Elevated PSA levels are a possible indication of health issues, including prostate cancer, and enlarged prostate gland. The condition is commonly diagnosed in males above the age of 60 and individuals are often screened for the condition around this age. A common doubt on the minds of patients is the effect of medications on these indicators – what medications can increase PSA levels? Following subsections offer a detailed look at PSA levels and also list out medications that can impact the PSA levels. This will help identify false positives and prevent unnecessary panic in the minds of patients.
Overview of PSA levels
Acronym for prostate-specific antigen, this refers to a protein produced by the cells of the prostate gland. PSA levels refer to the amount of this protein present in a person’s blood. Though PSA testing is commonly used as a screening tool for prostate cancer, elevated levels are also possible for other reasons, including inflammation of the prostate gland. Additional testing, such as a biopsy, may be necessary to determine the cause of elevated PSA levels, and it is a widely acknowledged that PSA testing is not perfect and can sometimes miss prostate cancer or give false-positive results. This makes it necessary to use the test along with other screening and diagnostic tools for an accurate assessment.
What are the right PSA levels?
The “right” PSA levels depend on several factors, including age, race, and individual risk factors for prostate cancer. Generally, PSA levels below 4 ng/mL (nanograms per milliliter) are considered normal. PSA levels can be elevated due to certain medical procedures also, such as a prostate biopsy or surgery. Additionally, men with prostate cancer may have PSA levels within the normal range, so further testing and monitoring may be necessary even if PSA levels are low. Screening for prostate cancer using PSA testing is ideally recommended around the age of 50 or earlier for men at higher risk.
What are the possible symptoms of high PSA levels?
High PSA levels alone do not typically cause any symptoms, though prostate cancer may present symptoms including:
- Difficulty urinating or a weak urine stream
- Frequent urination, particularly at night
- Blood in the urine or semen
- Pain or discomfort in the pelvic area
- Erectile dysfunction
These symptoms are not specific to prostate cancer and can also be attributed by other conditions such as BPH or prostatitis. A thorough evaluation can help determine the underlying cause of symptoms for appropriate treatment wherever necessary.
What are the different tests to check PSA levels?
Typically, there are two main tests to check PSA levels, with the second test branching off into two sub-categories of tests.
#1 Digital rectal exam (DRE): A healthcare provider inserts a lubricated, gloved finger into the rectum to feel the prostate gland. The test is to check for the presence of lumps, bumps, or other abnormalities that indicate prostate cancer. While a DRE cannot measure PSA levels directly, it can provide valuable information about the size, texture, and shape of the prostate gland.
#2 PSA blood test: This test measures the level of prostate-specific antigen in the blood, with elevated levels indicating prostate cancer, or prostatitis or benign prostatic hyperplasia (BPH). There are two types of PSA tests:
- Total PSA test: This measures the total amount of PSA in the blood, including both bound (attached to proteins in the blood) and free (unattached) PSA.
- Free PSA test: This measures only the amount of free PSA in the blood. This test can be useful in distinguishing between benign conditions and prostate cancer, as prostate cancer often produces more bound PSA than free PSA.
Treatment options for high PSA levels
The treatment varies and depends on the underlying cause, including the following:
- Active surveillance: This involves monitoring the cancer with regular PSA testing and biopsies, and only treating the cancer if it grows or causes symptoms.
- Surgery: Surgical removal of the prostate gland, known as a prostatectomy, is a common treatment option for prostate cancer.
- Radiation therapy: This involves using high-energy radiation to kill cancer cells in the prostate gland.
- Hormone therapy: This involves lowering the levels of testosterone in the body, which can help slow the growth of prostate cancer cells.
- Chemotherapy: This involves using drugs to kill cancer cells throughout the body.
When elevated PSA levels are caused by other conditions, treatment options may include antibiotics for prostate infection, anti-inflammatory medication for prostate inflammation, or lifestyle changes such as dietary modifications or stress reduction techniques.
What medications can increase PSA levels?
Several medications are known to increase PSA levels, and patients are to intimate treating specialists at the time of evaluation about intake of the following categories of medications:
- 5-alpha-reductase inhibitors commonly used to treat enlarged prostate or male pattern baldness.
- Testosterone replacement therapy, used to treat low testosterone levels in men.
- Medications used to treat prostate cancer, such as luteinizing hormone-releasing hormone (LHRH) agonists and antagonists.
- Medications used to treat benign prostatic hyperplasia, such as alpha-blockers.
- Nonsteroidal anti-inflammatory drugs such as ibuprofen or aspirin, that can cause inflammation of the prostate gland.
How to counter the effects of medications that increase PSA levels?
When medications are identified as the reason for an increase in PSA levels, the first step is to determine the importance of the medication and the condition it is used for treating. Doctors can help identify alternative medications to replace the drugs that impact PSA levels. Depending on the underlying condition, there may also be other treatment options available that do not have the same effect on PSA levels.
In certain instances, the medication may be necessary and cannot be stopped due to the nature of the condition. In such instances, the healthcare provider may monitor PSA levels more closely, and may rely on a different cutoff value to interpret the PSA test results, to factor in the impact of the medications. Depending on the new interpretations, a decision may then be taken to determine if the PSA levels require any additional assessment.
Education: Doctor of Pharmacy (PharmD) from the University of Florida. Experience: 5 years as a pharmacist and medical writer, creating content on medication management and pharmaceutical news for healthcare blogs and patient education sites.
