What medications cause elevated PSA levels?

October 10, 2025 •

5 min read

Prostate-specific antigen (PSA) levels can be affected by more than just prostate conditions; a 2024 study highlighted several drugs, including testosterone replacement therapy, that can significantly alter readings. Understanding what medications cause elevated PSA levels? is crucial for accurate prostate health assessment and avoiding unnecessary anxiety or misdiagnosis.

Quick Summary

This article details medications and drug classes, including testosterone therapy and certain BPH treatments, that can impact PSA test results. It covers the mechanisms behind these changes and highlights the importance of disclosing your full medication history to your doctor for a correct interpretation of PSA levels.

Key Points

Testosterone Replacement Therapy (TRT): TRT directly stimulates androgen-dependent PSA production, leading to increased levels that require regular monitoring.
Alpha-Blockers (for BPH): Medications like tamsulosin can cause a mild, variable increase in PSA, possibly by altering prostate blood flow.
5-Alpha Reductase Inhibitors (5-ARIs): Drugs such as finasteride and dutasteride cause a significant PSA decrease (around 50%), which necessitates doubling the reading for accurate cancer screening.
Statins and NSAIDs: Long-term use of common medications like statins and ibuprofen has been linked to lower PSA levels.
Importance of Disclosure: It is crucial to inform your doctor of all medications before a PSA test to ensure proper interpretation and avoid misdiagnosis.
Beyond Medications: Other factors, including age, prostate size, inflammation (prostatitis), and recent prostate stimulation, can also influence PSA results.

Understanding the PSA Test and Its Limitations

Prostate-specific antigen (PSA) is a protein produced by both cancerous and non-cancerous cells in the prostate gland. A PSA test measures the level of this protein in the blood. While often used for prostate cancer screening, an elevated PSA reading does not automatically indicate cancer. Factors such as benign prostatic hyperplasia (BPH), inflammation of the prostate (prostatitis), and—significantly—the use of certain medications can all cause PSA levels to rise. For this reason, it is vital to have an informed discussion with your healthcare provider about all factors that could influence your PSA levels.

The Primary Culprits: Medications That Raise PSA

Several common prescription medications are known to increase PSA levels. Some do so by directly influencing prostate function, while others may cause inflammation or interfere with hormonal pathways.

Testosterone Replacement Therapy (TRT)

Testosterone replacement therapy is used to treat hypogonadism, or low testosterone levels. Since PSA production is androgen-dependent, introducing exogenous testosterone can cause an increase in serum PSA levels. While this increase is often slight and doesn't necessarily indicate a higher risk of prostate cancer in the short term, any significant rise should be investigated. Clinicians are advised to monitor PSA levels regularly in patients on TRT, as a rising trend can be a more sensitive indicator of potential issues.

Alpha-Blockers

Alpha-blockers like tamsulosin (Flomax), alfuzosin (Uroxatral), and silodosin (Rapaflo) are frequently prescribed to manage the urinary symptoms of BPH. Evidence regarding their effect on PSA is mixed, but some studies have indicated they may cause a mild elevation. One hypothesis is that alpha-blockers, by relaxing prostate smooth muscle, may increase blood flow to the prostate, potentially increasing PSA release. Research into this area is ongoing, but it's another important factor for doctors to consider.

Steroids (Corticosteroids)

Corticosteroids, such as betamethasone, are powerful anti-inflammatory drugs. While typically associated with a decrease in PSA in cases of inflammation, some studies and case reports have linked certain steroids to increases in PSA levels. The mechanism is not fully understood but may relate to complex hormonal interactions or specific inflammatory responses in some individuals.

Other Hormonal Therapies

In addition to testosterone, other hormonal treatments, including Selective Estrogen Receptor Modulators (SERMs), human chorionic gonadotropin (hCG), and aromatase inhibitors (AIs), can influence PSA levels. This is due to their role in regulating the complex hormonal balance that controls prostate cell growth and function. Similarly, some agents used to treat advanced prostate cancer, like certain LHRH agonists and antagonists, can also cause transient or specific changes in PSA.

Medications that Lower PSA: The Risk of a False Negative

While this article focuses on what medications cause elevated PSA levels, it's equally important to understand drugs that can lower PSA, potentially masking a serious underlying issue.

5-Alpha Reductase Inhibitors (5-ARIs)

Drugs like finasteride (Proscar, Propecia) and dutasteride (Avodart) are used to treat BPH and male pattern baldness. These medications work by inhibiting the conversion of testosterone to dihydrotestosterone (DHT), which causes the prostate to shrink. A side effect is a significant reduction in PSA levels, often by about 50%. This can lead to a delayed or missed prostate cancer diagnosis, as the PSA reading may appear normal despite the presence of cancer. Doctors must account for this by doubling the measured PSA value for accurate interpretation.

Statins, NSAIDs, and Diuretics

Commonly used medications like statins (e.g., atorvastatin), nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g., ibuprofen), and thiazide diuretics have been shown to reduce PSA levels over time. This effect is typically less dramatic than with 5-ARIs, but prolonged use can still have a clinically relevant impact.

How Medications Affect PSA Levels: Mechanisms of Action

Testosterone Replacement Therapy: Increases PSA by stimulating prostate tissue, as PSA production is androgen-dependent.
Alpha-Blockers: Possible increase due to enhanced prostate perfusion and glandular relaxation.
5-Alpha Reductase Inhibitors: Decrease PSA by blocking the conversion of testosterone to DHT, causing the prostate to shrink.
Statins & NSAIDs: Decrease PSA, potentially by altering inflammation pathways, though the precise mechanism is not fully understood.

Key Medications and Their Impact on PSA: A Comparison


Medication Class	Examples (Brand/Generic)	Typical Impact on PSA	Mechanism of Action	Clinical Significance
Testosterone Replacement Therapy	AndroGel, Testopel	Increases PSA	Provides exogenous testosterone, stimulating androgen-dependent PSA production	May indicate a need for more vigilant prostate monitoring; requires baseline and follow-up PSA tests.
Alpha-Blockers	Flomax (Tamsulosin), Uroxatral (Alfuzosin)	Potential mild increase	May enhance prostate blood flow or cause mild irritation, leading to increased PSA release.	Effect is variable; should be disclosed to the clinician interpreting PSA results.
5-Alpha Reductase Inhibitors	Proscar (Finasteride), Avodart (Dutasteride)	Decreases PSA (~50%)	Blocks DHT production, shrinking the prostate and reducing PSA synthesis.	Can mask prostate cancer; PSA values must be adjusted (e.g., doubled) for accurate screening.
Statins	Lipitor (Atorvastatin), Zocor (Simvastatin)	Decreases PSA	Prolonged use associated with lower PSA levels; mechanism likely involves anti-inflammatory effects.	May slightly reduce sensitivity of PSA screening over the long term; clinicians should be aware.
Corticosteroids	Betamethasone, Prednisone	Possible increase	Complex effects on hormonal balance and inflammation, leading to altered PSA levels.	Any significant or unusual PSA rise while on steroids should prompt further investigation.

Non-Medication Factors That Influence PSA

In addition to pharmacological effects, several other factors can lead to an elevated PSA level:

Age: Older men typically have slightly higher PSA levels.
Prostate Size: A larger prostate due to BPH naturally produces more PSA.
Prostatitis: Inflammation of the prostate can cause a temporary, but sometimes dramatic, rise in PSA.
Urinary Tract Infections: Infections or irritation in the urinary tract can irritate the prostate.
Recent Prostate Stimulation: Activities like ejaculation, bike riding, or a recent digital rectal exam (DRE) can cause a short-term PSA spike.

What to Do Before Your PSA Test

Create a medication list: Before your appointment, write down every prescription, over-the-counter drug, and supplement you are taking.
Inform your doctor: Discuss your medication list with your healthcare provider. This is the most crucial step for accurate test interpretation.
Avoid prostate irritation: Your doctor may advise avoiding certain activities like ejaculation or riding a bicycle for a couple of days before the test.
Time your test correctly: If you have recently had a prostate infection or urinary procedure, your doctor may suggest waiting several weeks to allow your PSA level to stabilize.

Conclusion: Navigating Medications and PSA Testing

An elevated PSA reading is not a diagnosis of prostate cancer but rather a signal that warrants further discussion and investigation. Medications are a significant factor in influencing PSA levels, with some like testosterone replacement therapy known to cause increases, while others such as 5-alpha reductase inhibitors can cause decreases that may mask a cancer diagnosis. Open communication with your doctor about all medications, supplements, and recent health events is the most effective way to ensure your PSA results are interpreted correctly, preventing unnecessary concern or dangerous misdiagnosis. By being an informed participant in your healthcare, you can ensure that PSA testing remains a valuable tool for monitoring your prostate health. For additional authoritative information on PSA testing and prostate health, refer to the Prostate Cancer Foundation.

Frequently Asked Questions

Yes, because PSA production is androgen-dependent, testosterone replacement therapy can cause an increase in PSA levels. This increase requires vigilant monitoring by a healthcare provider, and any unusual or significant rise should be evaluated.

Yes, medications for benign prostatic hyperplasia (BPH) can significantly affect PSA readings. 5-alpha reductase inhibitors (like finasteride and dutasteride) reduce PSA levels by about 50%, while alpha-blockers (like tamsulosin) may cause a slight increase.

You should never stop taking a prescribed medication without consulting your doctor first. Instead, inform your healthcare provider about all medications you are taking so they can accurately interpret your PSA test results.

Yes, studies have shown that long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and aspirin, is associated with a decrease in PSA levels. This should be considered when interpreting test results.

For patients taking finasteride or dutasteride for six months or more, doctors typically double the PSA reading to compare it to the standard range for men not on the medication. This adjustment accounts for the medication's suppressive effect.

An elevated PSA from medication isn't necessarily a direct cause for concern on its own, but it does require careful interpretation. Your doctor will use the context of your medication use, age, and other risk factors to decide if further investigation is needed.

Besides medication, other factors that can raise PSA levels include age, a larger prostate due to BPH, inflammation of the prostate (prostatitis), a recent urinary tract infection, and even recent prostate stimulation from a digital rectal exam or ejaculation.