The prostate-specific antigen (PSA) test is an important screening tool for prostate cancer. This blood test measures the level of PSA, a protein produced by the prostate gland, in your blood. High PSA levels may indicate prostate cancer. While the PSA test is not perfect, it is currently the best way to detect prostate cancer early, before symptoms develop.
To help ensure the accuracy of your PSA test results, it’s important to avoid certain things in the days leading up to the test. Here’s an overview of what you should avoid before getting your PSA test.
Avoid Ejaculation
Ejaculation can temporarily increase PSA levels in some men. Current guidelines recommend avoiding ejaculation for 48 hours before a PSA test.
This includes masturbation and sex with a partner. The friction and stimulation of ejaculation can cause more PSA to leak into the bloodstream. Waiting at least 2 days allows PSA levels to stabilize.
Why Does Ejaculation Increase PSA Levels?
PSA is produced in the prostate and also composes one of the main components of semen. When you ejaculate, some additional PSA can leak out of the prostate gland and enter the bloodstream, causing a temporary spike.
For most healthy men, PSA levels return to a normal baseline within 48 hours after ejaculation. That’s why doctors recommend avoiding any sexual activity leading to ejaculation for the 2 days before your screening.
How Much Does PSA Increase After Ejaculation?
Studies show ejaculation may increase PSA levels by up to 0.5-1.0 ng/mL on average. However, there’s considerable individual variation. In some men, PSA can increase several ng/mL after ejaculation.
Because an elevated PSA level of 4.0 ng/mL or higher is considered abnormal, a transient spike of even 0.5 ng/mL could be enough to influence clinical decisions.
Does Age Impact PSA Response After Ejaculation?
Some research indicates younger men may experience greater PSA spikes after ejaculation compared to older men. However, the evidence is inconsistent.
Other studies show no significant difference in post-ejaculation PSA levels based on age. The 48-hour pre-PSA test abstinence rule therefore applies to both younger and older men.
Avoid Prostate Stimulation
In addition to ejaculation, prolonged stimulation of the prostate gland can also cause fluctuations in PSA. Activities that put pressure on or manipulate the prostate too vigorously are best avoided leading up to your screening.
This includes:
- Cycling – Long distance cycling where you remain seated for prolonged periods can put pressure on the prostate.
- Prostate massage – Should be avoided for at least 48 hours before your PSA test.
- Prostate milking – Manually “milking” prostatic fluid from the prostate should be avoided.
- Hemorrhoid creams – Anal suppositories or hemorrhoid creams should not be used the day of your PSA test.
All of these activities can inadvertently squeeze the prostate and push more PSA out of the glandular tissue into the bloodstream. It’s best to avoid any vigorous prostate stimulation for at least 2 days leading up to your screening.
Does Prostate Size Impact PSA Response?
Men with enlarged prostates tend to already have higher baseline levels of PSA. They may also experience greater transient spikes in PSA after ejaculation or prostate manipulation.
However, current guidelines still advise all men, regardless of prostate size, to avoid ejaculation and prolonged prostate stimulation for 48 hours before a PSA test.
Avoid Strenuous Exercise
Strenuous exercise that significantly raises your heart rate for prolonged periods should also be avoided for 48 hours before your PSA screening.
Types of exercise to avoid include:
- Endurance training – Such as long distance running or swimming.
- High intensity interval training (HIIT) – Bursts of intensive effort.
- Heavy strength training – Can spike blood pressure.
- Prolonged cycling – Puts pressure on the prostate.
Research shows even just 60 minutes of sustained vigorous exercise can temporarily increase PSA levels for up to 48 hours post-exercise. Easy short walks likely won’t impact your results, but more intense sweat-inducing workouts should be avoided.
Why Does Exercise Increase PSA Levels?
When you exercise strenuously, substances called prostaglandins and catecholamines are released in your body. These chemicals may irritate the prostate gland, causing more PSA to leak out into the bloodstream.
Allowing 48 hours for your PSA levels to return to baseline after exercise helps ensure you don’t get a falsely elevated reading.
Avoid Prostate Biopsies
Prostate biopsies involve using a needle to remove small samples of prostate tissue for examination under a microscope. This is done to check for cancerous cells if you’ve had repeatedly elevated PSA results or an abnormal prostate exam.
It’s recommended you wait at least 6 weeks after a prostate biopsy before having another PSA test. This allows PSA levels to stabilize and for any bleeding or inflammation from the biopsy to subside.
Why Do Biopsies Increase PSA Levels?
When a needle is inserted into the prostate to harvest tissue, some prostate cells spill into the bloodstream, elevating PSA. There may also be some bleeding into the prostate or irritation of the gland.
Waiting 6 weeks gives your PSA levels time to return to normal after this trauma to the gland.
Avoid Prostatitis and Prostate Infection
Prostatitis refers to inflammation or infection of the prostate gland. It often causes PSA levels to soar due to leakage of PSA from inflamed prostate tissue.
If you currently have prostatitis or recently had a prostate infection, it’s recommended to postpone your PSA testing until it has resolved and your PSA levels stabilize, which may take several weeks.
Types of Prostatitis That Increase PSA:
- Bacterial prostatitis – Caused by bacteria and leads to high PSA.
- Nonbacterial prostatitis – Inflammation without infection can also raise PSA.
- Chronic prostatitis – May cause intermittent PSA elevations.
In some cases your doctor may check your PSA levels to help diagnose prostatitis or monitor your response to treatment. But PSA isn’t a reliable diagnostic tool when your prostate is acutely inflamed.
Avoid Manipulating Your Testicles
Vigorously manipulating, massaging, or examining your testicles can indirectly transmit pressure to your prostate and push more PSA into your bloodstream.
Although limited research exists, some doctors recommend avoiding unnecessary handling of your testicles before a PSA test just to be safe.
Activities to Avoid Include:
- Testicular self-exams – do the day after your PSA test instead.
- Adjusting your testicles frequently – limit handling your testicles before testing.
- Intense testicular massage – avoid rough manipulation of your testicles.
If your testicles feel tender or painful before your PSA test, have them evaluated by your doctor soon afterwards. But rough handling that could bump your PSA should be avoided.
Avoid Over-the-Counter Medications
Certain over-the-counter (OTC) medications like antihistamines, decongestants and nonsteroidal anti-inflammatories (NSAIDs) may cause fluctuations in PSA levels.
Common OTC drugs that may impact PSA include:
- Ibuprofen (Advil, Motrin)
- Naproxen (Aleve)
- Aspirin
- Pseudoephedrine (Sudafed)
- Diphenhydramine (Benadryl)
The effects these medications have on PSA is likely small. However, it’s reasonable to avoid taking them close to your PSA screening if easily able to stop them temporarily.
Should I Stop All My Medications?
You only need to avoid select OTC medications around the time of your PSA testing. Prescription medications for chronic conditions like heart disease or diabetes should NOT be stopped unless your doctor instructs otherwise.
Avoid Prostate Procedures
Certain procedures involving the prostate can lead to large spikes or drops in PSA that obscure the accuracy of your screening results.
Procedures to avoid before PSA testing include:
- Prostate massage or milking
- Prostate biopsies
- Prostate surgery – Such as a radical prostatectomy to treat prostate cancer. PSA becomes undetectable after removal of the prostate gland.
- Transurethral resection of the prostate (TURP) – Can significantly lower PSA levels by reducing prostate volume.
Discuss recent prostate procedures with your doctor so they can interpret your PSA results in the appropriate context.
Avoid Alcohol
Drinking alcohol, especially heavily, may impact PSA results. Studies show consuming excessive amounts of alcohol can lower PSA levels in the blood by up to 20% in some men.
The effects alcohol has on PSA levels are variable. But to maximize the accuracy of your screening results, consider abstaining from alcohol for 24-48 hours before your test.
How Does Alcohol Lower PSA Levels?
Alcohol may lower PSA levels through several mechanisms, including:
- Decreasing prostate glandular secretions
- Suppressing release of testosterone, which controls PSA production
- Interfering with liver metabolism of PSA into the blood
Abstaining from alcohol around the time of your PSA test eliminates its confounding influence on results.
Avoid High-Fat Meals
Eating high amounts of dietary fats leading up to your PSA screening may impact test results. Studies show men put on a high-fat diet for several weeks show reductions in PSA levels.
To avoid this effect, it may help to limit high-fat foods on the day before and day of your screening. Foods to reduce may include:
- Red meat
- Whole milk dairy
- Butter and cream
- Fried foods
- Pastries and baked goods
- Fast food
Stick to low or moderate fat meals before your appointment to avoid any variability in your PSA levels.
Why Do Dietary Fats Lower PSA?
Researchers aren’t entirely sure why dietary fats affect PSA. Potential mechanisms include:
- Altering hormone levels that regulate PSA production
- Binding with PSA in the blood and interfering with its detection
- Delaying absorption of PSA from the prostate into the bloodstream
Conclusion
Getting an accurate PSA test result is key for proper prostate cancer screening. By avoiding ejaculation, prostate stimulation, exercise, medications, alcohol, and dietary fats near your appointment time, you can help ensure your PSA levels reflect your true baseline.
PSA results are just one factor doctors consider when assessing prostate cancer risk. But minimizing any potential influences on your test will provide your healthcare providers with the most accurate data to interpret.
Be sure to follow your doctor’s specific instructions about abstaining from certain activities leading up to your screening. This simple step empowers you to take an active role in getting the most from your PSA test.
