Elevated PSA Levels: Causes, Concerns, and Next Steps

Prostate issues

Hello, Doctor:
Q1.
In April of this year, I had a health check-up, and my PSA level was 7.96.
In May, I went to the hospital for further testing, and my PSA level was 7.92.
Initially, the doctor only performed a blood test, but later I researched online and found that (1) acute prostatitis, (2) chronic bacterial prostatitis, (3) chronic non-bacterial prostatitis, and (4) cystitis can cause elevated PSA levels.
I requested a urinalysis, but it was done after the doctor performed a digital rectal examination.
Can this method effectively identify prostatitis or cystitis as potential causes of the elevated PSA levels? Below are the results of my urinalysis:
Color: Yellow
Turbidity: Clear
Specific Gravity: 1.009
pH: 7.0
Leukocyte: Negative
Nitrite: Negative
Protein: Negative
Glucose: Negative
Ketone: Negative
Urobilinogen: 0.1
Bilirubin: Negative
Blood: Negative
RBC: 1
WBC: 0
Squamous Epithelial Cells: 1
Q2.
Which of these results can indicate that I do not have inflammation as a cause?
Q3.
In July, I had another check-up, and my PSA level rose to 8.81.
I am unsure if this is due to my attempt to reduce masturbation frequency from four times a week to once every two weeks, or if it is due to recent relationship stress causing increased pressure, leading to the elevated PSA levels.
Q4.
The hospital physician has been insisting that I undergo a biopsy, but I am concerned that a biopsy could lead to septic shock or death from superbugs.
Do I need to take this risk for a potential cancer diagnosis, or can I wait a bit longer? However, I am worried that waiting might cause me to miss the optimal treatment window.
Should the doctor recommend that I proceed with the biopsy immediately, or is it acceptable to wait?
Q5.
In my twenties, I frequently masturbated, sometimes as much as 14 times a week.
Could this be a contributing factor to my elevated PSA levels?
P.S.
I have had an ultrasound examination that showed no prostate enlargement; the prostate size was only 19.92.

Shehu Xian Fan Nao Ren, 30~39 year old female. Ask Date: 2014/07/27

Dr. Xu Weikai reply Urology

Hello,
1.
Elevated PSA levels can have many causes.
However, your levels are quite high, and further examination is necessary, such as a prostate ultrasound and prostate biopsy.

2.
Turbidity, leukocytes, nitrite, WBC, and RBC levels are all normal, which indicates no evidence of a urinary tract infection.

3.
Stress does not cause elevated PSA levels.
Typically, ejaculation can lead to a temporary increase, so it is recommended to avoid ejaculation for 2-3 days prior to blood testing.
Additionally, conditions like constipation or diarrhea may also affect the levels.

4.
The decision to proceed with a biopsy is up to you.
If you are uncertain, you may seek a consultation at another hospital before making a decision.

5.
Yes, it can have an impact.
If you have any further questions or need clarification, feel free to ask, and we can discuss it further.
Online responses should only be used as a reference; it is essential to seek medical attention at a healthcare facility if necessary.

Best regards,
Director of Urology, Hsu Wei-Kai, Taitung Hospital, Ministry of Health and Welfare.

Reply Date: 2014/07/27

More Info

Understanding elevated PSA (Prostate-Specific Antigen) levels is crucial for men, especially as they age. PSA is a protein produced by both normal and malignant cells of the prostate gland, and its levels can be influenced by various factors, including prostate health, inflammation, and even lifestyle choices.

Causes of Elevated PSA Levels
1. Prostate Conditions: Elevated PSA levels can indicate several prostate-related conditions:
- Prostatitis: This is an inflammation of the prostate gland, which can be acute or chronic. It can cause significant increases in PSA levels.

- Benign Prostatic Hyperplasia (BPH): This non-cancerous enlargement of the prostate can also lead to elevated PSA levels.

- Prostate Cancer: While elevated PSA levels can indicate cancer, it is not definitive. A biopsy is necessary for a conclusive diagnosis.

2. Recent Activities: Certain activities can temporarily raise PSA levels:
- Sexual Activity: Ejaculation can cause a temporary spike in PSA levels, so it is often recommended to abstain from sexual activity for 24-48 hours before testing.

- Medical Procedures: Procedures such as prostate biopsies, cystoscopies, or even vigorous digital rectal exams can elevate PSA levels.

- Cycling: Prolonged cycling can put pressure on the prostate and potentially elevate PSA levels.

3. Infections: Urinary tract infections or sexually transmitted infections can also lead to increased PSA levels.

Interpreting Your Results
In your case, the PSA levels have fluctuated, with readings of 7.96, 7.92, and then 8.81. The urine test results you provided show no signs of infection (negative leukocytes, nitrite, and blood), which suggests that an infection is less likely to be the cause of your elevated PSA. The clear turbidity and normal pH further support this conclusion.

Lifestyle Factors
You mentioned reducing the frequency of masturbation and experiencing stress. While lifestyle changes can influence overall health, they typically do not have a significant impact on PSA levels. Stress itself is not known to directly affect PSA levels, but it can influence your overall well-being and perception of health.

Next Steps: Biopsy Considerations
Your concern about the recommendation for a biopsy is valid. While biopsies can carry risks, including infection, they are often necessary to rule out prostate cancer, especially with elevated PSA levels. The risk of severe complications is relatively low, but it is essential to discuss these concerns with your healthcare provider. They can provide information on the likelihood of cancer based on your PSA levels and other factors, and help you weigh the risks and benefits of proceeding with a biopsy.

Monitoring and Follow-Up
Given your elevated PSA levels, regular monitoring is essential. Your healthcare provider may suggest repeating the PSA test in a few months to see if the levels stabilize or decrease. If they continue to rise, further investigation, including imaging studies or a biopsy, may be warranted.

Conclusion
Elevated PSA levels can be concerning, but they do not automatically indicate cancer. It is essential to consider all potential causes, including benign conditions and lifestyle factors. Regular follow-up with your healthcare provider is crucial for monitoring your prostate health and determining the best course of action. If you have ongoing anxiety about your health, consider discussing this with your doctor, as they may recommend speaking with a mental health professional to help manage your concerns.

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