Recent ejaculation can elevate PSA and mislead doctors and patients regarding prostate cancer risk

Doctors in Greece report the case of a 52-year-old Greek man who had no prostate symptoms and who in an annual routine blood test had an elevated serum total PSA of 6 ng/ml (normal range 0-4.0 ng/ml). His personal and family medical history was unremarkable. There was no history of using drugs, or having symptoms of benign prostate hypertrophy, prostate cancer or prostatitis, and he had no recent diagnostic clinical tests of the genitourinary tract. The patient refused digital rectal examination. An abdominal and prostate ultrasound scan showed no evidence of benign prostate hyperplasia or of prostate cancer. Serum total PSA after ten days was 5.2 ng/ml, but the percent free PSA was 27% (normal > 20%). After a month, serum total PSA value dropped to 1.2 ng/ml. In another blood test after 3 months, serum total PSA value rose to 7 ng/ml with a percent free PSA of 40%. The urologist recommended a prostate biopsy. The patient also refused biopsy. After discussing this situation with the patient, his doctors were informed that he had sexual activity and ejaculation in less than 24 hours before the first and before the last serum PSA measurements (being 6 and 7 ng/ml respectively). Ejaculation might have had an effect on serum PSA levels in our patient. All other values of serum total PSA measurements performed at least 4 days after sexual abstinence were < style=""> Greek doctors suggest a 48-hour period of abstinence prior to total PSA measurement. –Hellenic Journal Nuclear Medicine 10: 119, August 2007.