High PSA in Multiple Myeloma: What It Means and Next Steps

A high PSA (prostate‑specific antigen) in someone with multiple myeloma is usually related to the prostate itself, not the myeloma, and it often has benign explanations like prostate enlargement (BPH) or inflammation (prostatitis). ^[1] Many noncancerous conditions can raise PSA, so an elevated result alone does not mean prostate cancer, and repeat testing plus clinical context are important. ^[1]

What PSA Measures

• PSA is a protein made by prostate cells; small amounts circulate in the blood and can rise with prostate disorders. ^[2] The PSA test can detect these elevations but cannot, by itself, distinguish between cancer and benign causes. ^[3]

Common Reasons PSA Can Be High

• Benign prostate enlargement (BPH) can increase PSA without cancer. ^[4]
• Prostatitis (prostate inflammation or infection) can raise PSA, sometimes markedly. ^[5]
• Urinary tract infection, recent urologic procedures (like cystoscopy or biopsy), or recent catheterization can transiently elevate PSA. ^[2]
• PSA also tends to increase gradually with age. ^[3]

Importantly, most men with an elevated PSA do not have prostate cancer, and a single high value often needs confirmation. ^[5]

Does Multiple Myeloma Raise PSA?

• Multiple myeloma affects plasma cells in the bone marrow and bone, not the prostate, and there is no routine, direct link where myeloma itself elevates PSA. ^[6] Myeloma care can impact bone health, but that is separate from PSA dynamics. ^[7]

When to Be Concerned

• In general, the higher the PSA and the faster it rises over time, the greater the chance of a prostate problem that needs evaluation; still, noncancerous causes remain common. ^[4]
• An abnormal digital rectal exam (DRE) together with a worrisome PSA level increases the likelihood that further testing (e.g., MRI, biomarkers, or biopsy) will be recommended. ^[8]

Practical Next Steps

• Consider repeating the PSA after allowing time for temporary factors to settle (for example, after treating any suspected infection or avoiding recent instrumentation), as repeat testing helps confirm whether the elevation persists. ^[9]
• Share recent symptoms (urinary burning, frequency, pelvic discomfort), recent procedures, ejaculation timing, or infections with your clinician, since these can guide interpretation and timing of a retest. ^[2]
• If PSA remains elevated or rises, your clinician may recommend a DRE, prostate MRI, reflex biomarkers, or, if indicated, a biopsy to clarify the cause. ^[3]
• Medication review matters because certain drugs can lower PSA and influence interpretation. ^[9]

Screening and Follow‑up Considerations

• Screening intervals and thresholds for further workup depend on age, PSA level, rate of change, family history, and overall health; shared decision‑making is encouraged. ^[10]
• For example, some expert guidelines suggest closer follow‑up or additional testing when PSA is 3 ng/mL or higher, tailored to individual risk and preferences. ^[11]

Quick Reference Table: Interpreting a High PSA

Situation	What it may suggest	Typical next step
Recent UTI/prostatitis symptoms	Inflammation/infection	Treat infection, repeat PSA after recovery. [2]
Recent catheter, cystoscopy, biopsy	Procedure‑related bump	Wait and retest after an interval. [2]
Gradual rise with age, urinary symptoms	BPH	Clinical exam ± medications, periodic PSA. [4]
Persistent elevation and/or abnormal DRE	Higher suspicion	MRI/biomarkers ± biopsy per clinician. [8] [3]

Bottom Line

• A high PSA in someone with multiple myeloma is most often due to common prostate conditions like BPH or prostatitis rather than the myeloma itself. ^[1]
• Because PSA is not specific for cancer, it’s reasonable to confirm the result, assess for benign causes, and follow a structured evaluation plan with your clinician. ^[3]