by  Tanya Harter Pierce

With prostate cancer being the most common cancer diagnosis among men, an easy non-invasive blood test for the cancer marker called “prostate specific antigen,” or PSA, is a useful diagnostic tool.   But it is not a perfect cancer marker.  For example, up to three-quarters of all men with an elevated PSA do NOT have cancer, and about one-fifth of men known to have prostate cancer, have normal PSA levels.  Even so, to ensure the most accurate PSA count possible, there are certain things a man can do ¾ or more accurately, can AVOID doing  ¾ before getting his PSA level tested.  Abstaining from sex for up to 48 hours before having one’s blood drawn is one of them.

A quick Internet search reveals numerous medical sites recommending that men abstain from any type of sex for 1-2 days before a PSA test (with 48 hours being a commonly recommended length of time.)  Otherwise, a man’s test results may be skewed and indicate an artificially elevated PSA count.  Such medical sites recommending this are, and NHS.UK (the National Health Service of England), among others.  Why do these public resources recommend abstaining?  Because it has been found that ejaculation is often associated with a temporary increase in the amount of PSA in the blood.

Other Activities to Avoid As Well

However, keep in mind that ejaculation is not the only non-cancer reason a man’s PSA may be temporarily elevated.  For example, it has long been known that some medical conditions, such as a urinary tract infection, can also artificially raise a man’s PSA count.  Moreover, many sources recommend that, for 48 hours before a test, men should also avoid any physical activity that puts extra pressure on the prostate gland.  This includes riding a bike or motorcycle, having anal sex, or undergoing a prostate biopsy.  Even getting a digital rectal exam (DRE), where a doctor feels the shape and texture of a man’s prostate gland by inserting his gloved fingers into the rectum, can temporarily increase a man’s PSA count due to the pressure put on the gland.  This can be particularly confounding because it is common for a doctor to perform a DRE just before his patient is sent off to get his blood drawn for the PSA test.  Thus, men may want to ask their doctor to have the blood drawn first, then perform the DRE in order to achieve a more reliable reading.

Various studies have come up with differing conclusions, however, and this has sparked a controversy over whether certain activities need to be avoided before a PSA test or not.  Stephen B. Strum, MD. is an oncologist who believes there is enough reason for concern to take a cautionary stance.  In his article on the PSA controversy, published in the December, 2012 issue of Life Extension Magazine, Dr. Strum stated:

“The numerous articles on the effect of ejaculation on PSA, and free PSA are not in uniform agreement; and in light of this unresolved controversy I recommend that men going for PSA testing should be informed that no ejaculation should occur for 48 hours prior to PSA testing.  In 30 years of work in this field, I have never had a single patient acknowledge that this has been discussed with him.  In addition, any kind of manipulation of the prostate ¾ be it a DRE (digital rectal exam) or bicycle riding should be avoided as well.  Given the lack of consensus findings on all of these issues, there is no downside to following these recommendations.”

Why there is a lack of agreement among researchers is unclear, but other experts besides Dr. Strum also believe there is enough evidence to warrant precaution.  For example, Dr. Stacy Loeb, an internationally recognized prostate cancer researcher with 290 published peer-reviewed articles and the host of the Men’s Health Show on Sirius XM110, explains that:

“Trauma to the prostate and ejaculation may affect PSA levels, so it is a good idea to avoid activities such as vigorous cycling and ejaculation for a few days before getting a PSA test.”

Why You Don’t Want an Artificially High PSA Score

Is it really worth it for a man to abstain from sex, motorcycle and bike riding, and some other activities, for 48 hours ¾ not to mention having to tell his doctor that he wants his blood drawn first before the DRE is performed?  Yes!  The most important reason may be that a needle biopsy of the prostate gland is often recommended for men with a PSA of 4 or more to check if they have cancer.  However, the needle biopsy procedure involves multiple needle pricks through the wall between the rectum and the prostate gland and there is a some risk of the procedure causing an infection that can be serious.  Also, according to the Diagnostic Center for Disease in Sarasota, Florida, if a man does have cancer in his prostate, then the needle biopsy procedure, with its multiple needle pricks, may spread the cancer cells outside the gland.  This can potentially cause a small localized tumor to turn into metastasized cancer sooner than it normally would have if left alone.   For more information, readers can go to the Prostate Cancer Foundation’s website at and download a free 2019 Prostate Cancer Patient Guide.

Tanya Harter Pierce, M.A. LMFT, is the author of OUTSMART YOUR CANCER:  Alternative Non-Toxic Treatments That Work.  

For more information visit her Website: