Prostate Specific Antigen

When elevated (>2.5 ug/L in men <50, or >4.0 ug/L):

• Do NOT panic -- PSA elevation does not equal cancer; many causes are benign
• Retest in 4-6 weeks after eliminating confounders (see below)
• Track PSA velocity: a rise of >0.75 ug/L per year is more concerning than absolute value

Confounders that falsely elevate PSA:

• Recent ejaculation (within 48h of blood draw)
• Vigorous cycling or prostate pressure
• Urinary tract infection or prostatitis
• DHT-derivative AAS (Masteron, Primobolan, Anavar, Winstrol, Proviron) -- stimulate prostate tissue
• High-dose testosterone (more substrate for DHT conversion via 5-alpha reductase)

Supplements/Lifestyle:

• Saw Palmetto -- 320mg/day (standardised extract; may reduce 5-alpha reductase activity and support prostate health)
• Lycopene -- 10-15mg/day (from tomato extract or cooked tomatoes; associated with lower PSA and prostate cancer risk)
• Zinc -- 30mg/day (prostate health support)
• Pygeum -- 100mg/day (standardised bark extract; supports urinary flow and prostate health)
• Green Tea Extract (EGCG) -- 400mg/day (antioxidant, may support prostate health)
• Reduce or eliminate DHT-derivative compounds if PSA is trending upward
• Finasteride -- 1mg/day (reduces DHT by ~70%; will lower PSA by ~50% -- inform your doctor if using, as it masks PSA readings)

When to see a urologist (non-negotiable):

• PSA >4.0 ug/L confirmed on retest after eliminating confounders
• PSA velocity >0.75 ug/L/year across serial measurements
• PSA >2.5 ug/L in men under 50
• Any PSA elevation with urinary symptoms (difficulty urinating, frequency, nocturia)
• Family history of prostate cancer with any PSA elevation
• Urologist may order free PSA ratio, PSA density, or prostate MRI before biopsy

AAS-specific guidance:

• Baseline PSA before starting any AAS cycle (essential)
• Recheck PSA every 6-12 months while on androgens
• DHT derivatives carry the highest prostate stimulation risk
• Consider avoiding DHT derivatives entirely if baseline PSA is >2.0 ug/L

References:

• Baggish, A. L., Weiner, R. B., Kanayama, G., et al. (2017). Cardiovascular toxicity of illicit anabolic-androgenic steroid use. Circulation, 135(21), 1991-2002. DOI: 10.1161/CIRCULATIONAHA.116.026945
• Kanayama, G., Hudson, J. I., & Pope, H. G., Jr. (2008). Long-term psychiatric and medical consequences of anabolic-androgenic steroid abuse. Drug and Alcohol Dependence, 98(1-2), 1-12. DOI: 10.1016/j.drugalcdep.2008.05.004