE, they will do a prostate biopsy. The results of the biopsy will be sent to a pathologist to be analyzed and then sent back to the urologist.

If the pathology reports shows prostate cancer, your urologist will discuss the various treatment options depending on the Gleason score and stage of the disease. Most men benefit most from having a robotic prostatectomy. Although, this depends on whether you are a good candidate for surgery. Other treatment options that may be recommended include active surveillance, radiation, or others depending on how advanced the disease is.

If the prostate biopsy does not show prostate cancer, yet you continue to have an elevated PSA, your urologist will recommend follow-up PSA tests and a follow-up biopsy within six months. In either case, it’s important to see a prostate cancer specialist to monitor your case.