Prostate Specific Antigen PSA

Rising PSA
Can be the First Sign of Cancer

Prostate Specific Antigen or PSA, is an enzyme found in a man's blood produced exclusively by prostate cells. Normal PSA levels in the blood are very small amounts between 0-2.5 ng/ml. As men age, normal levels can increase slightly. View the table below for more detail.

Higher than normal levels, greater than 2.5 ng/ml, can have many different causes. Higher levels of PSA can be found in the blood as prostate cancer cells begin to proliferate in an uncontrolled way. PSA can also rise for benign, non-cancerous conditions such as enlarged prostate, prostate inflammation, infection, or trauma.

IMPORTANT: All elevated readings of PSA should be checked.

Prostate Specific Antigen or PSA, is an enzyme found in a man's blood produced exclusively by prostate cells. Normal PSA levels in the blood are very small amounts between 0-2.5 ng/ml. As men age, normal levels can increase slightly. View the table below for more detail.

Higher than normal levels, greater than 2.5 ng/ml, can have many different causes. Higher levels of PSA can be found in the blood as prostate cancer cells begin to proliferate in an uncontrolled way. PSA can also rise for benign, non-cancerous conditions such as enlarged prostate, prostate inflammation, infection, or trauma.

IMPORTANT: All elevated readings of PSA should be checked.

Prostate Cancer Screen – PSA combined with DRE

When screening for prostate cancer, the PSA test should be combined with a Digital Rectal Exam, DRE. Occasionally, the PSA is elevated but the DRE, does not reveal any abnormalities. Sometimes the opposite is true, and PSA is normal, but the DRE is abnormal. For this reason, the Prostate Specific Antigen PSA blood test together with the DRE is best for early detection.

To Learn more about the tests that confirm prostate cancer: See Our Test and Diagnosis Page.

PSA is measured by a simple blood test. The typical test for diagnosis and risk group determination is the “total PSA” which is simply a measure of all the PSA. Since the amount of PSA in the blood is very low, detection of it requires a very sensitive technology (monoclonal antibody technique). This test should be part of a man’s yearly exam, starting somewhere after age forty five.

PSA Monitoring Following Treatment

Normal prostate cells and prostate cancer cells make PSA even if they are outside the prostate. That is why PSA monitoring after treatment is so important. Returning prostate cancer cells, confined to the prostate or that have spread to the bone or lymph nodes, will cause the PSA to rise. Prostate Specific Antigen PSA is important for diagnosis, treatment and follow-up as well as useful for comparing treatment results.

Prostate Specific Antigen - PSA

PSA and Age

Austrian Researchers in the Tyrol PCa Early Detection Program, (PLoS ONE. 10(7):e0134134, 2015), have researched what PSA levels within age ranges should raise concern about the likelihood of significant prostate cancer. Based on age, what PSA level might trigger a referral to a urologist? Using these PSA trigger levels they “detected all relevant PCa with a significant reduction of biopsies.”

 

Age RangePSA Trigger Levels
Less Than 59 YearsPSA 1.75 ng/mL
Between 60-69 years PSA 2.25 ng/ml
Greater than 70 yearsPSA 3.25 ng/mL
What is “free PSA”?

Total PSA is the sum of the free and the bound forms. Most PSA binds to other proteins in the blood. The remaining unattached PSA is named “free” PSA. Men with a lower percentage of free PSA have a higher risk for prostate cancer. For example, a man whose total PSA is 6.0 ng/ml with a 10 percent free PSA has a higher likelihood of having prostate cancer than another patient whose total PSA also is 6.0 ng/ml but with 35 percent free PSA. Therefore a high free PSA percentage is good. Free PSA is not used to monitor results after treatment only to evaluate risk before diagnosis. The free PSA test is particularly helpful in situations where a biopsy is negative but the PSA is slightly high. If there is a low free PSA, another biopsy 6-12 months later is usually recommended. If it is high, then a longer wait is usually recommended.

The free PSA test is a road sign to help determine whether further work-up and follow-up is necessary. A high free PSA does not guarantee that a person is free of prostate cancer. In some cases, a biopsy of a nodule will turn up prostate cancer despite a low overall total PSA and a high level free PSA. The total PSA is what is measured with the standard PSA test.

  UNDERSTAND PROSTATE CANCER.

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