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Can Psa Be Normal In Prostate Cancer

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What Are Some Of The Limitations And Potential Harms Of The Psa Test For Prostate Cancer Screening

What Is a Normal PSA for a Man Without Prostate Cancer? | Ask a Prostate Expert, Mark Scholz, MD

Detecting prostate cancer early may not reduce the chance of dying from prostate cancer. When used in screening, the PSA test can help detect small tumors that do not cause symptoms. Finding a small tumor, however, may not necessarily reduce a mans chance of dying from prostate cancer. Many tumors found through PSA testing grow so slowly that they are unlikely to threaten a mans life. Detecting tumors that are not life-threatening

that requires treatment.

When Is A Psa Test Needed

If you are age 50 to 74, you should discuss the PSA test with your doctor. Ask about the possible risks and benefits.

Men under 50 or over 75 rarely need a PSA test, unless they have a high risk for prostate cancer.

  • You are more likely to get prostate cancer if you have a family history of prostate cancer, especially in a close relative such as a parent or sibling.
  • Your risks are higher if your relative got prostate cancer before age 60 or died from it before age 75. These early cancers are more likely to grow faster.
  • If you have these risks, you may want to ask your doctor about getting the PSA test before age 50.

This report is for you to use when talking with your healthcare provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.


When Should I Get A Psa Test

The guidelines below are adapted from the NCCN Clinical Practice Guidelines In Oncology for Prostate Cancer Early Detection. Please use these guidelines to have a discussion with your physician about your personal risk and make a plan for screening.

  • If you are between ages 45 and 75:
  • Discuss the risks and benefits of prostate cancer screening with your doctor, have a baseline PSA, and consider a baseline DRE
  • If your PSA is below 1 ng/mL and your DRE is normal, repeat testing every 2-4 years
  • If your PSA is between 1 and 3 ng/mL and your DRE is normal, repeat testing every 1-2 years
  • If your PSA is greater than 3 ng/ML or your DRE is very suspicious, your doctor may suggest additional testing or a biopsy
  • If you are over 75:
  • If you continue testing and your psA is less than 3 ng/mL and your DRE is normal, repeat testing every 1-4 years
  • If your PSA is greater than 3 ng/ML or your DRE is very suspicious, your doctor may suggest additional testing or a biopsy
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    What Is A Normal Psa Test Result

    There is no specific normal or abnormal level of PSA in the blood, and levels may vary over time in the same man. In the past, most doctors considered PSA levels of 4.0 ng/mL and lower as normal. Therefore, if a man had a PSA level above 4.0 ng/mL, doctors would often recommend a prostate biopsy to determine whether prostate cancer was present.

    However, more recent studies have shown that some men with PSA levels below 4.0 ng/mL have prostate cancer and that many men with higher levels do not have prostate cancer . In addition, various factors can cause a mans PSA level to fluctuate. For example, a mans PSA level often rises if he has prostatitis or a urinary tract infection. Prostate biopsies and prostate surgery also increase PSA level. Conversely, some drugsincluding finasteride and dutasteride , which are used to treat BPHlower a mans PSA level. PSA level may also vary somewhat across testing laboratories.

    Another complicating factor is that studies to establish the normal range of PSA levels have been conducted primarily in populations of White men. Although expert opinions vary, there is no clear consensus regarding the optimal PSA threshold for recommending a prostate biopsy for men of any racial or ethnic group.

    In general, however, the higher a mans PSA level, the more likely it is that he has prostate cancer. Moreover, a continuous rise in a mans PSA level over time may also be a sign of prostate cancer.

    Production In Benign Hyperplasia

    Guidance updated on PSA testing for prostate cancer

    The majority of PSA is produced by the glands in the transitional zone of the prostate. This portion of the prostate is associated with benign prostatic hyperplasia . The peripheral zone, where 80% of prostate cancers originate, produces very little PSA.

    The Hybritech monoclonal assay produced a measurement of 0.5 ± 0.4 ng/mL. Using the monoclonal assay, Lee et al calculated a serum PSA elevation of 0.12 ng/mL per gram of benign prostatic tissue.

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    Tests Used To Check The Prostate

    This first step lets your doctor hear and understand the “story” of your prostate concerns. You’ll be asked whether you have symptoms, how long you’ve had them, and how much they affect your lifestyle. Your personal medical history also includes any risk factors, pain, fever, or trouble passing urine. You may be asked to give a urine sample for testing.

    Prostate Cancer Screening Ages 55 To 69

    This is the age range where men will benefit the most from screening.Thats because this is the time when:

    • Men are most likely to get cancer
    • Treatment makes the most sense, meaning when treatment benefits outweigh any potential risk of treatment side effects

    Most men will get prostate cancer if they live long enough. Some prostatecancers are more aggressive others can be slow-growing. Doctors will takeyour age and other factors into consideration before weighing the risks andbenefits of treatment.

    You should ask your doctor how often he or she recommends you get screened.For most men, every two to three years is enough.

    Depending on the results of your first PSA test, your doctor may recommendyou get screened less frequently.

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    Some Men With Low Psas Still Have Prostate Cancer

    NIH/National Cancer Institute
    Men with low PSA levels on screening tests can still have prostate cancer, according to a study released today by scientists from the National Cancer Institute , part of the National Institutes of Health, and the Southwest Oncology Group, an NCI-funded network of researchers.

    Men with low PSA levels on screening tests can still have prostate cancer, according to a study* released today by scientists from the National Cancer Institute , part of the National Institutes of Health, and the Southwest Oncology Group, an NCI-funded network of researchers. In this study, prostate cancers were detected by biopsy in men with normal PSA levels.

    “The good news is that the vast majority of these cancers were low and intermediate grade, which often are not clinically significant,” said Leslie Ford, M.D., associate director for clinical research in NCI’s Division of Cancer Prevention, who participated in the research.

    “This was the first systematic study of men with PSA levels from 0 to 4 nanograms per milliliter . It shows that cancer of the prostate can be present in men with ‘normal’ PSAs,” said Ian Thompson, M.D., University of Texas Health Science Center at San Antonio, who led the study. Doctors often use the value of 4.0 ng/ml or greater as the trigger for further investigation, such as a prostate biopsy. A PSA level below 4.0 is generally considered normal.

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    Prostate Cancer In 15% Of Men With Normal Psa

    High PSA & Prostatitis | Ask a Prostate Expert, Mark Scholz, MD

    Best Test May Be to Follow PSA Levels Over Time, Expert Says

    May 26, 2004 — Fifteen out of every 100 older men with a normal PSA test actually has prostate cancer, a new study shows.

    PSA — prostate-specific antigen — is a chemical marker given off by cells of the prostate gland. Suspiciously high PSA levels are often an early sign of prostate cancer. A PSA over 4 ng/mL usually means that a man will have to undergo needle biopsy of his prostate.

    Men breathe a sigh of relief when their doctor tells them their PSA is normal. But some men with a low PSA do have cancer. Until now, it wasn’t clear how many, says researcher Charles A. Coltman Jr., MD, chair of the Southwest Oncology Group in San Antonio.

    “Our study emphasizes that there is a range of PSA levels, from 0 to 4, across which a man can have prostate cancer,” Coltman tells WebMD. “There is not a clear cut cutoff based on PSA alone which allows you to define individuals who need to be biopsied.”

    Driving home Coltman’s point is a dramatic picture. It shows a high-grade prostate cancer — from a man whose PSA level was less than 1. The picture and the study it illustrates appear in the May 27 issue of The New England Journal of Medicine.

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    Factors That Affect Psa Levels

    It is important to note that PSA levels can rise naturally with age, and that a number of benign conditions can also affect PSA levels, such as prostatitis , benign prostatic hyperplasia , urinary tract infection , or even injury to the prostate.

    Other factors such as sexual activity right before testing, certain exercises, or even diet can impact the PSA levels as well. It is essential to consult a doctor regarding the meaning and next steps of your PSA testing results.

    Average Psa Test Doubling Time

    Another red flag. This calculation denotes the time it takes your PSA values to double.

    Therefore it may signify the aggressiveness of any prostate abnormalities, whether it’s an enlarged prostate, prostatitis, or prostate cancer.

    If your average PSA readings double in less than three years your doctor will most likely order a biopsy, to look in to the problem further and discuss possible prostate cancer treatment options.

    Recommended Reading: Characteristics Of Prostate Cancer

    Pros And Cons Of The Psa Test


    • it may reassure you if the test result is normal
    • it can find early signs of cancer, meaning you can get treated early
    • PSA testing may reduce your risk of dying if you do have cancer


    • it can miss cancer and provide false reassurance
    • it may lead to unnecessary worry and medical tests when there’s no cancer
    • it cannot tell the difference between slow-growing and fast-growing cancers
    • it may make you worry by finding a slow-growing cancer that may never cause any problems

    How The Prostate Changes As You Age

    Fondation BOMOKO on Twitter: " WORD OF TODAY PSA test  ...

    Because the prostate gland tends to grow larger with age, it may squeeze the urethra and cause problems in passing urine. Sometimes men in their 30s and 40s may begin to have these urinary symptoms and need medical attention. For others, symptoms aren’t noticed until much later in life. An infection or a tumor can also make the prostate larger. Be sure to tell your doctor if you have any of the urinary symptoms listed below.

    Tell your doctor if you have these urinary symptoms:

    • Are passing urine more during the day
    • Have an urgent need to pass urine
    • Have less urine flow
    • Feel burning when you pass urine
    • Need to get up many times during the night to pass urine

    Growing older raises your risk of prostate problems. The three most common prostate problems are inflammation , enlarged prostate , and prostate cancer.

    One change does not lead to another. For example, having prostatitis or an enlarged prostate does not increase your risk of prostate cancer. It is also possible for you to have more than one condition at the same time.

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    What Is The Test To See If I Have Elevated Psa

    Healthcare providers use a blood test to measure PSA levels.

    You may have a digital rectal exam together with a PSA test to check for signs of prostate cancer. During a DRE, your provider inserts a gloved finger into the rectum to check for bumps or other irregularities.

    Depending on the results of your initial test, your provider may want you to repeat the test. PSA levels can change. A second test gives your provider more details about your prostate health.

    Getting A Prostate Biopsy

    For some men, getting a prostate biopsy might be the best option, especially if the initial PSA level is high. A biopsy is a procedure in which small samples of the prostate are removed and then looked at under a microscope. This test is the only way to know for sure if a man has prostate cancer. If prostate cancer is found on a biopsy, this test can also help tell how likely it is that the cancer will grow and spread quickly.

    For more details on the prostate biopsy and how it is done, see Tests to Diagnose and Stage Prostate Cancer.

    For more information about the possible results of a prostate biopsy, see the Prostate Pathology section of our website.

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    A Case Study Of A Prostate Cancer Patient Who Performed Laparoscopic With Robotic Assistance Radical Prostatectomy

    A.B. is a 55-year-old man who was referred to the urology clinic by his primary care provider for an elevated prostate-specific antigen . He reports that he has been feeling well and has no specific complaints. He had a CBC, basic metabolic panel , urinalysis , lipid profile, and screening PSA completed the week before when he was seen by his PCP. His CBC, lipid profile, UA, and blood chemistries are all within normal limits. His PSA is elevated at 11.9 ng/mL, and the prostate is slightly tender on exam.

    A.B. wonders whether he has prostate cancer. What can you tell A.B. about his PSA?

    PSA is a glycoprotein produced by prostate cells. It is unique to the prostate and is not produced anywhere else in the body. Normally, prostate cells leak a small amount of PSA into the bloodstream this small amount is what is measured when a PSA is drawn. An enlarged prostate naturally leaks more PSA and causes an elevated PSA level in the blood. When a prostate cell is damaged, it leaks more PSA damage might be caused by infection, inflammation, or cancer. A.B.s result of 11.9 ng/mL reflects a moderate elevation. Further testing needs to be done.

    A.B. is scheduled for a transrectal ultrasound  of the prostate. What is the purpose of this test?

    A biopsy needle is inserted through the wall of the rectum into the prostate to obtain a prostate tissue sample. The urologist will usually get six tissue samples from each side of the prostate for a total of 12 samples.


    During Watchful Waiting Or Active Surveillance

    What is a Normal PSA Test?

    If you choose observation or active surveillance, your PSA level will be monitored closely to help decide if the cancer is growing and if treatment should be considered.

    Your doctor will watch your PSA level and how quickly it is rising. Not all doctors agree on exactly what PSA level might require further action . Again, talk to your doctor so you understand what change in your PSA might be considered cause for concern.

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    What Is A Psa Test

    The PSA test is the leading method of screening for prostate cancer. PSA screening can help catch the disease at an early stage when treatment may be more effective and potentially have fewer side effects. The PSA test may be done along with a digital rectal exam , in which a physician inserts a gloved finger into the rectum to examine the prostate for irregularities.

    What Are Psa Levels

    Cells in the prostate gland produce PSA, and levels typically remain below 4 nanograms per milliliter .

    Most individuals with prostate cancer have PSA levels above 4 ng/mL. However, some men with prostate cancer have a normal PSA level. Similarly, some men with a higher than average PSA do not have prostate cancer.

    These variations mean that a PSA test alone cannot rule out or diagnose prostate cancer. However, the PSA test can identify whether a person has a higher risk of developing the disease.

    Initial testing may include both a PSA test and a DRE.

    During a DRE examination, a doctor inserts a finger into the rectum to check the prostate for anomalies.

    If both of these tests suggest prostate cancer, then the doctor will arrange for a biopsy to confirm the diagnosis.

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    Talking With Your Doctor

    Different kinds of doctors and other health care professionals manage prostate health. They can help you find the best care, answer your questions, and address your concerns. These health care professionals include:

    • Family doctors and internists
    • Physician assistants and nurse practitioners
    • Urologists, who are experts in diseases of the urinary tract system and the male reproductive system
    • Urologic oncologists, who are experts in treating cancers of the urinary system and the male reproductive system
    • Radiation oncologists, who use radiation therapy to treat cancer
    • Medical oncologists, who treat cancer with medications such as hormone treatments and chemotherapy
    • Pathologists, who identify diseases by studying cells and tissues under a microscope

    View these professionals as your partnersâexpert advisors and helpers in your health care. Talking openly with your doctors can help you learn more about your prostate changes and the tests to expect.

    Prostate Cancer With A Normal Psa


    In their study, Coltman and colleagues analyzed data from a clinical trial of nearly 10,000 men. After seven years, they had a prostate biopsy whether they had a high PSA or not.

    About 3,000 of these men never had a PSA level of more than 4.0. Fifteen percent of these men turned out to have prostate cancer. And 15% of these cancers were life-threatening, high-grade tumors.

    The chances of prostate cancer — and of high-grade cancer — went up as PSA levels rose. But high-grade cancers were seen in men at all PSA levels.

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