Management After a False Positive PSA Result

Understanding False Positive PSA Results

After 4 PSA tests, men have a 12.9% cumulative risk of at least one false positive result, defined as PSA >4.0 ng/mL with no prostate cancer diagnosis after 3 years, according to the American College of Physicians 1, 3
False positives lead to unnecessary biopsies in 5.5% of screened men, as reported by the American College of Physicians 1

Benign prostatic hyperplasia (BPH) is associated with an increased risk of false positive PSA results, as noted by the American Urological Association 4, 5
Recent prostate manipulation, such as biopsy or digital rectal examination, can also increase the risk of false positive results, according to the National Comprehensive Cancer Network 6
Prostatitis is another factor that can contribute to false positive PSA results, as reported by the American Urological Association 4

Evaluate for symptoms of prostatitis, as recommended by the American Urological Association 4
Consider recent prostate manipulation that could elevate PSA, as suggested by the National Comprehensive Cancer Network 6
Assess for BPH symptoms, as recommended by the American Urological Association 4, 5
Calculate free/total PSA ratio to improve specificity, as recommended by the American Urological Association 4, 5

Men with persistently elevated PSA despite ruling out benign causes should be considered for biopsy, according to the National Comprehensive Cancer Network 6, 7
Discuss potential harms of biopsy with patients, including moderate to severe pain during biopsy (26%), hematospermia (50.4%), hematuria (22.6%), fever (3.5%), and hospitalization for prostatitis or urosepsis (0.5%), as reported by the American College of Physicians 1

False positive PSA results can cause increased worry specifically about prostate cancer, higher perceived risk for prostate cancer, problems with sexual function for up to 1 year after testing, and increased likelihood of repeated PSA testing and additional biopsies, as reported by the American College of Physicians 8, 1

Consider the high rate of overdiagnosis (17-50% of prostate cancers detected by PSA) when making decisions about further testing, as recommended by the American College of Physicians 1, 9
Patient age, comorbidities, and life expectancy should be taken into account when deciding on further evaluation, as suggested by the American College of Physicians 9