Lifestyle factors and prostate-specific antigen

Background: Increasing prostate cancer awareness has meant that more men are seeking out prostate-specific antigen (PSA) testing than ever before. Prostate cancer is now the most common malignancy in men, affecting one in eight. This article addresses lifestyle factors that may elevate PSA readings. Methods: A systematic review of the literature was performed using Medline for studies examining the association of PSA and lifestyle factors, including exercise, diet, sexual function as well as medication use. Further resources were identified from the reference list of retrieved articles. Results: Minimal level 1 evidence on the association of PSA with lifestyle factors was identified. Weak and generally inconsistent evidence was found on the effect of cycling and sexual activity. Diabetes and obesity did have inversely proportional effects on PSA values in large cohort studies. There was no evidence for an independent effect of different types of food to PSA. With regard to medications, the greatest impact is from 5-alpha reductase inhibitors, and these are used as a hair-loss treatment. Statins, non-steroidal anti-inflammatory drugs and thiazide diuretics can also have a clinically significant impact on PSA levels but unlikely to alter management. Discussion: For a small group of patients, cautious counselling on the factors summarised here before they have their blood tests may prevent undue stress and anxiety, particularly in those with borderline PSA results. Due to the inconsistency of results and lack of level 1a evidence, if there is reasonable suspicion for prostate cancer, a patient should still always be referred to a specialist.