Can exercise elevate your PSA?

Physical activity releases prostate-specific antigen (PSA) from the prostate into the blood and increases serum PSA concentrations.

thelancet.com - New NHS guidelines for PSA testing in primary care - The Lancet

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The UK Department of Health has recently published the Prostate Cancer Risk Management Programme, which is currently being distributed to general practitioners. We wish to comment on several issues that we feel this information pack fails to deal with satisfactorily.

1 Crawford ED

Schultz MJ

Clejan S

et al. The effect of digital rectal examination on prostate specific-antigen levels. 2 Oremek GM Seiffert UB Physical activity releases prostate-specific antigen (PSA) from the prostate into the blood and increases serum PSA concentrations. 3 Leventhal EK

Rozanski TA

Morey AF

Rholl V The effects of exercise on serum prostate specific antigen levels. First, the Department of Health's advice is that testing for prostate-specific antigen (PSA) should be avoided within a week of a digital rectal examination, and at least 48 h after vigorous exercise. The largest study on the effect of digital rectal examinations on PSA concentrationsshowed that there was no effect in patients with a PSA concentration below 20 ng/mL. The authors felt that the difference seen in patients with a PSA above this concentration were not of clinical significance. Cycling for 15 min has been shown to increase PSA concentrations up to threefold,but other forms of exercise do not seem to have any effect.

4 Price CP

Allard J

Davies G

et al. Pre- and post-analytical factors that may influence the use of serum prostate specific antigen and its isoforms in a screening programme for prostate cancer. We therefore feel that patients would be better advised specifically not to cycle—which they may not even regard as vigorous exercise—within a week of their PSA test. Indeed, a UK government task force recommends, as we do, that only bicycle riding should be avoided before PSA testing.This advice would prevent unnecessary additional visits and wasting of primary health-care resources. Second, the covering letter to the resource pack states that the information is for advising and counselling of symptom-free men. However, information contained within the pack does not make a clear distinction between symptomatic and symptom-free men, which is likely to be misleading. They comment that early prostate cancer does not usually cause lower-urinary-tract symptoms. However, they fail to stress the importance of PSA testing in this symptomatic group to diagnose the cases of advanced disease that could otherwise be missed on clinical examination. This is an important group of patients who should be offered PSA testing, because if they are found to have an advanced prostate cancer, their symptoms are likely to be improved more promptly with hormone manipulation. PSA testing among this group of symptomatic patients would also avoid the potential problem of treating patients for what is assumed to be benign disease, only to discover later that they have carcinoma of the prostate. Among 171 consecutive patients presenting to us over the past 3 years with advanced prostate cancer, 84 had an initial PSA concentration of more than 50 ng/mL. In many cases, the general practitioners volunteered that they initially thought that the prostate felt benign and were surprised by the high PSA concentration. We agree that careful counselling should be given before offering a PSA test, since the result can raise difficult issues for patient and clinician. However, we feel strongly that it should not be omitted in symptomatic men older than 50 years. The guidelines need to be clarified. Article Info Publication History Identification DOI: https://doi.org/10.1016/S0140-6736(03)12158-7 Copyright © 2003 Elsevier Ltd. All rights reserved. ScienceDirect Access this article on ScienceDirect

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