What Do My PSA Levels Mean?

"Testing your PSA level and getting a digital rectal exam are important tools for prostate cancer screening," said Edward Loizides, MD, Chief of Urology at Good Samaritan University Hospital. "I encourage my patients to ask questions about when and how often they should be screened and what the results mean."

When should I get screened for prostate cancer?

Nearly one in nine men will be diagnosed with prostate cancer during their lifetime. But prostate cancer can be treated successfully if caught early, which makes scheduling a prostate screening an essential part of your health care plan.

The U.S. Preventive Services Task Force (USPSTF) recommends that men aged 55 to 69 talk to their doctor about prostate-specific antigen (PSA) testing and if it benefits them as part of prostate cancer screening. 

Men who have high-risk factors, such as a first-degree relative who was diagnosed with prostate cancer or are African American, should talk to their doctor about being screened as early as their 40s with a PSA test and a digital rectal exam (DRE).

In general, prostate cancer has no symptoms. But you should schedule an appointment with your physician if you are experiencing: 

• Difficulty starting or stopping your urine flow
• Frequent urination, especially at night
• Inability to urinate
• Pain or burning during urination
• Urine flow that starts and stops
• Weak urine flow

Learn more about why you should see a urologist.

What is PSA? How is it measured?

PSA is a protein produced by the prostate gland’s normal cells and cancer cells. A PSA test measures the level of PSA in the blood in units called nanograms per milliliter (ng/m). A blood sample is sent to a laboratory for analysis.

A digital rectal exam (DRE) may be done in addition to the PSA test for more accurate cancer detection. 

If you are diagnosed with prostate cancer, your doctor may use a PSA test to determine the cancer stage, the best treatment options and the success of treatment.

What do my PSA levels mean?

No specific normal or abnormal PSA level exists, so results vary by person. A higher or ongoing rise in PSA levels may indicate prostate cancer.

According to the American Cancer Society (ACS):

• Most men without prostate cancer have PSA levels under 4 ng/mL of blood, but it does not guarantee that cancer is not present. 
• Men with a PSA level between 4 and 10—called the “borderline range”—have a 1 in 4 chance of being diagnosed with prostate cancer. 
• At a PSA level of over 10, the likelihood of being diagnosed with prostate cancer is over 50%.

What can cause an increase in PSA levels?

• An enlarged prostate—benign prostatic hyperplasia (BPH)—is common in older men.
• Age. As men age, their PSA levels typically rise.
• Prostatitis. Infection or inflammation of the prostate gland may raise PSA levels.
• Ejaculation within one to two days of the PSA test.
• Vigorous exercise (like bicycling) may raise levels for a brief time.
• Certain urologic procedures.
• Certain medicines.

What can cause a decrease in PSA levels?

• 5-alpha reductase inhibitors that treat BPH or other urinary symptoms.
• Certain medications like aspirin or statins.
• Herbal mixtures or supplements. (May skew PSA testing results.)

Will I need further testing?

Since PSA levels fluctuate over time for various reasons, your doctor may recommend:

• A second test after a specific time to confirm the results. If the second test shows elevated PSA levels, you may need to continue with additional tests and DREs to monitor changes over time.
• A prostate biopsy if your PSA levels continue to rise.
• Additional testing if a suspicious lump is found during a DRE and PSA levels continue to increase.
• Specialized PSA tests such as the Prostate Health Index (PHI), 4Kscore test, or percent-free PSA.
• Imaging tests of the prostate gland, such as MRI or transrectal ultrasound.