Prostate-Specific Antigen (PSA) is a protein produced by the prostate gland. It’s commonly used as a biomarker to screen for prostate cancer and monitor the health of the prostate.

While elevated PSA levels can be a sign of prostate cancer, other factors can also contribute to high PSA levels, including certain medications. Understanding how medications can affect PSA levels is crucial.

What is PSA and why is it important?

PSA is a substance naturally produced by the prostate gland. It’s primarily found in semen, but small amounts are also present in the blood.

In medical testing, PSA levels are used to detect signs of prostate conditions such as benign prostatic hyperplasia (BPH), prostatitis, and prostate cancer. A high PSA level might indicate the presence of one of these conditions, but it’s important to note that other factors – like medications – can also contribute to elevated PSA levels.

Understanding high PSA levels

Before we dive into how certain medications can influence PSA readings, it’s important to clarify what constitutes high PSA levels.

Typically, a PSA level above 4.0 ng/mL is considered elevated. However, age and other factors, such as family history, can also affect what’s considered a normal PSA range. Men over the age of 50 are at a higher risk of having an elevated PSA, and it’s essential to monitor these levels regularly for any significant changes.

It’s worth noting that PSA levels can fluctuate for a variety of reasons, such as infections, sexual activity, or even vigorous exercise. Certain medications, however, can directly impact PSA levels, leading to potential misinterpretation of test results.

Read more: What Is A Dangerous PSA Level?

UK medications that can affect PSA levels

Several classes of medications have been identified as potentially raising PSA levels. Here are some of the most common culprits:

1. 5-Alpha Reductase Inhibitors (5-ARIs)

5-ARIs are commonly prescribed to treat benign prostatic hyperplasia (BPH) and male pattern baldness. These drugs work by inhibiting the conversion of testosterone into dihydrotestosterone (DHT), a hormone that plays a key role in prostate growth.

While 5-ARIs can be highly effective in reducing prostate size, they can also lower PSA levels by up to 50%, potentially masking the presence of prostate cancer.

For men who are taking 5-ARIs, doctors typically recommend doubling the PSA value to get an accurate reading of prostate health. For example, a PSA level of 2.0 ng/mL while on 5-ARIs may actually indicate a normal level of 4.0 ng/mL.

2. Statins

Statins, widely prescribed for lowering cholesterol, have been shown to have a slight effect on PSA levels. Some studies suggest that statins may reduce PSA levels, possibly due to their anti-inflammatory properties. Since PSA levels can be affected by inflammation in the prostate, statins might cause a reduction in PSA, potentially obscuring the diagnosis of prostate cancer.

In the UK, statins are commonly prescribed, and research has indicated that men on statin therapy might experience lower PSA levels compared to those not taking these medications. However, the relationship between statins and PSA levels is still being studied, and further research is needed to fully understand the impact of statins on PSA testing.

3. Alpha-Blockers

Alpha-blockers are often prescribed to treat the symptoms of BPH, such as urinary retention and frequent urination. While these medications do not directly affect PSA production, they can impact the interpretation of PSA levels. Alpha-blockers work by relaxing the muscles in the prostate and bladder, making it easier to urinate, but their effect on PSA readings remains inconclusive.

Some studies suggest that long-term use of alpha-blockers may lead to a slight increase in PSA levels, although the evidence is not consistent. As a result, doctors may recommend additional tests or biopsies if PSA levels are high while on these medications.

4. Thiazide Diuretics

Thiazide diuretics, commonly used to treat hypertension and fluid retention, have also been shown to potentially elevate PSA levels. While the exact mechanism remains unclear, thiazide diuretics can cause changes in the prostate that lead to increased PSA production. If you are taking thiazides and have concerns about your PSA levels, it’s important to discuss this with your doctor, as elevated PSA levels could complicate the interpretation of prostate health.

5. Cyclooxygenase-2 (COX-2) Inhibitors

COX-2 inhibitors are a class of non-steroidal anti-inflammatory drugs (NSAIDs) used to treat pain and inflammation. These drugs are thought to reduce the risk of prostate cancer by inhibiting the COX-2 enzyme, which is involved in cancer cell growth. However, some studies suggest that COX-2 inhibitors can increase PSA levels, making it more difficult to interpret PSA results accurately.

If you are using COX-2 inhibitors for an extended period, it’s essential to monitor your PSA levels regularly and consult your healthcare provider if any significant changes occur.

6. Testosterone Replacement Therapy

Testosterone replacement therapy (TRT) is prescribed to men with low testosterone levels, a condition known as hypogonadism. While TRT can help alleviate symptoms such as fatigue, depression, and reduced libido, it can also cause an increase in PSA levels. This is because the added testosterone can stimulate the prostate to produce more PSA.

Men undergoing TRT are typically monitored closely for any significant changes in PSA levels, as this can indicate potential prostate problems, including prostate cancer. It’s crucial for men undergoing TRT to have regular PSA screenings to ensure their prostate health remains in check.

Other factors that can influence PSA levels

While medications play a significant role in influencing PSA levels, it’s important to consider other lifestyle and health factors that may impact PSA readings. These include:

PSA testing in the UK

Prostate cancer is the most common cancer among men in the UK. According to Prostate Cancer UK, about 1 in 8 men will be diagnosed with prostate cancer during their lifetime. Regular PSA testing is often recommended for men over the age of 50, especially those with a family history of prostate cancer. However, it’s crucial to remember that PSA levels can be influenced by various factors, including the medications you are taking.

In the UK, healthcare providers follow strict guidelines when interpreting PSA levels. If you have concerns about how your medications might be affecting your PSA levels, it’s important to have a detailed discussion with your doctor. They may recommend alternative testing methods or adjust your medication regimen to ensure accurate PSA readings.

Final notes

High PSA levels can be a cause for concern, as they may indicate the presence of prostate problems, including prostate cancer. However, it’s important to remember that medications can also influence PSA levels, sometimes leading to inaccurate results. Medications such as 5-alpha reductase inhibitors, statins, alpha-blockers, and others can either increase or decrease PSA levels, making it vital for healthcare providers to consider all factors when interpreting test results.

If you’re taking medication and concerned about your PSA levels, discuss it with your doctor to ensure your tests are accurately reflecting your prostate health. Regular screenings, along with an understanding of how your medications may affect PSA levels, are key in maintaining prostate health.

Related read: What Not To Do Before A PSA Blood Test