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Q: Possible reasons for high PSA reading in relation to prostate problem. ( Answered,   0 Comments )
Subject: Possible reasons for high PSA reading in relation to prostate problem.
Category: Health > Men's Health
Asked by: medquest-ga
List Price: $20.00
Posted: 16 Jul 2006 10:17 PDT
Expires: 15 Aug 2006 10:17 PDT
Question ID: 746815
I need to find further information on misleading PSA readings, and
whether this can be caused by catheter insertion traumatising my

My situation is that I am abroad, in a remote area, and following a
complete failure to urinate due to an enlarged prostate, I had 5
attempted catheterisations over 3 days ( 2 successful when the correct
catheters had finally been located) plus 5 Digital Rectal

I am now returning to my home country, to visit an urologist. 

Question: could current high PSA of 12.5, measured after
catheterisations and DREs above, be partly or wholly due to the
procedures mentioned above?

Although I?ve done quite a bit of web research, I haven?t been able to
locate much material on PSA readings being significantly increased by
rough or incorrect catheterisation.

I am 58 years old, no previous symptoms, and no previous PSA readings:
I would just like to know if this (one) reading could be artificially
Subject: Re: Possible reasons for high PSA reading in relation to prostate problem.
Answered By: crabcakes-ga on 16 Jul 2006 11:24 PDT
Hello Medquest,

     You probably know by now that prostate cancer, and BPH (Benign
prostatic hypertrophy), enlargement of the prostate can cause both an
elevated PSA and difficulty urinating. While BPH is not cancerous, it
can lead to prostate cancer.  Why did you have 5 DREs in 3 days? Was
this to assist in the placement of the catheter in light of a blockage
of the bladder? Another thought is that you were in a remote area, and
the PSA measuring units may not be the same as in the US or other
countries. Perhaps the remote performing laboratory was a rudimentary
type and the reading is not accurate? (A off chance, I know, but to be

  When you have your PSA redrawn, be sure to abstain from taking Saw
Palmetto supplements for several weeks, if you are taking it, as it
can cause falsely low PSA results. You can also ask your doctor to
test your Free PSA (PSA-f). ?The PSA-f blood test measures the
percentage of free PSA (PSA-f) compared to bound PSA (PSA-ACT) out of
the total PSA circulating in your blood. PSA-f circulates in the blood
"unbound," without a carrier protein.
The "free" PSA test can help your urologist decide whether an elevated
or rising PSA is caused by benign prostate growth (BPH), which is a
common condition, or is caused by prostate cancer.

Patients with free PSA (PSA-f) over 25% usually have benign prostate hyperplasia.
Most patients with prostate cancer have a free PSA below 15%.
If your free PSA is below 7% the likelihood of prostrate cancer is
high. You should undergo biopsy.?

   Yes, urinary catheterization and DREs can mildly elevate a PSA
result. The best way to determine if the DREs and catheterization
actually elevated your PSA is to have it redrawn, upon arrival at
home, BEFORE any exercise, DREs, before any catheterizations, and 
before any sexual activity or 48 hours after. It is recommended that
men over 40 have an annual PSA drawn, so a rise over time can be

?Trauma to the prostate, as by physicians performing prostate massage,
and sex can also cause minor transient elevations of PSA.?
?The PSA level in the blood can vary by about 20% from day to day.
Nevertheless, the data are clear that a single abnormal PSA value puts
one in the higher group for prostate cancer. Now that we know the test
can be falsely elevated by trauma, infections, and intercourse, we
inquire after these factors before accepting the validity of the blood

   According to Family Practice Notebook, a catheter can elevate your PSA value:
? Causes of elevated PSA 
A.	Prostate Cancer 
B.	Benign Prostatic Hyperplasia (BPH) 
C.	Prostatitis 
D.	Prostate inflammation, trauma, or manipulation 
E.	Prostatic infarction 
F.	Recent sexual activity 
G.	Urologic procedures 
1.	Cystoscopy 
2.	Urinary Catheterization

According to ProstateCancerWatchfulWaiting, a DRE can elevate the PSA.
While it may elevate the PSA, I doubt if it would elevate it to 12.5.
Other studies, as is sometimes the case, show that exercise does not
elevate the PSA.
?It is recommended that blood for PSA testing should be drawn as early
in the day as is convenient and preferably before eating. Constipation
and weightlifting are thought to affect PSA levels as does virtually
anything that disturbs the prostate gland might have some effect. Some
of the major physical activities which should be avoided before
drawing the blood are shown below.

? DRE (Digital Rectal Examination). Although doctors often carry out
the DRE before drawing blood, they should reverse these procedures

? Sexual activity: Ejaculation can elevate PSA levels for up to 48
hours after it has taken place.

? Cycling or Motor Cycling: This can increase levels up to three times
for up to a week, depending on how strenuous the cycling is and it
includes an exercise bicycle

? Alcohol and Coffee: Both can irritate the prostate and should be
avoided for 48 hours prior to blood being drawn?

?It is therefore important to have a series of PSA tests done to
establish the average level before making any treatment decision. Many
men monitor their PSA levels for some years watching for any upward
trend in the numbers.
The key issue in looking at these series of numbers is the doubling
time of the PSA numbers - referred to in the PCa shorthand as PSADT.
There is more about this issue - and some interesting illustrations of
just how variable PSA readings can be in my Personal PSA History.

The most important point is that no decision to treat should be made
on the basis of one isolated PSA reading. Elevated PSA numbers should
always be checked by having a second test in case there is an error.?

   ?In this study, levels of PSA did not rise after men completed a
13-mile bicycle course. Having elevated PSA levels does not
necessarily mean that a man has prostate cancer because PSA blood test
are raised more frequently by other factors such as having a prostate
exam, infection and ejaculation.?

?CONCLUSIONS: There is no statistically or clinically significant
increase in PSA after bicycle riding. However, the few participants
with an initially elevated PSA had an increase after bicycle riding,
although this change does not represent the population and more
research is warranted to define further its clinical implications.?

  ?? What if the test results show an elevated PSA level?
A man should discuss elevated PSA test results with his doctor. There
are many possible reasons for an elevated PSA level, including
prostate cancer, benign prostate enlargement, inflammation, infection,
age, and race.
If no other symptoms suggest cancer, the doctor may recommend
repeating DRE and PSA tests regularly to watch for any changes. If a
man?s PSA levels have been increasing or if a suspicious lump is
detected during the DRE, the doctor may recommend other tests to
determine if there is cancer or another problem in the prostate. A
urine test may be used to detect a urinary tract infection or blood in
the urine. The doctor may recommend imaging tests, such as ultrasound
(a test in which high-frequency sound waves are used to obtain images
of the kidneys and bladder), x-rays, or cystoscopy (a procedure in
which a doctor looks into the urethra and bladder through a thin,
lighted tube). Medicine or surgery may be recommended if the problem
is BPH or an infection.

If cancer is suspected, a biopsy is needed to determine if cancer is
present in the prostate. During a biopsy, samples of prostate tissue
are removed, usually with a needle, and viewed under a microscope. The
doctor may use ultrasound to view the prostate during the biopsy, but
ultrasound cannot be used alone to tell if cancer is present.?

False positive tests: False positive test results (also called false
positives) occur when the PSA level is elevated but no cancer is
actually present. False positives may lead to additional medical
procedures that have potential risks and significant financial costs
and can create anxiety for the patient and his family. Most men with
an elevated PSA test turn out not to have cancer; only 25 to 30
percent of men who have a biopsy due to elevated PSA levels actually
have prostate cancer.?

   ?PSA levels can fluctuate up and down -- so a man with a high PSA
level may not actually have any prostate problems at all. In fact,
after studying nearly 1,000 men, researchers found that about half of
those whose PSA levels were initially high had a normal result in a
subsequent test.

But unfortunately, says the study's lead researcher, James Eastham,
MD, FACS, of Memorial Sloan-Kettering Cancer Center, the initial
finding of an elevated PSA is enough to warrant one of three typical
responses from doctors.
"The first scenario, and a common one, is that the patient is referred
for a biopsy, which may be unnecessary and painful," Eastham tells
WebMD. "The second is that the PSA is immediately repeated, within a
week or so. But that will only take into account any possible lab
error, since it's not enough time to get a handle on natural
fluctuations. And the third scenario is that the patient is assumed to
have inflammation or infection in the prostate, and put on antibiotics
or anti-inflammatory drugs."

   ?Scientists are searching for ways to reduce the number of
unnecessary biopsies triggered by high PSA results. One approach is to
measure two types of PSA, the PSA that travels in the blood bound to
other proteins and the PSA that travels unbound and free. When the
free PSA constitutes more than 25% of the total PSA, cancer is less
likely. But the free-PSA test is imperfect, and doctors are looking
for other ways to unravel the high-PSA puzzle. Since asymptomatic
prostatitis is a relatively common cause of a high PSA in the absence
of cancer, might a trial of antibiotics save some men from a biopsy?
Two studies, one from Europe, the other from the United States,
propose just such a plan.?

   Interestingly (but not relevant to you) is the fact that PSA can
come from other areas of the body:?"Prostate specific antigen (PSA) is
a widely used marker for prostate cancer. In the literature, there are
reports of nonprostatic expression of PSA that potentially can affect
early diagnosis. However, the results are scattered, which motivated
us to conduct a more comprehensive study of the tissue distribution of
PSA and the closely related protein human glandular kallikrein 2
(hK2). RT-PCR, in situ hybridization and immunohistochemistry were
used to detect expression of both PSA and hK2 in secretory epithelial
cells of trachea, thyroid gland, mammary gland, salivary gland,
jejunum, ileum, epididymis, seminal vesicle and urethra, as well as in
Leydig cells, pancreatic exocrine glands and epidermis. Immunometric
measurements revealed that the concentration of PSA in nonprostatic
tissues represents less than 1% of the amount in normal prostate.
Pronounced expression of PSA was detected in the Paneth cells in
ileum, which prompted us to compare functional parameters of PSA in
ileum and prostate. We found that in homogenates from these 2 tissues,
PSA manifested equivalent amidolytic activity and capacity to form
complexes with protease inhibitors in blood in vitro. Thus, PSA
released from sources other than the prostate may add to the plasma
pool of this protein, but given the lower levels detected from those
sites, it is unlikely that nonprostatic PSA normally can interfere
with the diagnosis of prostate cancer. Nevertheless, this risk should
not be neglected as it may be of clinical significance under certain
circumstances. Supplementary material for this article can be found on
the International Journal of Cancer website. Int J Cancer, January 10,
2005; 113(2): 290-7. Urol Clin North Am. 1997 May;24(2):275-82.
Related Articles, Links?

   ?The second aspect that needs to be taken into account is the rate
of change of the PSA level over time (known as 'PSA velocity'). For
example, a man may have a normal PSA level of 1.0 one year, and then a
higher, but still normal level of 3.5 the next. Although both readings
are in the 'normal' range, the rapid increase is significant and would
indicate the need to rule out a cancer, since benign tissue does not
exhibit such a rapid increase within such a short period of time.

In today's world of medicine, the PSA test stands out as a superb
'marker' of abnormalities in the prostate gland. When the PSA level is
supplemented by the other considerations mentioned here, the test will
help detect those prostate cancers that are truly significant,
hopefully before they have had a chance to grow too extensively.? 

   ?Results of the PSA are not diagnostic of prostate cancer, and a
high PSA number does not necessarily mean you have cancer. PSA test
interpretation varies among health practitioners. The PSA test is best
used to provide a "snapshot" of your prostate for your doctor to watch
for trends that warrant further study.?

I hope this has helped you out. Be sure to visit your urologist as
soon as possible for a thorough exam. I wish you the best!

If any part of my answer is unclear, please request an Answer
Clarification, and allow me to respond before you rate.

Sincerely, Crabcakes

Search Terms
Prostate trauma + elevated PSA
Falsely elevated + PSA
Foley catheter + elevated PSA
DRE causes elevated PSA
Urinary catheter causes elevated PSA
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