Causes of PSA Flucturation

Causes of PSA Fluctuation

Table IVa.   Factors Related to Fluctuation in PSA Level

Factors

Effect on PSA levels

Comment

Prostate Disease

     BPH

     Prostatitis

     Prostate Ischemia

May be elevated

False positive when used to diagnose prostate cancer

Other disease

     Acute Renal Failure

     Bypass Surgery

May be elevated

Clinical Manipulation

     Digital Rectal Exam

     Trans-rectal ultrasound

     Prostate biopsy

     TURP

May be elevated

Result elevated

May be elevated 6%

Do not test until 4-6 weeks afterwards

Treatment

     Radiation treatment

     (transient)

     Radiation treatment

     Antiandrogen drug therapy:      nafarelin, buserelin,

     goserelin (Zoladex),

     leuprolide, flutamide,

     finasteride (Proscar)

     Prostatectomy

May be temporarily elevated

Result decreased

Result decreased

Result should be undetectable unless residual disease

Nadir has prognostic significance. Lowest level expected in 3-9 months

Nadir has prognostic significance. Do not test until 3-6 months after treatment. Lowest level expected in 3-12 months

Do not test until one month after surgery

Other Patient Characteristics

     Prolonged exercise

     Patient age and prostate size

     Ejaculation

May be increased

May lead to increase

May be increased or decreased (studies vary)

Age-adjusted reference ranges may be helpful

Adapted from: Bunting PS. Clin Biochem 1995;28:221-241