Just found out you or someone you care about has an elevated PSA? This may sound worrying, but the good news is it doesn’t necessarily mean prostate cancer. Your prostate specific antigen (PSA) level is just one measure of your prostate function at a given point in time. Further testing may be needed to help you and your doctor decide what to do next.
What is the PSA test?
The PSA test measures the level of a specific protein produced by the prostate gland in a blood sample.
PSA testing is often used to screen men for prostate cancer, but it is not a diagnostic test. It is just one tool to help doctors evaluate the health of your prostate gland.
What is a normal PSA test result?
The amount of PSA in a blood sample is measured in nanograms per milliliter (ng/mL).
There is no single cut-off point that marks a PSA test result as ‘normal’ or ‘abnormal’.
Previously, a PSA level of 4 ng/mL or below was considered normal. However, we now know that men with PSA levels of less than 4 ng/mL can have prostate cancer1.
Meanwhile, men with a higher PSA level do not necessarily have prostate cancer. In fact, studies have shown that less than 30% of prostate biopsies showed signs of cancer in men with a PSA of 4–10 ng/mL2.
As a general rule, however, the higher the PSA level, the greater the likelihood a man has prostate cancer3.
What are some limitations and potential harms of the PSA test for prostate cancer screening?
PSA testing is highly sensitive but not very precise, because both benign and cancerous processes can cause PSA levels to rise4.
A key limitation of PSA screening is the high rate of false positive results. A false positive result means your PSA level is elevated, but you don’t actually have cancer. This can cause needless worry and result in you having unnecessary medical procedures, such as a prostate biopsy. One recent study found a false positive rate of almost 50% in a group of 1664 men undergoing PSA screening6.
PSA screening can also lead to the detection of cancers that are slow growing and unlikely to spread beyond the prostate—known as non-aggressive cancers. This may lead to an unnecessary biopsy, exposing you to potential risks and complications such as pain, bleeding and infection.
That’s why it’s important to have additional tests to not only confirm you have prostate cancer, but to determine whether it is non-aggressive or aggressive.
Advanced testing methods for prostate cancer are now available, capable of detecting aggressive forms of the disease that are more likely to grow and become life-threatening. These tests use highly precise algorithms, analyzing blood biomarkers and clinical data provided by your physician to assess the risk of clinically significant, aggressive prostate cancer. Discover if this test is right for you here.
What does elevated PSA mean?
Elevated PSA means there is more prostate specific antigen in your blood than expected.
An elevated PSA result does not mean you have prostate cancer.
Other things can cause an elevated PSA, including:
- your age – PSA levels tend to rise as you get older
- benign prostatic hypertrophy (BPH or enlarged prostate)
- prostatitis (inflammation of the prostate)
- urinary tract infections
- recent sexual activity or vigorous exercise7.
Certain drugs—including some drugs used to treat BPH—can lower your PSA level8.
If you have a PSA test, your doctor will interpret the results based on how much PSA is in your blood and other factors like your age, race/ethnicity, and family history.
Is the PSA test recommended for prostate cancer screening?
If you’re a man aged 55 to 69 years, guidelines recommend you should make an individual decision about PSA screening after discussing the potential pros and cons with your doctor9. It’s important to consider things like your risk factors and health history, as well as your personal preferences.
If you’re over 70, the guidelines do not recommend PSA-based screening for prostate cancer.
These guidelines are currently under review, so it’s best to talk to your doctor about what’s right for you.
If a screening test shows your PSA is elevated, your primary care physician may refer you to a urologist who specialises in prostate disease for further assessment.
A urologist may recommend advanced screening tests that are more sensitive and specific to help detect how likely it is you have aggressive prostate. These tests can help you and your urologist make more informed healthcare decisions.
Remember, a PSA test is just a one-off measure, and more information is often needed to work out the best course of action in your situation.
References
- Thompson IM, Pauler DK, Goodman PJ, et al. Prevalence of prostate cancer among men with a prostate-specific antigen level < or =4.0 ng per milliliter [published correction appears in N Engl J Med. 2004 Sep 30;351(14):1470]. N Engl J Med. 2004;350(22):2239-2246. doi:10.1056/NEJMoa031918
- Zhong, JG., Shi, L., Liu, J. et al. Predicting prostate cancer in men with PSA levels of 4–10 ng/mL: MRI-based radiomics can help junior radiologists improve the diagnostic performance. Sci Rep 13, 4846 (2023). https://doi.org/10.1038/s41598-023-31869-1
- Gretzer MB, Partin AW. PSA Levels and the Probability of Prostate Cancer on Biopsy. European Urology Supplements 2002 Vol. 1 Issue 6 Pages 21-27. doi: 10.1016/S1569-9056(02)00053-2
- Dvorácek J. Adenokarcinom prostaty [Adenocarcinoma of the prostate]. Cas Lek Cesk. 1998;137(17):515-521
- David MK, Leslie SW. Prostate Specific Antigen. [Updated 2022 Nov 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557495/
- Lumbreras B, Parker LA, Caballero-Romeu JP, et al. Variables Associated with False-Positive PSA Results: A Cohort Study with Real-World Data. Cancers (Basel). 2022;15(1):261. Published 2022 Dec 30. doi:10.3390/cancers15010261
- National Cancer Institute. Prostate-Specific Antigen (PSA) Test. Available at https://www.cancer.gov/types/prostate/psa-fact-sheet#what-are-some-of-the-limitations-and-potential-harms-of-the-psa-test-for-prostate-cancer-screening. Accessed 28 Aug 2024.
- Ibid.
- US Preventive Services Task Force. Prostate Cancer: Screening. May 08, 2018. Available at https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/prostate-cancer-screening. Accessed 28 Aug 2024.
