Does Sexual Activity Before Blood Tests Affect Free/Total PSA Ratio? - Urology

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The relationship between sexual activity, particularly ejaculation, and prostate-specific antigen (PSA) levels is a topic of considerable interest in urology. PSA is a protein produced by both normal and malignant cells of the prostate gland, and its levels can be indicative of prostate health. Elevated PSA levels can be associated with various conditions, including benign prostatic hyperplasia (BPH), prostatitis, and prostate cancer.

In your case, you noted that your PSA levels increased from 4.6 to 5.2 ng/mL between two tests, and you also reported that you engaged in sexual activity (ejaculation) the day before both tests. Research indicates that sexual activity can indeed influence PSA levels. Specifically, ejaculation can lead to a temporary increase in PSA levels, which may last for up to 48 hours post-ejaculation. This is due to the release of PSA from the prostate into the bloodstream during ejaculation.

Regarding the Free/Total PSA (f/t PSA) ratio, this measurement is often used to help differentiate between benign and malignant prostate conditions. The free PSA is the unbound form of PSA, while total PSA includes both free and bound forms. A lower f/t PSA ratio can suggest a higher likelihood of prostate cancer, while a higher ratio is often associated with benign conditions.

While sexual activity can elevate total PSA levels, it is less clear how it directly affects the free PSA levels or the f/t PSA ratio. Some studies suggest that the f/t PSA ratio may not be significantly influenced by ejaculation, but the total PSA increase could potentially lead to a lower f/t PSA ratio if the free PSA does not increase proportionately. This means that while your total PSA levels rose, the free PSA levels might not have increased to the same extent, thereby affecting the ratio.

In your specific situation, the increase in total PSA from 4.6 to 5.2 ng/mL, combined with a f/t PSA ratio of 10.7%, could suggest that the recent sexual activity may have contributed to the elevated total PSA. However, it is essential to consider other factors that could influence PSA levels, including age, prostate size, and any underlying medical conditions such as prostatitis or BPH.

To summarize, while sexual activity can lead to an increase in total PSA levels, its effect on the free PSA levels and the f/t PSA ratio is less straightforward. It is advisable to refrain from sexual activity for at least 48 hours before a PSA test to obtain the most accurate results. If you have concerns about your PSA levels or the implications of your test results, it is crucial to discuss these with your healthcare provider, who may recommend further testing or monitoring based on your individual risk factors and clinical history. Regular follow-up and possibly additional tests, such as a prostate biopsy or imaging studies, may be warranted depending on the context of your PSA levels and any symptoms you may be experiencing.