Understanding PSA
Welcome to this Decision Guide about PSA testing.
Prostate-specific antigen, or PSA, is a blood test used by many doctors to screen for prostate cancer. If you've had your PSA level checked, you may have been told that your results were "normal" or "abnormal." However, some men would like to know more about what their PSA level means.
This tool provides more information about PSA levels, and what's considered to be reassuring or worrisome for men of different ages.
Keep in mind that PSA is simply a screening tool -- used alone, it cannot answer the question of whether or not you have prostate cancer. However, PSA levels are often helpful for deciding which men need further testing or evaluation. High PSA levels can signal prostate cancer, but they can also reflect benign (non-cancerous) growth of the prostate, as well as prostate infections. Only a biopsy can tell whether or not you have prostate cancer or another cause for your increased PSA test.
It's also important to know that many doctors consider PSA testing to be controversial. That's because PSA results can be misleading, but also because there is uncertainty about whether aggressive treatment of prostate cancer makes sense for many older men. While this tool is designed for men who have had their PSA checked, keep in mind that PSA testing may not make sense for everybody. If you have questions about PSA testing, be sure to speak with your health care provider.
In order to understand your PSA results, we'll ask you a series of questions about you and your medical history. Before you begin, it may be helpful to have your most recent PSA result in front of you, as well as results from any prior PSA tests.
We'll start by finding out your age. That's because PSA levels tend to increase with age, and the cut-off for "normal" PSA levels goes up as well.
How old were you when you had your most recent PSA test?
Less than age 50
Age 50 to 69
Age 70 to 75
Over age 75
Next, we need to know your most recent PSA test result. Usually this is a number between one and ten (PSA is measured in nanograms per milliliter, or ng/ml).
What was your most recent PSA level?
Less than four
Four to 9.99
Ten or higher
Your PSA level is above the normal range. However, given your age or medical history, further evaluation may or may not be worthwhile. Speak with your doctor about appropriate follow-up. Your options include
Your PSA level is in the normal range. This is a reassuring result.
Given your age or medical history, many doctors would question whether it makes sense to have your PSA tested regularly. This is because prostate cancer is often a slow-growing disease, especially in older men. Even if prostate cancer is detected, the risks of side effects from treatment may be greater than any potential benefits.
Speak with your doctor about whether it makes sense to continue being screened for prostate cancer on a regular basis.
Next, we need to know your most recent PSA test result. Usually this is a number between one and ten (PSA is measured in nanograms per milliliter, or ng/ml).
What was your most recent PSA level?
Less than 1.0
1.0 to 3.99
4.0 to 6.49
6.5 to 9.99
10 or higher
Your PSA level is moderately elevated. About one in three men with a moderately elevated PSA level will be found to have early stage prostate cancer if a biopsy is performed. Early stage prostate cancer rarely causes symptoms, and your prostate may feel totally normal when examined by your doctor (digital rectal exam). One piece of good news is that early stage prostate cancer can often be cured.
The other piece of good news is that most men with a moderately elevated PSA level don't have prostate cancer. Instead, their PSA level has risen for another reason, such as
Therefore, if your PSA level is between 6.5 and ten , the first thing to find out is whether you may have had any of the following within the past two months:
Have you experienced any of these conditions?
Yes, I have.
No, I have not.
Your PSA level is above four ng/ml. In younger men, this is usually considered to be a worrisome level. However, your PSA level may be normal for someone in your age group.
Speak with your doctor about options for follow-up, including
-
referral to a urologist (prostate specialist)
-
repeat testing in 3-6 months to make sure that your PSA level is not rising by measuring your "free" PSA level. This special way of testing your PSA level may help to decide if a prostate biopsy is needed. High levels of free PSA are reassuring, while low levels are worrisome for cancer.
Next, we need to know your most recent PSA test result. Usually this is a number between one and ten (PSA is measured in nanograms per milliliter, or ng/ml).
What was your PSA level?
Less than 1.0
1.0 to 3.99
4.0 to 9.99
10 or higher
Your PSA level is in the normal range. This is a reassuring result.
Consider having your test repeated in one to two years.
Most doctors recommend waiting until age 50 to start PSA testing. That's because prostate cancer is uncommon before this age. However, PSA levels are sometimes checked in men younger than age 50 because they have a risk factor for prostate cancer, such as having a close family member with the disease or being African-American (African American men are more likely than other men to develop prostate cancer and can develop an aggressive form of the disease at a young age).
Next, we need to know your most recent PSA test result. Usually this is a number between one and ten (PSA is measured in nanograms per milliliter, or ng/ml).
What was your PSA level?
Less than 1.0
1.0 to 2.49
2.5 to 3.99
4.0 to 9.99
10 or higher
Your PSA level is moderately elevated. More than half of men whose PSA level is ten or above will be found to have prostate cancer if a biopsy is performed.
However, not all men with an elevated PSA level have prostate cancer. Instead, the PSA level can rise for another reason, such as
-
benign growth of the prostate gland (also known as BPH or benign prostate hypertrophy)
-
a prostate infection or urinary tract infection
-
damage to the prostate caused by a surgery or trauma.
Therefore, if your PSA level is above ten , the first thing to find out is whether you may have had any of the following within the past two months:
-
a prostate or bladder infection
-
urinary symptoms such as burning with urination, dribbling, hesitancy, or pain in the groin
-
prostate or bladder surgery
-
a bladder catheter used to drain urine while you are in the hospital or during minor surgery
-
trauma to the groin, for example, a major car or industrial accident.
Have you experienced any of these conditions?
Yes, I have.
No, I have not.
Contact your doctor. Your PSA level is high. Your risk of prostate cancer is greater than 50 percent. Immediate follow-up is warranted. Speak to your doctor about referral to a urologist (prostate specialist) or arranging for a prostate biopsy.
Your PSA level may be falsely elevated. This means that although your PSA level is above normal, there is a good chance that you do not have prostate cancer.
Contact your doctor. You may need antibiotic treatment if you have evidence of a urinary tract infection or prostatitis. You should also talk to your doctor about repeating your PSA test in 1-2 months. If your repeat PSA level returns to normal (less than four), this is excellent news. If your PSA test remains elevated, further evaluation and a referral to a urologist is probably needed.
Your PSA level is moderately elevated. About one in three men with a moderately elevated PSA level will be found to have early stage prostate cancer if a biopsy is performed. Early stage prostate cancer rarely causes symptoms, and your prostate may feel totally normal when examined by your doctor (digital rectal exam). One piece of good news is that early stage prostate cancer can often be cured.
The other piece of good news is that most men with a moderately elevated PSA level don't have prostate cancer. Instead, their PSA level has risen for another reason, such as:
-
benign growth of the prostate gland (also known as BPH or benign prostatatic hyperplasia)
-
a prostate infection or urinary tract infection
-
damage to the prostate caused by a surgery or trauma.
Therefore, if your PSA level is between four and ten , the first thing to find out is whether you may have had any of the following within the past two months:
-
a prostate or bladder infection
-
urinary symptoms such as burning with urination, dribbling, hesitancy, or pain in the groin
-
prostate or bladder surgery
-
a bladder catheter used to drain urine while you are in the hospital or during minor surgery
-
trauma to the groin, for example, a major car or industrial accident.
Have you experienced any of these conditions?
Yes, I have.
No, I have not.
PSA levels can also go up for other reasons. For example, riding a bicycle can put pressure on the prostate and cause a temporary spike in your PSA level. The same is true for ejaculation during sex or masturbation. In general, these activities cause PSA levels to rise only a little, and the PSA should return to normal within several days.
Did you ride a bicycle, have sexual intercourse or ejaculate in the 48 hours before blood was drawn for your PSA test?
Yes, I did.
No, I did not.
The next thing to determine is how fast your PSA levels has been rising. You can figure this out if your PSA was checked within the past year or so. You should subtract your last PSA result from your current results. For example, if your PSA was 4.5 last year and is 5.0 this year, it has increased by 0.5 points (ng/ml) over the past year. A quickly rising PSA is worrisome, while a slowly rising PSA (or PSA level that goes down) is reassuring.
Has your PSA level been checked within the past year?
Yes, my PSA level was checked within the past year.
No, my PSA level was not checked within the past year.
Knowing your previous PSA levels is helpful, but not necessary. Nonetheless, your PSA level is mildly elevated. Follow-up is needed. Keep in mind that your risk of prostate cancer still less than 40 percent.
Your options include
-
referral to a urologist (prostate specialist)
-
repeat PSA testing in several months
-
measuring your "free" PSA level. This special way of testing your PSA level may help to decide if a biopsy is needed. High levels of free PSA are reassuring, while low levels are worrisome for cancer.
Speak to your doctor about which option makes the most sense for you.
Has your PSA level gone down, or increased by less than 0.75 points (ng/ml) within the past year?
Yes, my PSA has gone down or risen less than 0.75 points.
No, my PSA has risen by more than 0.75 points.
Your PSA level is moderately elevated and increasing at a worrisome rate. Follow-up is needed. However, keep in mind that your risk of prostate cancer still less than 40 percent.
Your options include
-
referral to a urologist (prostate specialist)
-
repeat PSA testing in several months
-
measuring your "free" PSA level. This special way of testing your PSA level may help to decide if a biopsy is needed. High levels of free PSA are reassuring, while low levels are worrisome for cancer.
Speak to your doctor about which option makes the most sense for you.
This may be a normal fluctuation in your PSA level. An increase in your PSA of less than 0.75 ng/ml over one year is generally felt to be reassuring. Repeat testing in 3-6 months is a reasonable option. Discuss this with your doctor.
Ejaculation or vigorous bicycle riding can cause a small increase in your PSA level. Consider repeating your PSA test in two weeks, after you've avoided bicycle riding and intercourse for at least 48 hours. If your repeat PSA level returns to normal (less than four), this is excellent news. If your PSA test remains elevated, further evaluation is probably needed. Your options include:
-
referral to a urologist (prostate specialist)
-
measuring your "free" PSA level. This special way of testing your PSA level may help to decide if a biopsy is needed. High levels of free PSA are reassuring, while low levels are worrisome for cancer.
Your PSA level may be falsely elevated. This means that although your PSA level is above normal, there is a good chance that you do not have prostate cancer.
Contact your doctor. You may need antibiotic treatment if you have evidence of a urinary tract infection or prostatitis. You should also talk to your doctor about repeating your PSA test in 1-2 months. If your repeat PSA level returns to normal (less than four), this is excellent news. If your PSA test remains elevated, further evaluation is probably needed. Your options include
-
referral to a urologist (prostate specialist)
-
measuring your "free" PSA level. This special way of testing your PSA level may help to decide if a prostate biopsy is needed. High levels of free PSA are reassuring, while low levels are worrisome for cancer.
Your PSA level is below four ng/ml. This is generally a reassuring result, and your risk of having prostate cancer is low.
However, your PSA level is slightly higher than expected for someone less than age 50. Speak with your doctor about the following options
-
referral to a urologist (prostate specialist)
-
repeat testing in 3-6 months to make sure that your PSA level is not rising
-
measuring your "free" PSA level. This special way of testing your PSA level may help to decide if a biopsy is needed. High levels of free PSA are reassuring, while low levels are worrisome for cancer.
If you have had previous PSA testing and the level is about the same as before, your doctor may simply recommend repeat testing in one to two years.
Your PSA level is in the normal range. This is a reassuring result. You have a low risk of being diagnosed with prostate cancer within the next few years.
Consider having your test repeated in one to two years.
Your PSA level is very low. This is a reassuring result. You have a very low risk of being diagnosed with prostate cancer within the next few years.
Recent research suggests that it's probably safe to wait two years before having your PSA checked again.
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