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DaSlink

A bit of goggling turned this up;

prostatecancer.about.com/od/symptomsanddiagnosis/a/psacauses.htm

What are some other causes of an elevated PSA?

Thousands of men each year are told that they have a high PSA level after undergoing a routine screening test. The most important and most concerning cause of an elevated PSA is prostate cancer. However, prostate cancer is only one of many potential causes of an elevated PSA. Virtually anything that irritates the prostate will cause the PSA to rise, at least temporarily.
Six Non-Cancerous Causes of an Elevated PSA

Benign Prostatic Hyperplasia (BPH)

This benign (non-cancerous) condition is oftentimes called simply an “enlarged prostate”. It is extremely common in older men and, unlike cancer, has no risk of spreading throughout the body. More information about this important condition is available.

Prostatitis

Prostatitis is a condition where the prostate becomes inflamed due to an infection or another cause. Most cases of this condition are acute, or come and go away again over a short period of time, but some men also can have chronic prostatitis. This condition, if due to a bacterial infection, can be treated with antibiotics.

Prostate Biopsy

Men who have recently undergone a prostate biopsy will usually have artificially elevated PSA levels. Because of this, most physicians will draw blood for the PSA test before any biopsies are done. Also, after a biopsy, most physicians will wait a few weeks before taking a repeat PSA level in order to let the level drop back to a baseline level.

Recent Ejaculation

Ejaculation (the ejecting of semen from the penis) can cause a mild increase in the PSA level. Because of this, most physicians will advise you to avoid any sexual activity for at least a couple of days before your PSA blood test.

Digital Rectal Exam (DRE)

The digital rectal exam may cause a small increase in the PSA level. Therefore, blood for the PSA test is usually drawn prior to this exam.

Bicycle Riding

Some studies have shown that strenuous bicycle riding can mildly elevate the PSA level over the short term. Because of this, you should avoid this activity for a few days prior to the PSA test.

DaSlink -

There are several options at this point, in my opinion only (I'm not a doc.)

Free PSA test would give some indication whether high PSA was due to PCA or some benign cause. PCA3 test is another variation on PSA test that is better for this kind of situation.

Calculating PSA density would give an idea whether the size of his prostate and the amount of PSA were consistent.

If he takes an antibiotic and retests PSA in two weeks, or right at the end of the antibiotic series, the PSA should have gone down. (If infection was the cause of the high PSA) it is important to do the test at the proper time, otherwise the infection can return and lead, again, to a high PSA.

All the considerations Raddad lists above, should be addressed.

If the PSA is persistently and unexplainably high he should get rebiopsied or go to a place that does color doppler ultrasound. Several people on this board have had the unfortunatle experience of 2-3 biopsies missing the cancer.

I think it was Sherlock Holmes line that after you have ruled out everything, then what remains, no matter how implausible, has to be the answer. A negative biopsy, particularly one that only tests 6-12 samples cannot be assumed rule out PCa in the presence of a rapidly and/or consistently rising PSA with no other explanation.

David

Post Edited (proscapt) : 7/29/2012 2:27:03 PM (GMT-6)