An elevated PSA level can be concerning, but it’s important not to think the worst. While elevated PSA levels can be a sign of prostate cancer, it’s not a sure thing. There are several conditions, most of them non-cancerous, that can lead to an increased production of the PSA protein. Let’s look at these conditions and what’s next if you have a prostate cancer diagnosis.
What is a PSA Test?
Prostate-specific antigen (PSA) is a protein produced by the male prostate gland cells. Regular checkups often include a PSA test, especially after age 40, to measure the levels of PSA in the blood.
The PSA test helps diagnose and monitor prostate conditions, including cancer. This approach can catch and treat prostate cancer early, which makes a real difference in patient outcomes. If the PSA level is higher than normal, your doctor may want to rerun the test or another version of a PSA test to see if the results are accurate.
What Range of PSA Levels Are Considered Normal?
The average range for PSA levels changes as men age. Because of this, doctors will typically refer to your PSA test results as non-elevated or elevated.
- Age 60 or older - PSA should be at or below 4.0 ng/mL
- Age 59 or younger - PSA should be at or below 2.5 ng/mL
While prostate cancer can be present even with non-elevated PSA test results, the American Cancer Society states that most men with a PSA under 4ng/mL of blood do not have prostate cancer.
There is a one in four chance that men whose PSA level falls in the borderline range between 4.0 and 10.0 have prostate cancer. A PSA level greater than 10.0 means there’s a fifty percent chance that prostate cancer is present.
Based on the results, your doctor will run other tests and evaluate you for several conditions to see what’s causing the rise in PSA. Cancer is just one of several conditions.
Non-cancerous Conditions Associated With an Elevated PSA Level
Before you have a PSA blood test, tell your doctor about any medications and supplements you take, including testosterone supplements. Also, let them know if you regularly ride a bike. This activity can cause your PSA to increase due to extra pressure placed on the prostate. It’s also a good idea to avoid ejaculation in the 48 hours before the test because this can also cause your PSA to elevate temporarily.
Some of the prostate conditions that can cause your PSA levels to be elevated, other than prostate cancer, include:
- Benign prostate hyperplasia (BPH) - this is an enlarged prostate
- Prostatitis - a painful infection in your prostate gland that causes swelling and inflammation
- Urinary tract infection (UTI)—Sometimes, men don’t realize they have a UTI. An irritated urethra or bladder can impact the prostate, causing elevated PSA.
I Have an Elevated PSA. Now What?
Remember, an elevated PSA level can indicate several things, only one of which is cancer.
While a single elevated PSA test result does not usually cause alarm, it does mean you need to be retested in the next several months to see if it’s returned to the normal range. During this time, be sure to watch for symptoms that could indicate you have a prostate condition, such as:
- Frequent urination, especially at night
- Blood in the urine or semen
- Painful ejaculations
- Trouble starting the stream of urine
- Decreased force in the stream of urine
Related reading: Frequent Urination and Prostate Cancer: Is There a Connection?
If your PSA level is consistently elevated after a few tests, your doctor may do one of the following:
- Test the ratio of protein-bound PSA to free PSA (PSA not bound to other blood proteins). A higher ratio suggests a non-cancerous condition, while a lower ratio may indicate the need for further testing, such as a biopsy, to rule out prostate cancer. The difference is particularly important for PSA levels in the 4-10 ng/ml range, where the cancer risk is less clear-cut. By testing the free PSA levels, the doctor can determine whether a prostate biopsy is necessary to look for cancer cells.
- Recommend other tests to rule out non-cancerous prostate problems. Your doctor may use the prostate health index (PHI) blood test, which is more advanced than the traditional PSA test and provides a more accurate assessment of prostate cancer risk. A 4K score test, which measures four prostate-specific blood proteins (biomarkers) in the blood, helps determine the risk of having aggressive prostate cancer on a biopsy.
- Recommend a biopsy based on the above tests. Although other tests can indicate the presence of prostate cancer, a biopsy is the most accurate way to confirm it.
Related reading: What You Should Know About Your Prostate Pathology Report
What PSA Level Confirms a Prostate Cancer Diagnosis?
Although a PSA test helps identify that a prostate condition may exist, the only way prostate cancer is diagnosed is through a biopsy. A biopsy involves taking several tissue samples from the prostate to be examined under a microscope by a pathologist. The pathologist will check for abnormalities, assign a score to the most- and second-most predominant cell pattern, and then add them together. This final score is called the Gleason Score. If the Gleason score is six or less, cancer is not present. However, it can still develop in the future, which means regular screening should continue.
A Gleason score of seven is an indication that you may have early-stage prostate cancer. Because most prostate cancer is slow-growing, treatment may not be necessary yet. Gleason scores of 8-10 mean cancer is present, and treatment is likely to be started soon.
Related reading: A Gleason Score of 7: Why is it So Important?
What to Do Next if You’re Diagnosed with Prostate Cancer
If you or your loved one recently received a prostate cancer diagnosis, the next step is to meet with an oncologist. The urologist who performed the biopsy may suggest surgery. By talking with a prostate cancer specialist at Rocky Mountain Cancer Centers, you can discuss treatment options other than surgery. The oncologist will answer your questions and discuss the right timing for treatment. Many men don’t need to start treatment right away, and surgery can often be delayed or avoided entirely.
Our prostate cancer specialists are located throughout the Colorado Front Range, including Boulder, Colorado Springs, and Denver. We encourage you to request an initial consultation or a second opinion to ensure complete confidence in the recommended treatment plan.
