Editing AUA: Early Detection of Prostate Cancer (2023) (section)

== Elevated PSA ==
*'''<span style="color:#ff0000">If newly elevated PSA, then repeat the PSA prior to a secondary biomarker, imaging, or biopsy.</span>'''
** '''In people with a newly elevated PSA, it will return to a normal level in 25-40% upon retesting.'''
** '''<span style="color:#ff0000">Causes of transient increases in PSA</span>'''
***'''<span style="color:#ff0000">May meaningfully influence PSA</span>'''
***#'''<span style="color:#ff0000">Urinary tract infections</span>'''
***#'''<span style="color:#ff0000">Instrumentation (e.g., recent bladder catheterization, prostate biopsy or cystoscopy, urinary retention)</span>'''
***'''<span style="color:#ff0000">Unlikely to meaningfully influence PSA</span>'''
***#'''<span style="color:#ff0000">DRE</span>'''
***#'''<span style="color:#ff0000">Bicycle riding</span>'''
***#'''<span style="color:#ff0000">Ejaculation</span>'''
***#*Most controlled studies evaluating ejaculation suggest it either does not significantly impact or modestly increases (~10%) PSA.
** '''A repeat PSA in a few months is recommended, though it can be shortened or lengthened depending on other clinical factors.'''
***'''Half-life of PSA is 2 to 3 days.'''
* '''<span style="color:#ff0000">If PSA ≥ 2 ng/mL, strongly consider supplementary DRE to establish risk of clinically significant prostate cancer.</span>'''
** Highest utility of DRE in randomized trials is demonstrated in the workup of patients with an elevated PSA.
***In contrast to a screening application, use of DRE subsequent to the screening encounter may be of value.
****In patients undergoing prostate biopsy for an elevated PSA during screening, abnormal DRE improves the PPV for any prostate cancer and GG2+ detection