What Are Normal Psa Levels By Age
The definition of physiological PSA levels remains an active debate. 2.5 ng/mL is safe. 2.6 to 4 ng/mL is safe in most men but talk with your doctor about other risk factors. 4.0 to 10.0 ng/mL is suspicious. Although this is not always the case. Men with high PSAs do not always have prostate cancer, while men with very low PSAs sometimes DO have prostate cancer. The prostate gland increases in size and produces more PSA as you get older.
Note that the American Urological Association recommends against routine PSA screening in men aged less than 54 years . If your PSA test result is high for your age or persistently increasing, a prostate biopsy may be recommended.
Your health care provider should consider conditions that can elevate PSA levels before recommending a prostate biopsy.
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What Does An Elevated Psa Level Mean If Ive Had Prostate Cancer In The Past
If youve ever had treatment for prostate cancer, youll have regular PSA screenings for the rest of your life. An increasing PSA level may mean the cancer has returned. Your care team may use other tests, including imaging scans and biopsies, to check for signs of cancer. If cancer returns, your team will discuss your treatment options with you.
Improving Sensitivity Of Psa Testing
Prostate-specific antigen testing with a cutoff of 4.0 ng/mL has a sensitivity of 67.5-80%, which implies that 20-30% of cancers are missed when only the PSA level is obtained. Sensitivity can be improved by lowering the cutoff or by monitoring PSA values so that a rise in PSA level of more than 20-25% per year or an increase of 0.75 ng/mL in 1 year would trigger performance of a biopsy regardless of the PSA value.
The specificity of PSA at levels higher than 4.0 ng/mL is 60-70%. Specificity can be improved by using age-adjusted values, PSA velocity , and the ratio of free PSA to total PSA . Another method is to adjust the PSA according to the size of the prostate or volume determinations of the transitional zone, which produces most of the PSA, and the peripheral zone, which produces less PSA but a majority of prostate cancers.
In the European Randomized Study of Screening for Prostate Cancer, Schroder et al studied a strategy for the early detection of prostate cancer that excluded digital rectal examination results and used a PSA cutoff of 3.0 ng/mL as the only indication for a biopsy. This protocol was compared with one in which a PSA level of 4.0 ng/mL or higher or the presence of a positive DRE or transrectal ultrasound was the indication for a biopsy. In a follow-up study, Schroder et al confirmed a substantial reduction in mortality from prostate cancer as a result of PSA testing.
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Follow The Prostate Diet
Men who want to help keep PSA levels low, support overall prostate health, and fight inflammation are encouraged to follow The Prostate Diet. The diet has 10 foundations which, if you follow them consistently, should reward you with a healthy prostate and overall health as well. Post them where you can refer to them until they become a habit.
- Eat lots of fruits and vegetables, organic whenever possible
- Consume healthy fats monounsaturated, omega-3 fatty acids
- Choose plant protein over animal protein
- Drink green tea often
- Choose whole, natural foods over refined, processed foods
- Include foods rich in omega-3 fatty acids
- Avoid or significantly limit certain foods and supplements
- Choose prostate cancer-killing foods and supplements, such as tomatoes, green tea, and vitamin D
- Stay well hydrated with pure water
- Consider taking natural supplements that support prostate health
What Is A Dangerous Psa Level
PSA levels above 10 ng/mL are considered especially risky. Patients should consult their doctor immediately, as there is a chance of prostate cancer. Elevated PSA levels may indicate cancer or other types of infections or conditions.
Note that other factors may cause increased levels, such as prostatitis and urinary tract infections. Similarly, certain drugs can also increase levels.
Unfortunately, most studies of PSA levels are conducted primarily on populations of white men and do not include a range of men from various demographics including other ethnic groups, which may have other factors affecting their PSA levels. In general, though, higher levels are considered a risk and should call for further testing.
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How Are Prostate Problems Diagnosed
To diagnose prostate problems, the health care provider will perform a digital rectal exam . The health care provider will also ask the patient
- when the problem began and how often it occurs
- what symptoms are present
- whether he has a history of recurrent urinary tract infections
- what medications he takes, both prescription and those bought over the counter
- the amount of fluid he typically drinks each day
- whether he consumes caffeine and alcohol
- about his general medical history, including any major illnesses or surgeries
Answers to these questions will help the health care provider identify the problem or determine what medical tests are needed. Diagnosing BPH may require a series of medical exams and tests.
Enhancing Healthcare Team Outcomes
There is no prostate-specific antigen value that guarantees the presence or absence of prostate cancer. However, it currently is the best manner in which to detect early, and often asymptomatic malignancy. Yet, the decision to screen healthy individuals will continue to be controversial while utilizing the test. Individuals between the ages of 55 and 69 years should be given the opportunity to be screened following a conversation regarding the risks and benefits of screening with particular consideration given to patient preference. Following the decision to screen, PSA values will be instrumental in determining the next steps in treatment. It is generally accepted that low PSA values in asymptomatic individuals are reassuring, and significantly elevated PSA values are concerning for prostate cancer. Although these assumptions are not definitive.
There is uncertainty, and controversy, regarding the best manner in which to handle an intermediate PSA value. The crux of the conundrum is that many individuals with benign conditions, leading to the minimally elevated PSA value, are subjected to unnecessary prostate biopsy in an effort to differentiate between a condition that is likely to be benign versus the less-likely chance of malignancy. Especially when considering that the majority of the malignancies discovered are indolent and are likely not to require medical management.
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The Test Is Often Not Needed
Most men with high PSAs dont have prostate cancer. Their high PSAs might be due to:
- An enlarged prostate gland.
- Recent sexual activity.
- A recent, long bike ride.
Up to 25% of men with high PSAs may have prostate cancer, depending on age and PSA level. But most of these cancers do not cause problems. It is common for older men to have some cancer cells in their prostate glands. These cancers are usually slow to grow. They are not likely to spread beyond the prostate. They usually dont cause symptoms, or death.
Studies show that routine PSA tests of 1,000 men ages 55 to 69 prevent one prostate cancer death. But the PSA also has risks.
Prostate Cancer: Advancements In Screenings
You may know thatprostate canceris one of the most common cancer types in men. The good news is that thereare many treatment and management options, even if the cancer is caught ata later stage.
What you may not know: There are several options when it comes toprostate cancer screening. After considering multiple factors, your doctor may recommend theprostate-specific antigen test, and/or one of the newer screeningtests that are now available.
Johns Hopkins urologistChristian Pavlovich, M.D., explains what you should know.
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If I Have Elevated Psa Levels What Should I Ask My Healthcare Provider
If you have any symptoms of prostate cancer, or if it runs in your family, ask your provider:
- Should I have regular tests to check my PSA level?
- What can I do to lower my risk for prostate cancer?
- What other tests or monitoring do I need?
- What are my treatment options if I get prostate cancer?
- What other signs or symptoms should I look out for?
A note from Cleveland Clinic
An elevated PSA level can be a sign of prostate cancer, but it doesnt always mean you have cancer. Your healthcare provider will watch you and do more tests to arrive at a diagnosis. Prostate cancer is often slow-growing and may never become life-threatening. If you have symptoms of prostate problems, such as difficulty urinating, don’t hesitate to let your provider know.
Last reviewed by a Cleveland Clinic medical professional on 04/06/2021.
References
Prostate Specific Antigen Test
A blood test called a prostate specific antigen test measures the level of PSA in the blood. PSA is a substance made by the prostate. The levels of PSA in the blood can be higher in men who have prostate cancer. The PSA level may also be elevated in other conditions that affect the prostate.
As a rule, the higher the PSA level in the blood, the more likely a prostate problem is present. But many factors, such as age and race, can affect PSA levels. Some prostate glands make more PSA than others.
PSA levels also can be affected by
- Certain medical procedures.
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What Causes An Elevated Psa Level
Prostate cancer is the main cause of an elevated PSA level. But PSA levels increase with age and can reflect different prostate conditions. Other factors that may raise a persons PSA level include:
- Prostate enlargement and inflammation .
- Urinary tract infection.
- Urinary catheter placement.
Your healthcare provider will also consider whether your medications affect PSA levels. For example, 5-alpha reductase blockers treat enlarged prostates and will lower PSA levels.
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.
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What Is A Psa Test
Prostate-specific antigen, or PSA, is a protein produced cells of the prostate gland and a PSA test measures the level of PSA in a mans blood.
What Is the PSA Test Used For?
The PSA test is a standard screening test for prostate cancer because PSA levels are often elevated in men with prostate cancer.
Who Should Get A Psa Test
Not everyone should get a PSA test. Why? Because many in this country are treated for low-risk prostate cancer that is discovered through the PSA test, even when it is unlikely that the disease will ever cause symptoms or lead to death. And treatment is associated with significant side effects, including impotence and incontinence . You should discuss whether prostate cancer early detection is right for you with your personal primary care physician.
To avoid the risks of over-treatment, Roswell Park follows the guidelines established by the National Comprehensive Cancer Network . The NCCN brings together world-renowned experts from 30 of the nations top cancer centers to write guidelines that specify the best ways of preventing, detecting and treating cancer. The guidelines are updated at least every year, on the basis of the latest research.
Michael Kuettel, MD, PhD, MBA, Chair of Roswell Park’s Department of Radiation Medicine, serves on the NCCN Prostate Cancer Panel.
If you decide that Prostate Cancer Early Detection is right for you, the NCCN recommends PSA testing as follows:
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The Role Of Psa In Staging
Prostate cancer causes cells to become malignant and multiply uncontrollably. This can lead to overproduction of PSA, and higher levels of PSA in the bloodstream.
However, some men who have prostate cancer do not exhibit elevated PSA levels. And certain noncancerous conditions, like a prostate infection or benign enlargement, can also cause high PSA levels.
PSA levels are just one factor used in determining the stage of prostate cancer. Another diagnostic tool is called the Gleason scale. This rates the extent of abnormality in your prostate cells after biopsy.
At a certain point in prostate cancers late-stage progression, Gleason and PSA become less useful. When a tumor is large enough, doctors no longer need these numbers to predict its growth or malignancy.
Psa Level After Prostatectomy: What Does Your Number Mean
If you’re a man over age 55, you may have already had a PSA, or prostate-specific antigen test. This test screens for prostate cancer by measuring the amount of a protein in your bloodstream released by cells in your prostate gland.
This test isn’t just for screening, though. You’ll also have it after a prostatectomy — surgery to take out all or part of your prostate. This will tell you how well the treatment worked and whether your cancer has come back.
You’ll need this test every few months after your operation. But getting tested for cancer many times can cause a lot of anxiety. And because the results aren’t always clear, you may worry about them.
A little knowledge can help calm your fears. Before you have this test, find out what to expect. Ask your doctor what your results might mean and what will happen if your PSA level is higher than it should be.
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Cell Cycle Inhibitor P27
The cell cycle inhibitor p27 is a putative tumor suppressor gene. Loss of p27 is associated with a poor prognosis in patients with breast, colorectal, and prostate carcinoma. In men treated with radical prostatectomy, loss of p27 expression correlates with an increased probability of cancer recurrence and lower survival rates. Decreased p27 expression also is associated with high-grade cancer cells, positive surgical margins, seminal vesicle invasion, and lymph node metastases.
If Screening Test Results Arent Normal
If you are screened for prostate cancer and your initial blood PSA level is higher than normal, it doesnt always mean that you have prostate cancer. Many men with higher than normal PSA levels do not have cancer. Still, further testing will be needed to help find out what is going on. Your doctor may advise one of these options:
- Waiting a while and having a second PSA test
- Getting another type of test to get a better idea of if you might have cancer
- Getting a prostate biopsy to find out if you have cancer
Its important to discuss your options, including their possible pros and cons, with your doctor to help you choose one you are comfortable with. Factors that might affect which option is best for you include:
- Your age and overall health
- The likelihood that you have prostate cancer
- Your own comfort level with waiting or getting further tests
If your initial PSA test was ordered by your primary care provider, you may be referred to a urologist for this discussion or for further testing.
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Normal Psa Levels By Age Chart
What is a normal PSA level by age? We mentioned earlier in this article that PSA levels increase with age due to age related growth of the prostate gland. A doctor will therefore take into account an age-adjusted PSA level when discussing your prostate health:
| Age Range | |
| 70 | 0 to 6.5 |
Although there are normal PSA levels by age range, it is still important to screen routinely to ensure these normal levels are not rising.
Why It Is Done
The prostate-specific antigen test is done to:
- Screen men for prostate cancer. Since other common medical conditions, such as benign prostatic hyperplasia and prostatitis, can cause high PSA levels, a prostate biopsy may be done if your doctor is concerned about signs of prostate cancer.
- Check if cancer may be present when results from other tests, such as a digital rectal examination, are not normal. A PSA test does not diagnose cancer, but it can be used along with other tests to determine if cancer is present.
- Watch prostate cancer during active surveillance or other treatment. If PSA levels increase, the cancer may be growing or spreading. PSA is usually not present in a man who has had his prostate gland removed. A PSA level that rises after prostate removal may mean the cancer has returned or has spread.
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What Is A Psa Test How To Understand Your Levels
Perhaps one of the most feared cancers for men, prostate cancer can be deadly if detected too late. It causes about 26,000 deaths per year and affects one out of every seven men. Helping detect cases of prostate cancer, the PSA blood test is a crucial tool for early diagnosis.
The first step in prostate cancer early detection is the prostate-specific antigen test or PSA test.