A high PSA does not always mean you have prostate cancer.
PSA and Prostate Cancer – What You Should Know
Many men are understandably concerned when they’re told they have a high PSA (Prostate-Specific Antigen) level. But here’s the important truth:
There are many other reasons your PSA could be raised — some completely harmless, others related to inflammation, lifestyle, or recent activity. In this newsletter, I’ll walk you through the most common causes of a high PSA, and what they might mean for you.
What Is PSA?
PSA is a protein made in the prostate and found in semen. Small amounts naturally leak into the bloodstream, which is why we can measure it with a simple blood test.
The PSA test is a valuable tool for detecting prostate cancer early, but it’s not perfect. Other factors can cause your PSA to rise temporarily — and that can be stressful if you’re not expecting it.
Common Reasons for a High PSA (That Aren’t Cancer)
Here are 9 key reasons your PSA might be elevated:
1. Benign Prostatic Hyperplasia (BPH)
This is the most common cause of a raised PSA.
As men age, the prostate often enlarges. This condition is called BPH — and it’s not cancer. But because a larger prostate makes more PSA, your levels can rise naturally.
You may notice:
Slower urine stream
Hesitation when starting
Needing to go more often
2. Prostatitis (Inflammation or Infection of the Prostate)
Prostatitis can be caused by a bacterial infection or chronic inflammation. Either way, it can trigger a sharp rise in PSA.
Types of prostatitis:
Acute bacterial: You’ll feel unwell, with fever, chills, and pelvic pain.
Chronic non-bacterial: Ongoing discomfort, especially around the perineum (between the scrotum and anus).
3. Urinary Tract Infection (UTI)
Though UTIs are less common in men, they can still occur — especially if the bladder doesn’t empty fully due to an enlarged prostate. A UTI can irritate the prostate and push PSA levels up.
Symptoms might include:
Burning when urinating
Cloudy or smelly urine
Urinary urgency or frequency
4. Recent Ejaculation
Sexual activity in the 48 hours before a PSA test can temporarily raise your level by 5–10%.
Tip: Try to avoid ejaculation for at least 2 days before your test.
5. Prostate Biopsy or Examination
Even a routine rectal exam (DRE) or recent prostate biopsy can cause irritation that raises PSA.
If you've had:
A biopsy
A prostate massage
Any rectal procedure
…you may need to wait a few weeks before a reliable PSA test.
6. Catheterisation or Bladder Procedures
If you've recently had a catheter placed, or surgery involving your bladder or urinary tract, this can stimulate the prostate and increase PSA temporarily.
7. Cycling or Perineal Pressure
Extended periods of cycling, particularly road cycling, can cause prolonged pressure on the perineum — the area right under the prostate — and may artificially raise PSA.
Advice:
Avoid long rides in the few days before your blood test if you're monitoring PSA.
8. False Negatives in Prostate Cancer
On the flip side — some aggressive prostate cancers don’t make much PSA.
So it’s also possible to have a normal PSA but still have cancer. That’s why we use MRI scans and targeted biopsies to investigate further when needed.
9. Long-Term Effects of Biopsy
Even months after a biopsy, your PSA can remain slightly elevated — especially if you also have BPH. This makes it tricky to interpret results unless we account for timing and context.
Final Thoughts
The PSA test is an important tool in screening for prostate cancer — but like any test, it has limitations. Knowing what else can affect your result is the key to making sense of your numbers. Today, we also use MRI imaging to refine our assessments and avoid unnecessary biopsies. Together, this gives us a much clearer picture of your prostate health.
If your PSA is elevated, don’t panic — let’s explore why, and work out the next step together.
Stay informed, stay proactive — and don’t hesitate to reach out if you have concerns about your prostate health.