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Raised PSA during urinary tract infection — MSRA MCQ

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ModeratePSARaised PSA during urinary tract infectionMSRA

A 63-year-old man presents with 4 months of nocturia, hesitancy and reduced urinary flow. During the past 5 days he has also developed dysuria and urinary frequency. He has no visible haematuria, bone pain, weight loss, urinary retention or recent urinary instrumentation. Digital rectal examination shows a smooth, symmetrically enlarged prostate. Midstream urine culture grows Escherichia coli. His PSA, taken at this consultation, is 7.0 micrograms/L. He is fit for radical treatment should clinically significant prostate cancer be diagnosed. What is the most appropriate next management plan?

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Correct answer: E — Treat the urinary tract infection and repeat PSA 4 to 6 weeks after the infection has cleared; make a suspected cancer pathway referral if it remains above 4.5 micrograms/L

Explanation lettering: C = shown as B · D = shown as C · E = shown as D · B = shown as E

The PSA result was obtained during a culture-confirmed urinary tract infection, which can cause a transient PSA elevation. It should therefore not be used in isolation to trigger referral when the prostate examination is benign. Treat the infection, ensure symptoms have resolved, and repeat PSA after 4 to 6 weeks. If the repeat PSA remains above the NICE age-specific threshold for a man aged 60 to 69 years (>4.5 micrograms/L), a suspected cancer pathway referral should be considered, taking account of his fitness and preferences. A is initially attractive because 7.0 micrograms/L exceeds the age-specific threshold, but it fails to account for the active infection as a recognised confounder. C repeats the test too soon: PSA testing should be deferred for 4 to 6 weeks after a urine infection has cleared. D bypasses the repeat-test step despite a plausible reversible explanation and benign DRE. E may help LUTS due to benign prostatic enlargement, but delaying reassessment for 12 months risks missing a persistently raised PSA requiring cancer-pathway referral.

Reference: PSA test (Last reviewed 2 September 2024) — https://www.nhs.uk/tests-and-treatments/psa-test/ Suspected cancer: recognition and referral (NG12), prostate cancer recommendations (2015, amended 2025) — https://www.nice.org.uk/guidance/ng12/chapter/recommendations-organised-by-site-of-cancer