In which condition is PSA least likely to be elevated?

Prostate-specific antigen (PSA) is a protein produced by both normal and malignant cells of the prostate gland. Its levels are often measured to evaluate for prostate issues, including benign conditions, cancer, and post-surgical states.

In the context of the choices, digital rectal examinations (DRE) involve palpating the prostate gland, which may cause a transient increase in PSA levels due to mechanical irritation. Therefore, while some elevation might be seen after a DRE, it is not typically significant or considered indicative of underlying pathology.

In contrast, precancerous lesions of the prostate can lead to noticeable increases in PSA, as can benign prostatic hypertrophy (BPH), which is a common condition in older men that causes enlargement of the prostate. Similarly, after a prostate biopsy, which involves taking samples from the prostate to check for cancer, there is often a substantial increase in PSA levels due to the inflammation and trauma caused by the procedure.

Given this context, the condition after a digital rectal examination is least likely to show significant elevation of PSA compared to the other conditions listed, making it the correct answer.