Pearls of Wisdom: Does Elevated PSA Always Mean Prostate Cancer?
Patrick, a 25-year-old man, and his 23-year-old wife, Julie, both received a diagnosis of hepatitis A virus infection several days after having consumed undercooked shellfish. Due to a clerical error, both Patrick and Julie underwent tests for prostate-specific antigen (PSA) levels.
Surprisingly, the results showed elevated PSA levels in both patients.
What explains this result?
A. Laboratory error resulting in a false-positive PSA elevation in Julie
B. Asymptomatic prostate cancer in Patrick
C. Elevated PSA levels in both patients as a result of hepatitis A infection
D. None of the above
What is the correct answer?
(Answer and discussion on next page)
Louis Kuritzky, MD, has been involved in medical education since the 1970s. Drawing upon years of clinical experience, he has crafted each year for almost 3 decades a collection of items that are often underappreciated by clinicians, yet important for patients. These “Pearls of Wisdom” often highlight studies that may not have gotten traction within the clinical community and/or may have been overlooked since their time of publishing, but warrant a second look.
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Answer: The elevated PSA levels are a result of the patients’ hepatitis A infection
On further questioning, Patrick had recently experienced prostatitis, and that can certainly raise the PSA level. Simply aging can raise the PSA level, as well. Anecdotally, I have seen some urologists treat a patient with a borderline-elevated PSA level with a course of antibiotics (usually trimethoprim-sulfamethoxazole or a quinolone) to see whether silent prostatitis was contributing to the elevated PSA level before progressing to biopsy for prostate cancer.
A Case Report
An interesting case report appeared in 1997 about a couple that had been admitted to a hospital for acute hepatitis A infection.1 The admitting physician mistakenly ordered, in addition to liver function tests, PSA tests for the man and the woman. Both patient's results were markedly elevated and then decreased as the hepatitis infection resolved, leading us to the conclusion that hepatitis should be added to the list of causes of PSA level elevations.
What’s the “Take Home”?
While an elevated PSA level is typically regarded as a potential indicator of prostate cancer, aging, prostatitis, and even hepatitis can cause PSA elevations.
1. Bosch X, Bernadich O. Increased serum prostate-specific antigen in a man and a woman with hepatitis A. N Engl J Med. 1997;337(25):1849-1850.