These Medications Can Increase Your PSA Levels

T'Keyah Bazin, PharmD
·7 min read

Medically reviewed by Femi Aremu, PharmD

Prostate-specific antigen (PSA) is a protein the prostate produces from both normal and abnormal cells. The prostate is a male reproductive organ that produces and transports reproductive fluid.

The PSA test, a lab test, is used to measure how much PSA is in the blood.

Higher PSA levels may indicate that there is a problem with the prostate, such as:

PSA tests are most notably a screening tool to help determine if an individual may have prostate cancer. However, taking certain medications can increase these PSA levels, which can cause misleading results.

This article discusses factors that affect PSA levels, including medications that can alter these test results.

<p>Getty Images / FatCamera</p>

Getty Images / FatCamera

What Is a PSA Test?

The PSA test is not a routine lab test for most people. PSA testing typically begins around age 55. In higher-risk individuals, PSA screening may begin as early as 40.

Because the PSA test is a screening test, it is not for diagnostic purposes. Prostate cancer is often diagnosed after an elevated PSA is detected and additional testing and imaging, such as a prostate biopsy, are completed.

An abnormal PSA level does not always mean something is wrong. Age, race, and taking certain medications can impact PSA levels.

It is important to be aware of which medications have the potential to increase PSA levels. Inform your healthcare provider if you are taking any of these medications before having PSA levels tested to help ensure results are interpreted accurately.

Medications That Increase PSA Levels

Certain medications may increase PSA levels by causing the prostate gland to release PSA, resulting in extra amounts of the protein in the blood. Falsely elevated PSA levels can indicate that there is a problem with the prostate when there isn't.

It is important to be aware of medications that can increase PSA levels. This way, you can make informed decisions regarding your health, avoid unnecessary concerns, and ensure appropriate follow-up monitoring is complete.

Betamethasone

Betamethasone is a corticosteroid medication. It is available in oral, topical, transdermal, and injectable formulations. It treats symptoms associated with several skin conditions.

Topical betamethasone can be absorbed by the body even though it is applied externally to the skin. It has been associated with increased PSA levels due to its ability to activate androgen receptors.

Androgens are a class of sex hormones, with testosterone being the most prominent androgen. Androgen receptors play a significant role in the development and progression of prostate cancer, hence the potential impact of increased PSA in those using topical betamethasone.

Changes in PSA levels may also occur in people taking betamethasone orally (by mouth).

Additional research is necessary to determine the actual impact of betamethasone on PSA levels in the blood of people living with prostate cancer as well as those undergoing screening for prostate cancer.

Testosterone Replacement Therapy

Hypogonadism is a condition that is characterized by testosterone deficiency, or low testosterone. Testosterone replacement therapy is a common treatment.

Testosterone is involved in several processes throughout the body. Clinically, testosterone deficiency is defined as having low testosterone levels, considered 300 nanograms (ng) per deciliter (dL). Symptoms of testosterone deficiency include:

Testosterone replacement therapy refers to any type of treatment for increasing serum testosterone levels, including:

  • Direct testosterone therapy, which is available in oral, topical, and injectable forms

  • Selective estrogen receptor modulators (SERMs)

  • Human chorionic gonadotropin (hCG)

  • Aromatase inhibitors (AIs)

The goal of testosterone replacement therapy is to raise testosterone levels to normal and achieve resolution of symptoms.

Testosterone replacement therapy, particularly when given as an injection into the muscle, has been associated with a rise in PSA levels that is dependent on testosterone levels at baseline. People with lower initial testosterone levels are more likely to experience increases in PSA.

It is recommended that those on testosterone replacement therapy have PSA levels tested before beginning therapy and as directed by their healthcare provider.

The U.S. Food and Drug Administration (FDA) has issued a warning regarding the risk of prostate cancer in those on testosterone therapy. However, clinical trials and research have failed to provide a definitive link between the cancer and the therapy.



What Is Considered a High PSA Level?

Your provider will be able to interpret your PSA results. In general, a PSA level is considered normal if it is less than 4 ng/mL. A PSA level between 4 and 10 ng/mL is considered borderline, and greater than 10 ng/mL is considered high.

It is important to note that even PSA levels considered to be high are not diagnostic. It is possible to have what is considered a normal PSA and still have prostate problems. Conversely, high PSA levels do not necessarily mean there is something wrong with the prostate.



Medications That Lower PSA Levels

Medications can lower PSA levels through a variety of different processes depending on the medication. The following medications can lower PSA levels:

5-ARIs

5-ARIs are commonly taken over long periods to treat BPH. Drugs in this class have been shown to suppress PSA, resulting in a nearly 50% decrease in levels.

Statins

Statins help lower cholesterol and reduce heart disease risk in high-risk people. They have been associated with up to a 13% decrease in PSA levels when used long-term.

Atorvastatin was most significantly associated with lower PSA levels than other statins, followed by rosuvastatin with intermediate lowering and simvastatin with minimal PSA lowering. Other statins were not associated with notable PSA changes.

Thiazide Diuretics

Thiazide diuretics are TAKEN to lower blood pressure. They are also associated with lowering PSA levels by more than 20% with long-term use. Taking a thiazide diuretic with a statin resulted in the largest difference in PSA levels. This combination of medications is not uncommon and may warrant clinical consideration when evaluating PSA results.

NSAIDs

NSAIDs are commonly taken as pain and fever reducers. Regular and long-term use of NSAIDs may reduce PSA levels in the blood by nearly 6% due to their anti-inflammatory effects.

Though these medications may lower PSA levels when taken long-term, additional studies are necessary to determine if they may also reduce the risk of prostate cancer.

Other Causes for High PSA Levels

Besides medications, other factors can contribute to high PSA levels, such as:

  • Older age

  • Prostate cancer

  • Prostate conditions such as BPH

  • Infections such as prostate and urinary tract infections

  • Prostate procedures

  • Ejaculation (for a short time afterward)

Understanding which factors can influence PSA results allows you to provide valuable insights that your healthcare provider may have otherwise not known. This can aid in their assessment of your prostate health.

Summary

PSA is a protein produced by the prostate. A normal prostate may produce smaller amounts of PSA, whereas higher PSA levels may indicate an underlying health condition.

PSA testing usually begins around age 55 but may begin sooner for high-risk individuals. The PSA test is a screening tool and should not be used for diagnosis. If your PSA is elevated, the lab may be repeated, or additional imaging may be required. A PSA level of less than 4 ng/mL is typically considered normal.

However, having an elevated PSA does not necessarily mean something is wrong. In some cases, taking certain medications can affect how high or low your levels are. Betamethasone and testosterone replacement therapy, for example, have been shown to increase PSA levels. This means you should tell your healthcare provider if you take these medications before PSA testing.

Talk to your provider if you are taking or considering taking a medication that has the potential to impact your PSA levels to help ensure your prostate health is accurately assessed.

Read the original article on Verywell Health.