Prostate-specific antigen; Prostate cancer screening test
No certain PSA level that is called normal or abnormal. No PSA level means you do or do not have prostate cancer. Remember that the PSA test cannot diagnose cancer. Only a biopsy can diagnose cancer. Always discuss PSA test results with your doctor
Your doctor will look at your PSA results and must consider your age, your race, medicines you are taking, and a number of other factors to decide whether your PSA is normal and whether you need more tests done.
Older men typically have slightly higher PSA levels than younger men. Normal ranges by age group commonly used include:
- Men below age 50: PSA less than 2.5
- Men 50 - 59 years: PSA level less than 3.5
- Men 60 - 69 years: PSA level less than 4.5
- Men older than 70 years: PSA level less than 6.5
Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.
What abnormal results mean
A high PSA level has been linked to an increased chance of having prostate cancer. However, a high PSA level only identifies patients at higher risk of having prostate cancer.
As a general guideline, the following results indicate a need for further follow-up and testing:
- A PSA of 4 nanograms per milliliter (ng/mL) for most men
- For men under age 49, levels above 2.5 ng/mL
- For men aged 50 - 59, levels above 3.5 ng/mL
- For men aged 60 - 69, levels above 4.5 ng/mL
- A significant rise from one year to the next may also indicate a higher risk of having prostate cancer.
- African Americans and Asian Americans may need follow-up testing if they have lower PSA levels.
- A rapidly changing PSA, even within the normal range, raises the likelihood of cancer.
Keep in mind that, although PSA testing is an important tool for detecting prostate cancer, it is not foolproof. Your doctor must also think about other factors besides cancer that may cause higher PSA values:
- Men with a larger prostate
- Men who ejaculated in the 48 hours before the blood test was done
- Prostate infection (prostatitis)
- Urinary tract infection
- Recent tests on your bladder (cystoscopy) or prostate (biopsy)
- Catheter tube recently placed into your bladder to drain urine
Your doctor will think about the following factors when deciding on the next step:
- Your age
- If you had a PSA test in the past and how much and how fast your PSA levels have changed
- If your doctor finds a prostate lump during your exam
- Other symptoms you may have
- Other risk factors for prostate cancer, such as race and family history
People at higher risk may need to have more tests. Next steps your doctor may take include:
- Repeating your PSA test, most often sometime within 3 months
- Doing a prostate biopsy so samples of prostate can be viewed under a microscope
- Do a follow-up test called a free PSA (fPSA). The lower the level of this test, the more likely it is that prostate cancer is present.
For someone who has been treated for prostate cancer, the PSA level can show if a treatment is working or if the cancer has come back. Often, PSA levels will begin to rise before there are any symptoms, sometimes months or years beforehand.