What PSA Level Is Too High?

The American Cancer Society (ACS) recommends PSA screening for men:

• Age 50 who have an average risk of prostate cancer and are expected to live at least 10 more years
• Age 45 who are at high risk of developing prostate cancer
  • This includes African Americans, who have a higher risk of developing more aggressive cancers 
  • Men who have a first-degree relative (father or brother) who was diagnosed with prostate cancer at an early age (younger than age 65)
• Age 40 who are at even higher risk 
  • Men who have more than one first-degree relative who had prostate cancer at an early age

Prostate problems can cause PSA levels to be too high, which may result in symptoms such as: 

• Frequent urge to urinate
• Frequent nighttime urination
• Feeling an urgent need to urinate, but being unable to urinate or only urinating a little
• Dribbling urine
• Leaking urine
• Weak urine stream
• Unusual color or odor to urine
• Blood in urine or semen
• Pain or burning urination
• Painful ejaculation
• Recurrent pain or stiffness in lower back, hips, pelvic or rectal area, or upper thighs
• Chronic pain and discomfort in the penis or scrotum, the area between the scrotum and anus, the abdomen, and lower back

Causes of a PSA level that is too high include:

• Enlarged prostate (benign prostatic hyperplasia, or BPH) — common in older men
• Bacterial prostatitis, can be acute (comes on quickly) or chronic (recurring)
• Chronic prostatitis (chronic pelvic pain syndrome)
• Urinary tract infection (UTI)
• Prostate cancer 
• Older age
• Recent ejaculation
• Certain urologic procedures
  • Prostate biopsy
  • Cystoscopy
• Use of male hormones such as testosterone or other medicines that raise testosterone levels 

Treatment for a PSA level that is too high depends on the prostate problems that caused the PSA levels to rise. 

Treatment for benign prostatic hyperplasia (BPH) includes:

• Watchful waiting (active surveillance, including regular checkups) when symptoms are not bothersome
• Lifestyle changes if symptoms are mild
  • Limit drinking liquids before bedtime or before going out
  • Avoid or limit alcohol or caffeine
  • Avoid medications that can affect the bladder, such as certain cold and allergy medicines
  • Change the timing of certain medicines, such as diuretics (water pills) or high blood pressure drugs
• Medications to help stop prostate growth or shrink the prostate 
• Alpha-blocker medications to relax prostate and bladder muscles to ease symptoms
• Radio waves, microwaves, or lasers which use different kinds of heat to reduce extra prostate tissue to treat urinary problems caused by BPH
• Surgery 

Treatment for bacterial prostatitis includes:

• Antibiotics 
• Pain medications 
• Drink plenty of fluids

Treatment for chronic prostatitis includes:

• Medications 
  • To reduce pain and inflammation
  • Alpha-blockers to relax the muscles in the prostate and part of the bladder
• Lifestyle changes
  • Warm baths
  • Relaxation exercises
  • Physical therapy 
• Surgery

Treatment for prostate cancer depends on whether cancer is in part or all of the prostate, if it has spread (metastasized) to other parts of the body, and the age and overall health of the patient and may include one or more of the following:

• Watchful waiting (active surveillance)
• Surgery: removal of the whole prostate and some nearby tissue
• Radiation therapy
• Hormone therapy