Sudden PSA Level Increase: Causes and Concerns

Sudden increase in PSA levels?

Hello Doctor, I had my annual health check-up on May 17th this year.
Since 2013, I have been monitoring my PSA levels, which were consistently between 2 and 2.1 until 2018.
However, this year, the level suddenly increased to 8.
Before the check-up, I didn't have any specific symptoms that would restrict my activities, so I engaged in sexual activity late the night before the test.
Could this have influenced the elevated PSA level? I haven't experienced any discomfort, my urination is normal, and all other cancer markers are well below the standard values.
However, I occasionally feel a bit of warmth in my right testicle.
Could this indicate an inflammatory issue? I'm a bit concerned and plan to get further tests at a nearby hospital, so I wanted to consult with you.
Thank you.

MK, 30~39 year old female. Ask Date: 2019/06/06

Dr. Xu Wencang reply Urology

Prostatitis can also cause an increase in PSA levels.
The incidence of prostate cancer in a 39-year-old is very low, so close monitoring is recommended.

Reply Date: 2019/06/06

More Info

The sudden increase in PSA (Prostate-Specific Antigen) levels can be concerning, especially when there is a significant jump from previous readings. In your case, the rise from a stable range of 2-2.1 to 8 is noteworthy and warrants further investigation.
First, it is important to understand that PSA levels can be influenced by various factors, including recent sexual activity. Engaging in ejaculation within 24 hours before a PSA test can lead to a temporary increase in PSA levels. This is due to the release of PSA from the prostate gland during ejaculation. Therefore, your activity the night before the test could potentially explain part of the increase. However, a rise to 8 is substantial and may indicate other underlying issues.

Aside from sexual activity, several other factors can contribute to elevated PSA levels:
1. Prostatitis: This is an inflammation of the prostate gland, which can be caused by bacterial infections or other non-bacterial factors. Symptoms may include pelvic pain, painful urination, or discomfort in the genital area, but some men may not experience noticeable symptoms.

2. Benign Prostatic Hyperplasia (BPH): This is a non-cancerous enlargement of the prostate that is common as men age. BPH can lead to elevated PSA levels, even in the absence of cancer.

3. Prostate Cancer: While a sudden increase in PSA can be alarming, it is important to note that not all elevated PSA levels indicate cancer. However, cancer is a serious consideration, especially with significant increases.

4. Recent Medical Procedures: Any recent procedures involving the prostate, such as a biopsy or catheterization, can also elevate PSA levels.

5. Urinary Tract Infections (UTIs): Infections in the urinary tract can cause inflammation and lead to increased PSA levels.

Regarding your concern about the occasional warmth in your right testicle, this could suggest inflammation or infection, such as epididymitis or orchitis. It is advisable to discuss this symptom with your healthcare provider, as they may recommend further evaluation, including a physical examination and possibly imaging studies or laboratory tests.

Given your history of stable PSA levels and the recent spike, it is prudent to follow up with your healthcare provider for additional testing. This may include repeating the PSA test after a few weeks to see if the levels stabilize or decrease, as well as considering a free PSA test to help differentiate between benign conditions and potential malignancy. If necessary, a prostate biopsy may be recommended based on the results of these tests and your clinical presentation.

In summary, while there are several benign explanations for elevated PSA levels, the significant increase you experienced should not be overlooked. It is essential to maintain open communication with your healthcare provider, who can guide you through the necessary steps for diagnosis and management. Regular monitoring and appropriate follow-up are key to ensuring your prostate health.

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