Type

Blood

Part of

Prostate health

Part of

Prostate health

Blood biomarker

Part of

Prostate health

Prostate Specific Antigen (PSA)

Prostate specific antigen (PSA) is a protein produced by the prostate gland which has a role in sperm production.

Prostate Specific Antigen (PSA)

Normal range

< 2.5 ng/mL (age dependent)

Normal range

< 2.5 ng/mL (age dependent)

Normal range

Prostate Specific Antigen (PSA)

Prostate specific antigen (PSA) is a protein produced by the prostate gland which has a role in sperm production.

Prostate Specific Antigen (PSA)

Normal range

< 2.5 ng/mL (age dependent)

Normal range

< 2.5 ng/mL (age dependent)

Normal range

Prostate Specific Antigen (PSA)

Prostate specific antigen (PSA) is a protein produced by the prostate gland which has a role in sperm production.

Prostate Specific Antigen (PSA)

Normal range

< 2.5 ng/mL (age dependent)

Normal range

< 2.5 ng/mL (age dependent)

Normal range

Prostate Specific Antigen (PSA)

Dr. Daniel McNally

MBBS

The Prostate Health Indicator

PSA (Prostate-Specific Antigen) is a protein produced by your prostate gland that can reveal important information about prostate health. While PSA testing can help detect prostate cancer and is raised in other prostate conditions, it's not a perfect test and requires careful interpretation alongside other factors to guide medical decisions.

PSA is normally present in small amounts in your blood, but levels can rise due to various prostate conditions, such as benign enlargement, urinary tract infections, and cancer. Understanding what influences PSA levels helps you and your doctor make informed decisions about prostate health monitoring and treatment.

Get tested

What Makes Your PSA Levels Rise

Discover the various prostate conditions—from benign enlargement to cancer—that can elevate PSA levels in your blood.

Why PSA Isn't a Perfect Cancer Test

Learn about the limitations of PSA testing and why doctors use it carefully alongside other assessments.

When Doctors Recommend PSA Testing

Find out key PSA testing considerations and factors that influence decisions.

Understanding Your Results

Understand how to interpret PSA numbers and what additional tests might be needed for a complete picture.

What Makes Your PSA Levels Rise

PSA levels can increase for various reasons, and understanding these causes helps explain why elevated PSA doesn't automatically mean cancer and why doctors consider multiple factors when interpreting results.

Benign prostate enlargement: As men age, the prostate naturally enlarges (benign prostatic hyperplasia), which can gradually increase PSA levels. This common condition affects most men over 50 and can cause urinary symptoms alongside elevated PSA.
Prostate inflammation: Prostatitis (inflammation and/or infection) causes irritation that can significantly elevate PSA levels, sometimes higher than cancer would. When it is a prostate infection, it can cause pain, fever, and urinary symptoms requiring antibiotic treatment.
Prostate cancer: Harmful growth in the prostate can produce elevated PSA levels, though the relationship isn't straightforward. Some aggressive cancers produce little PSA and may not cause a significant increase, whilst some slow-growing cancers produce substantial amounts. Many prostate cancers require surgical removal. Some prostate cancers are slow growing and may not affect patient care, and urologists may advise to take no action depending on the specific patient and situation.
Recent prostate manipulation: Medical procedures like prostate biopsy, catheter insertion, or even digital rectal examination can temporarily elevate PSA levels for several weeks.
Physical activity: Intense exercise, particularly cycling or activities that put pressure on the prostate, can temporarily increase PSA levels. This is why doctors often recommend avoiding strenuous activity before testing.
Age-related changes: PSA levels naturally increase with age as the prostate grows, which is why doctors use age-adjusted reference ranges rather than single cutoff values.
Medications: Some medications can affect PSA levels, with finasteride and dutasteride (used for prostate enlargement) actually reducing PSA by about 50%.

What Makes Your PSA Levels Rise

Benign prostate enlargement: As men age, the prostate naturally enlarges (benign prostatic hyperplasia), which can gradually increase PSA levels. This common condition affects most men over 50 and can cause urinary symptoms alongside elevated PSA.
Prostate inflammation: Prostatitis (inflammation and/or infection) causes irritation that can significantly elevate PSA levels, sometimes higher than cancer would. When it is a prostate infection, it can cause pain, fever, and urinary symptoms requiring antibiotic treatment.
Prostate cancer: Harmful growth in the prostate can produce elevated PSA levels, though the relationship isn't straightforward. Some aggressive cancers produce little PSA and may not cause a significant increase, whilst some slow-growing cancers produce substantial amounts. Many prostate cancers require surgical removal. Some prostate cancers are slow growing and may not affect patient care, and urologists may advise to take no action depending on the specific patient and situation.
Recent prostate manipulation: Medical procedures like prostate biopsy, catheter insertion, or even digital rectal examination can temporarily elevate PSA levels for several weeks.
Physical activity: Intense exercise, particularly cycling or activities that put pressure on the prostate, can temporarily increase PSA levels. This is why doctors often recommend avoiding strenuous activity before testing.
Age-related changes: PSA levels naturally increase with age as the prostate grows, which is why doctors use age-adjusted reference ranges rather than single cutoff values.
Medications: Some medications can affect PSA levels, with finasteride and dutasteride (used for prostate enlargement) actually reducing PSA by about 50%.

What Makes Your PSA Levels Rise

Benign prostate enlargement: As men age, the prostate naturally enlarges (benign prostatic hyperplasia), which can gradually increase PSA levels. This common condition affects most men over 50 and can cause urinary symptoms alongside elevated PSA.
Prostate inflammation: Prostatitis (inflammation and/or infection) causes irritation that can significantly elevate PSA levels, sometimes higher than cancer would. When it is a prostate infection, it can cause pain, fever, and urinary symptoms requiring antibiotic treatment.
Prostate cancer: Harmful growth in the prostate can produce elevated PSA levels, though the relationship isn't straightforward. Some aggressive cancers produce little PSA and may not cause a significant increase, whilst some slow-growing cancers produce substantial amounts. Many prostate cancers require surgical removal. Some prostate cancers are slow growing and may not affect patient care, and urologists may advise to take no action depending on the specific patient and situation.
Recent prostate manipulation: Medical procedures like prostate biopsy, catheter insertion, or even digital rectal examination can temporarily elevate PSA levels for several weeks.
Physical activity: Intense exercise, particularly cycling or activities that put pressure on the prostate, can temporarily increase PSA levels. This is why doctors often recommend avoiding strenuous activity before testing.
Age-related changes: PSA levels naturally increase with age as the prostate grows, which is why doctors use age-adjusted reference ranges rather than single cutoff values.
Medications: Some medications can affect PSA levels, with finasteride and dutasteride (used for prostate enlargement) actually reducing PSA by about 50%.

When Doctors Recommend PSA Testing

PSA testing decisions involve balancing potential benefits against risks and limitations, with recommendations varying based on individual circumstances and preferences.

Age considerations: Most guidelines suggest discussing PSA testing with men aged 50-70, though men at higher risk (African heritage, family history) might start discussions earlier, around age 45.
Risk factor assessment: Men with fathers or brothers who had prostate cancer face higher risk and might benefit from earlier or more frequent testing. African men also have higher prostate cancer rates.
Symptom evaluation: PSA testing might be recommended for men experiencing urinary symptoms like difficulty starting urination, weak stream, frequent urination, or pelvic pain to help identify underlying causes.
Shared decision-making: Current guidelines emphasise informed choice, where doctors discuss PSA testing benefits and limitations, allowing men to make personalised decisions based on their values and preferences.
Previous results: Men who choose PSA testing typically have it repeated every 1-2 years, with frequency potentially adjusted based on previous results and risk factors.
Monitoring known conditions: Men with diagnosed prostate conditions often have regular PSA monitoring to track changes and treatment responses.

When Doctors Recommend PSA Testing

PSA testing decisions involve balancing potential benefits against risks and limitations, with recommendations varying based on individual circumstances and preferences.

Age considerations: Most guidelines suggest discussing PSA testing with men aged 50-70, though men at higher risk (African heritage, family history) might start discussions earlier, around age 45.
Risk factor assessment: Men with fathers or brothers who had prostate cancer face higher risk and might benefit from earlier or more frequent testing. African men also have higher prostate cancer rates.
Symptom evaluation: PSA testing might be recommended for men experiencing urinary symptoms like difficulty starting urination, weak stream, frequent urination, or pelvic pain to help identify underlying causes.
Shared decision-making: Current guidelines emphasise informed choice, where doctors discuss PSA testing benefits and limitations, allowing men to make personalised decisions based on their values and preferences.
Previous results: Men who choose PSA testing typically have it repeated every 1-2 years, with frequency potentially adjusted based on previous results and risk factors.
Monitoring known conditions: Men with diagnosed prostate conditions often have regular PSA monitoring to track changes and treatment responses.

When Doctors Recommend PSA Testing

PSA testing decisions involve balancing potential benefits against risks and limitations, with recommendations varying based on individual circumstances and preferences.

Age considerations: Most guidelines suggest discussing PSA testing with men aged 50-70, though men at higher risk (African heritage, family history) might start discussions earlier, around age 45.
Risk factor assessment: Men with fathers or brothers who had prostate cancer face higher risk and might benefit from earlier or more frequent testing. African men also have higher prostate cancer rates.
Symptom evaluation: PSA testing might be recommended for men experiencing urinary symptoms like difficulty starting urination, weak stream, frequent urination, or pelvic pain to help identify underlying causes.
Shared decision-making: Current guidelines emphasise informed choice, where doctors discuss PSA testing benefits and limitations, allowing men to make personalised decisions based on their values and preferences.
Previous results: Men who choose PSA testing typically have it repeated every 1-2 years, with frequency potentially adjusted based on previous results and risk factors.
Monitoring known conditions: Men with diagnosed prostate conditions often have regular PSA monitoring to track changes and treatment responses.

Why PSA Isn't a Perfect Cancer Test

PSA testing has both strengths and limitations, and understanding these nuances helps explain why thoughtful implementation and interpretation are essential for patient care.

The sensitivity considerations: PSA testing successfully detects about 80% of prostate cancers, making it one of the most effective cancer screening tools available. While it may miss some cancers, particularly those that produce little PSA, it identifies the majority of clinically significant cases.
The specificity challenge: Elevated PSA levels can result from benign conditions, particularly in younger men where prostate infections and inflammation are more common. However, modern diagnostic approaches using MRI scanning and targeted biopsies have significantly improved our ability to distinguish between benign and harmful causes.
Early detection considerations: PSA screening can identify prostate cancer at earlier, more treatable stages when cure rates are highest. Many men diagnosed through PSA screening have cancers that, whilst slow-growing, would eventually cause problems if left undetected. In other cases, PSA testing and screening may cause false positives or lead to procedures that may not have made a long-term clinical difference. There are uncertainties and risks associated with every medical intervention, and it is important that patients understand these and discuss them with their doctor.
Risk stratification: PSA testing allows doctors to identify men at higher risk who benefit from closer monitoring or additional testing, whilst reassuring those at lower risk.
The evolving landscape: Modern prostate cancer management has evolved significantly, with active surveillance for low-risk cancers and improved treatments that minimise side effects. PSA screening, combined with these advances, offers men better outcomes with reduced treatment burden.

Why PSA Isn't a Perfect Cancer Test

PSA testing has both strengths and limitations, and understanding these nuances helps explain why thoughtful implementation and interpretation are essential for patient care.

The sensitivity considerations: PSA testing successfully detects about 80% of prostate cancers, making it one of the most effective cancer screening tools available. While it may miss some cancers, particularly those that produce little PSA, it identifies the majority of clinically significant cases.
The specificity challenge: Elevated PSA levels can result from benign conditions, particularly in younger men where prostate infections and inflammation are more common. However, modern diagnostic approaches using MRI scanning and targeted biopsies have significantly improved our ability to distinguish between benign and harmful causes.
Early detection considerations: PSA screening can identify prostate cancer at earlier, more treatable stages when cure rates are highest. Many men diagnosed through PSA screening have cancers that, whilst slow-growing, would eventually cause problems if left undetected. In other cases, PSA testing and screening may cause false positives or lead to procedures that may not have made a long-term clinical difference. There are uncertainties and risks associated with every medical intervention, and it is important that patients understand these and discuss them with their doctor.
Risk stratification: PSA testing allows doctors to identify men at higher risk who benefit from closer monitoring or additional testing, whilst reassuring those at lower risk.
The evolving landscape: Modern prostate cancer management has evolved significantly, with active surveillance for low-risk cancers and improved treatments that minimise side effects. PSA screening, combined with these advances, offers men better outcomes with reduced treatment burden.

Why PSA Isn't a Perfect Cancer Test

PSA testing has both strengths and limitations, and understanding these nuances helps explain why thoughtful implementation and interpretation are essential for patient care.

The sensitivity considerations: PSA testing successfully detects about 80% of prostate cancers, making it one of the most effective cancer screening tools available. While it may miss some cancers, particularly those that produce little PSA, it identifies the majority of clinically significant cases.
The specificity challenge: Elevated PSA levels can result from benign conditions, particularly in younger men where prostate infections and inflammation are more common. However, modern diagnostic approaches using MRI scanning and targeted biopsies have significantly improved our ability to distinguish between benign and harmful causes.
Early detection considerations: PSA screening can identify prostate cancer at earlier, more treatable stages when cure rates are highest. Many men diagnosed through PSA screening have cancers that, whilst slow-growing, would eventually cause problems if left undetected. In other cases, PSA testing and screening may cause false positives or lead to procedures that may not have made a long-term clinical difference. There are uncertainties and risks associated with every medical intervention, and it is important that patients understand these and discuss them with their doctor.
Risk stratification: PSA testing allows doctors to identify men at higher risk who benefit from closer monitoring or additional testing, whilst reassuring those at lower risk.
The evolving landscape: Modern prostate cancer management has evolved significantly, with active surveillance for low-risk cancers and improved treatments that minimise side effects. PSA screening, combined with these advances, offers men better outcomes with reduced treatment burden.

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Understanding Your Results

Understanding PSA interpretation helps you better comprehend what your results indicate and what steps might follow. PSA is measured in nanograms per millilitre (ng/mL), with reference ranges that increase with age to account for natural prostate growth:

Age-Adjusted PSA Reference Ranges for Men:

<49 years: 0-2.5 ng/mL
50-59 years: 0-3.5 ng/mL
60-69 years: 0-4.5 ng/mL
70 years: 0-6.5 ng/mL

Elevated PSA Levels PSA levels above age-adjusted reference ranges warrant further evaluation. Moderately elevated levels (typically 4-10 ng/mL in older men) carry more cancer risk, whilst higher levels (above 10 ng/mL) indicate greater concern but can still result from benign conditions.

PSA Velocity and Trends The rate of PSA increase over time can be more important than absolute levels. Rapid rises (more than 0.75 ng/mL per year) may indicate cancer even when absolute levels remain within normal ranges. This is why doctors often track PSA changes over multiple tests rather than relying on single measurements.

Follow-up protocols: Abnormal PSA results typically lead to repeat testing, and possibly MRI scanning or prostate biopsy, depending on the level and other risk factors.

Understanding Your Results

Age-Adjusted PSA Reference Ranges for Men:

<49 years: 0-2.5 ng/mL
50-59 years: 0-3.5 ng/mL
60-69 years: 0-4.5 ng/mL
70 years: 0-6.5 ng/mL

Follow-up protocols: Abnormal PSA results typically lead to repeat testing, and possibly MRI scanning or prostate biopsy, depending on the level and other risk factors.

Understanding Your Results

Age-Adjusted PSA Reference Ranges for Men:

<49 years: 0-2.5 ng/mL
50-59 years: 0-3.5 ng/mL
60-69 years: 0-4.5 ng/mL
70 years: 0-6.5 ng/mL

Follow-up protocols: Abnormal PSA results typically lead to repeat testing, and possibly MRI scanning or prostate biopsy, depending on the level and other risk factors.

The Takeaway

PSA testing provides valuable information about prostate health but requires careful interpretation alongside other factors. While it can help detect prostate cancer, it's not a perfect test and can sometimes cause unnecessary anxiety or procedures.

The decision to have PSA testing should be made after discussing the benefits and limitations with your doctor, considering your age, risk factors, and personal preferences. Understanding what PSA results mean helps you make informed decisions about further testing and treatment.

Don't ignore persistent urinary symptoms or avoid discussing prostate health with your doctor. Early detection and appropriate management of prostate conditions can significantly improve outcomes and quality of life.

The Takeaway

References

National Institute for Health and Care Excellence. (2019). Prostate cancer: diagnosis and management. NICE Clinical Guideline.
British Association of Urological Surgeons. (2020). PSA testing and prostate cancer screening guidelines. BAUS Clinical Guidelines.
European Association of Urology. (2021). Prostate cancer screening and early detection. EAU Clinical Practice Guidelines.

References

National Institute for Health and Care Excellence. (2019). Prostate cancer: diagnosis and management. NICE Clinical Guideline.
British Association of Urological Surgeons. (2020). PSA testing and prostate cancer screening guidelines. BAUS Clinical Guidelines.
European Association of Urology. (2021). Prostate cancer screening and early detection. EAU Clinical Practice Guidelines.

References

National Institute for Health and Care Excellence. (2019). Prostate cancer: diagnosis and management. NICE Clinical Guideline.
British Association of Urological Surgeons. (2020). PSA testing and prostate cancer screening guidelines. BAUS Clinical Guidelines.
European Association of Urology. (2021). Prostate cancer screening and early detection. EAU Clinical Practice Guidelines.