When It’s Not Cancer: 6 Surprising Reasons Your PSA Might Be High

By Dr. David Samadi

You’ve just gotten your PSA test results, which are higher than expected. Understandably, alarm bells start ringing. But after further evaluation, including a prostate biopsy, there’s good news: no signs of prostate cancer.

While the relief is immense, a lingering question remains: What else could be causing the elevated PSA levels?

Let’s take a closer look.

What Is PSA?

Prostate-specific antigen, or PSA, is a protein the prostate gland produces. PSA levels are typically measured through a blood test and are used as a screening tool for prostate cancer.

Generally, a PSA level under four nanograms per milliliter (ng/mL) is considered normal. But PSA levels can rise for reasons other than cancer, and that’s where things get a bit more complex.

6 Common Causes of Elevated PSA That Aren’t Cancer

An elevated PSA doesn’t automatically signal prostate cancer. Several non-cancerous conditions and even lifestyle factors can push PSA levels higher. Here are six of the most common causes:

1. Aging

It’s natural for PSA levels to increase gradually with age. One key reason? Benign prostatic hyperplasia (BPH), a non-cancerous enlargement of the prostate that’s incredibly common in older men. While the exact cause of BPH isn’t fully understood, age-related hormonal shifts likely play a role.

2. Benign Prostatic Hyperplasia (BPH)

BPH doesn’t raise your cancer risk, but it can mimic some of the same urinary symptoms, like a weak stream or frequent nighttime trips to the bathroom. The prostate grows large enough to squeeze the urethra, making urination more difficult and sometimes increasing PSA production as a result. This can significantly impact your daily routine and quality of life.

3. Prostatitis

Prostatitis is inflammation of the prostate, and it can be acute (sudden and severe) or chronic (lingering over time). It’s often painful and can lead to swelling and irritation, which raises PSA levels. Symptoms may include pain or burning during urination, frequent urination, and pain in the genital area. While uncomfortable, it’s not cancerous and can usually be treated with medication.

4. Urinary Tract Infections (UTIs)

A UTI affects the bladder and can also inflame the prostate. This irritation can trigger a temporary spike in PSA. If you have a UTI, it is best to delay PSA testing until the infection has cleared to avoid misleading results.

5. Recent Physical Activity or Prostate Stimulation

Activities that put pressure on the prostate, like cycling, horseback riding, or even vigorous exercise, can elevate PSA levels. Likewise, specific medical exams, such as digital rectal (DRE), may cause a temporary bump. Avoid these activities for at least 48 hours before your PSA test for the most accurate results.

6. Medications and Supplements

Some medications can influence PSA levels. Testosterone replacement therapy, for example, may elevate PSA. Other drugs like NSAIDs, statins, and even certain medicines for urinary symptoms (such as finasteride or dutasteride) can alter your PSA reading, sometimes raising it, sometimes lowering it. Always let your doctor know about all medications and supplements you’re taking.

The Bottom Line

An elevated PSA doesn’t automatically mean prostate cancer, but it does mean your prostate needs attention. It’s essential to work closely with your urologist, a specialist in the urinary system and male reproductive system, to understand the whole picture, rule out serious conditions, and determine next steps.

Knowledge is power. Understanding the possible reasons behind a high PSA can help you make informed decisions about your health, with clarity, not fear.

Dr. David Samadi is the Director of Men’s Health and Urologic Oncology at St. Francis Hospital in Long Island. He’s a renowned and highly successful board certified Urologic Oncologist Expert and Robotic Surgeon in New York City, regarded as one of the leading prostate surgeons in the U.S., with a vast expertise in prostate cancer treatment and Robotic-Assisted Laparoscopic Prostatectomy.  Dr. Samadi is a medical contributor to NewsMax TV and is also the author of  two books, Prostate Cancer, Now What? A Practical Guide to Diagnosis, Treatment, and Recovery, and The Ultimate MANual, Dr. Samadi’s Guide to Men’s Health and Wellness, available online both on Amazon and Barnes & Noble. Visit Dr. Samadi’s websites at robotic oncology and prostate cancer 911.