Elevated PSA; a. Prostatic carcinoma b. BPH c. Prostatic infections d. Perineal

Possible causes of an elevated PSA include prostate cancer, benign prostatic enlargement (BPH), and prostate infection or inflammation, including prostatitis or urinary tract infection; PSA is not specific to cancer, and levels also tend to rise with age NICE CKS.

Temporary elevation can follow vigorous exercise such as cycling, recent ejaculation, or urological procedures such as prostate biopsy; the prostatitis consensus also lists physical factors including DRE and biopsy as potential causes of raised results Rees 2015 NICE CKS.

Pelvic or perineal injury may be relevant when assessing prostatitis-like pelvic symptoms, but the supplied guidance and literature do not establish uncomplicated perineal injury as a direct cause of raised PSA NICE CKS Rees 2015.

Chronic constipation is not identified in the supplied sources as a cause of elevated PSA; constipation or bowel symptoms alone should therefore not be assumed to explain a raised result NICE CKS Rees 2015.

For interpretation, check for recent infection, ejaculation, vigorous exercise, and prostate instrumentation: NICE advises avoiding PSA testing during an active urinary infection or within the preceding 6 weeks, after ejaculation or vigorous exercise within 48 hours, and within 6 weeks of a urological intervention such as biopsy NICE CKS.

A raised PSA does not diagnose cancer: NICE notes that about three-quarters of men with PSA ≥3 ng/mL do not have prostate cancer, while a normal PSA does not exclude it NICE CKS.