Is PSA Testing Accurate During Prostate Inflammation? Expert Insights

Q: Is PSA Testing Accurate During Prostate Inflammation? Expert Insights

Nicole： It is generally recommended to have a follow-up blood test after three months to check for any changes. <br>If there is a decrease, monitoring can continue; if the levels are higher or have not decreased, then a biopsy should be considered. <br>However, typically, inflamm

Is the PSA test result accurate when inflammation is present?

Hello Dr.
Hsu, my father (59 years old) visited the hospital on December 26, 2015, due to difficulty urinating.
After a physical examination, the urologist found an enlarged prostate and recommended a blood test for PSA.
On that day, the doctor prescribed Harnalidge D and the antibiotic Cravit for two weeks.
After taking the medication, his condition improved immediately, and he has been urinating smoothly since then.
On January 16, 2016, he returned for a follow-up and the test results showed a PSA level of 19.077, Free PSA of 1.411, and a Free PSA/PSA ratio of 7.40.
I would like to ask Dr.
Hsu whether a biopsy is necessary or if another PSA blood test should be done.
Is the PSA value accurate in the context of prostatitis? Thank you!

Nicole, 30~39 year old female. Ask Date: 2016/01/19

Dr. Xu Weikai reply Urology

Nicole: It is generally recommended to have a follow-up blood test after three months to check for any changes.
If there is a decrease, monitoring can continue; if the levels are higher or have not decreased, then a biopsy should be considered.
However, typically, inflammation does not cause such a significant increase in PSA levels unless the inflammation has been prolonged and severe.
Note: There have been clinical cases where patients with inflammation had PSA levels exceeding 30.
Usually, this is accompanied by examinations such as prostate ultrasound and digital rectal examination, and a comprehensive assessment is made before deciding on a biopsy.
If there are any unclear points, feel free to ask again for further discussion and research.
Answers found online should only be used as a reference; if necessary, it is important to seek medical attention at a healthcare facility.
This response is provided by Dr.
Hsu Wei-Kai, Chief of Urology at Taitung Hospital, Ministry of Health and Welfare.

Reply Date: 2016/01/19

More Info

Prostate-Specific Antigen (PSA) testing is a crucial tool in the evaluation of prostate health, particularly in the context of potential prostate cancer. However, the accuracy of PSA testing can be significantly affected by various factors, including prostate inflammation, also known as prostatitis. In your father's case, the elevated PSA level of 19.077 ng/mL, alongside the presence of prostate enlargement and subsequent treatment with antibiotics, raises important questions regarding the reliability of this measurement.

When the prostate is inflamed, PSA levels can rise due to the increased permeability of the prostate gland, which allows more PSA to enter the bloodstream. This can lead to misleadingly high PSA levels that do not necessarily indicate cancer. In fact, inflammation can cause PSA levels to spike significantly, sometimes even exceeding 30 ng/mL in severe cases. Therefore, it is essential to consider the context in which the PSA test was performed.

In your father's situation, the initial high PSA level could be attributed to the inflammation caused by prostatitis. After treatment with antibiotics, if the PSA level decreases, it may suggest that the initial elevation was indeed due to the inflammatory process rather than malignancy. It is generally recommended to wait a few months after the resolution of prostatitis before re-testing PSA levels to obtain a more accurate assessment. This allows the prostate to return to its baseline state, providing a clearer picture of its health.

Regarding the Free PSA and the Free PSA to Total PSA ratio, these metrics can also provide additional insights. A Free PSA level of 1.411 ng/mL and a Free PSA ratio of 7.40% may indicate a lower likelihood of prostate cancer, as higher ratios are often associated with benign conditions. However, these values should be interpreted in conjunction with the total PSA level and clinical findings.

Given the complexity of interpreting PSA results, especially in the presence of inflammation, it is advisable to follow a stepwise approach. The recommendation to repeat the PSA test after a few months is prudent. If the PSA levels remain elevated or continue to rise, further investigation, such as a prostate biopsy, may be warranted to rule out cancer definitively.
In summary, while PSA testing is a valuable tool in assessing prostate health, its accuracy can be compromised by conditions such as prostatitis. In your father's case, monitoring PSA levels after treatment and considering a repeat test before deciding on a biopsy is a reasonable approach. Always consult with a healthcare provider for personalized medical advice and to discuss the best course of action based on the specific clinical context.

Similar Q&A

Understanding PSA Levels: Accurate Testing for Prostate Cancer Risk

Hello Dr. Lee, I have a history of prostatitis, during which my PSA level was 5.6. After two weeks of antibiotic treatment, I was re-evaluated and found to be free of inflammation. However, over the past year, my PSA levels have fluctuated, rising from 6 to 9, then dropping to 8,...

Dr. Li Xinyi reply Urology
Monitoring PSA levels, digital rectal examination, and multi-parametric prostate MRI at certain medical centers may be beneficial.

Understanding Prostatitis: PSA Tests and Their Limitations

I have recently experienced a cooling sensation in my penis and scrotum, and I previously had issues with urination. Therefore, I visited a large hospital to see a urologist and expressed my desire to check for any problems or inflammation in my prostate. The doctor simply ordere...

Dr. Du Shixi reply Urology
Hello: The penis and scrotum feel cold, and there were previous issues with difficulty urinating, which are not typical symptoms of chronic inflammation. Wishing you good health.

Understanding Transrectal Ultrasound Accuracy for Prostate Health

Hello, doctor. I apologize for asking again, but I would like to inquire about the accuracy of transrectal ultrasound examinations for the prostate. I previously underwent a transrectal ultrasound at Wan Fang Hospital, where the doctor mentioned that there were some calcification...

Dr. Xu Weikai reply Urology
All tests are merely references and not absolute. For most individuals, they can serve as reference values, but they may not necessarily apply to everyone. In other words, while the PSA levels for most people fall between 0 and 4, indicating benign conditions, some individuals wi...

Understanding Elevated PSA Levels: Is It Prostate Cancer?

Recently, I visited a urologist due to urinary issues. In addition to a digital rectal exam, my PSA level was measured and found to be in the sixties. The doctor prescribed antibiotics, and after taking them, my urinary flow improved. The doctor recommended a follow-up appointmen...

Dr. Fu Shizhang reply Urology
There are many reasons for elevated PSA levels, with cancer, inflammation, and benign prostatic hyperplasia being common causes. A definitive diagnosis requires a prostate biopsy. Generally, if PSA levels are high but digital rectal examination and ultrasound imaging show no abno...