The PSA level can also be increased by a number of factors other than prostate cancer, such as:
- An enlarged prostate: Conditions such as benign prostatic hyperplasia (BPH), a non-cancerous enlargement of the prostate that affects many men as they grow older, may raise PSA levels.
- Older age: PSA levels normally go up slowly as you get older, even if you have no prostate abnormality.
- Prostatitis: This term refers to infection or inflammation of the prostate gland, which may raise PSA levels.
- Ejaculation: This can cause the PSA to go up for a short time, and then go down again. This is why some doctors suggest that men abstain from ejaculation for 2 days before testing.
- Riding a bicycle: Some studies have suggested that cycling may raise PSA levels (possibly because the seat puts pressure on the prostate), although not all studies have found this.
- Certain urologic procedures: Some procedures done in a doctor’s office that affect the prostate, such as a prostate biopsy or cystoscopy, may result in higher PSA levels for a short time.
- Digital Rectal Exam (DRE): Some studies have suggested that a DRE might raise PSA levels slightly. Still, if both a PSA test and a DRE are being done during a doctor visit, some doctors advise having the blood drawn for the PSA before having the DRE, just in case.
- Certain medicines: Taking male hormones like testosterone (or other medicines that raise testosterone levels) may cause a rise in PSA.
- Obesity: Obese (very overweight) men tend to have lower PSA levels.
Some medicines may cause PSA levels to go down (even if cancer is present):
- 5-alpha reductase inhibitors: Certain drugs used to treat BPH or urinary symptoms, such as finasteride (Proscar or Propecia) or dutasteride (Avodart), may lower PSA levels. These drugs can also affect prostate cancer risk. You should tell your doctor if you are taking these medicines because they may lower PSA levels and require the doctor to adjust the reading.
- Herbal mixtures: Some mixtures that are sold as dietary supplements may also mask a high PSA level. This is why it is important to let your doctor know if you are taking any type of supplement, even ones that are not necessarily meant for prostate health. Saw palmetto (an herb used by some men to treat BPH) does not seem to affect PSA.
- Aspirin: Some recent research has suggested that men taking aspirin regularly may have lower PSA levels. If you take aspirin regularly (such as to help prevent heart disease), talk to your doctor before you stop taking it for any reason.
- Statins: Cholesterol-lowering drugs known as statins, such as atorvastatin (Lipitor®), rosuvastatin (Crestor®), and simvastatin (Zocor®), are linked to lower PSA levels if taken over years. However, this effect on PSA levels is not seen if calcium channel blockers are taken at the same time. Calcium channel blockers, such as diltiazem (Cardizem®), amlodipine (Norvasc®), and verapamil (Calan®), are drugs used to treat high blood pressure and heart problems.
- Thiazide diuretics: Thiazide diuretics, such as hydrochlorothiazide (HCTZ), are a type of water pill often used to treat high blood pressure. Taking a thiazide diuretic for years is linked to lower PSA levels. Taking both a thiazide diuretic and a statin is linked to even lower PSA levels than with either type of drug alone.