PSA (prostate-specific antigen)

What raises PSA

• Prostate cancer.
• Benign prostatic hyperplasia, the common age-related enlargement of the prostate.
• Prostatitis or a urinary tract infection.
• Recent ejaculation, a prostate biopsy or vigorous exercise such as cycling.
• Testosterone therapy, which can modestly raise PSA in some men.

What lowers it

Finasteride and dutasteride, used for an enlarged prostate and sometimes hair loss, lower PSA. Clinicians use a lower threshold for "abnormal" in men taking them, so always tell the person ordering the test about these medicines, including topical or compounded forms.

Screening: a personal decision

The U.S. Preventive Services Task Force recommends that men 55 to 69 decide about PSA screening individually after weighing benefits and harms with a clinician, and recommends against routine screening at 70 and older. That 2018 recommendation is being updated.

The trade-offs are real. The National Cancer Institute notes that only about 25% of men who have a biopsy because of an elevated PSA are found to have cancer, and screening can detect slow-growing cancers that would never have caused harm, leading to treatment side effects such as urinary, bowel and sexual problems.

PSA and testosterone therapy

Testosterone can stimulate prostate tissue, so prostate safety is checked before and during treatment. The American Urological Association advises measuring PSA in men over 40 before starting testosterone therapy. The Endocrine Society recommends against therapy in men with a PSA above 4 ng/mL or a prostate nodule without further evaluation, and suggests urology referral if PSA rises more than 1.4 ng/mL in the first year or a confirmed value exceeds 4.0 ng/mL.

Getting an accurate result

MedlinePlus advises avoiding ejaculation for about 24 hours before the test, and the NCI notes some men also avoid vigorous exercise like cycling beforehand. If a result is borderline, repeating it, often with free PSA or other tests, is common before any biopsy. Your HealifyMD clinician will include PSA in baseline and follow-up labs when you are on testosterone.

PSA trends over time

A single PSA value is less informative than the pattern. A slow, steady rise over years is common as the prostate enlarges with age, while a sudden jump deserves a closer look. Keeping results from the same lab and noting any new medications, infections or procedures near each test date helps your clinician interpret changes accurately and avoid unnecessary biopsies.