A PSA blood test is one of two ways that your doctor and/or urologist screen for prostate cancer, with the other being a digital rectal examination (DRE). Unsurprisingly, there may be confusion as to what constitutes an elevated PSA, as well as what other terms men (or other doctors) may use to refer to an elevated PSA.
What is an Elevated PSA?
PSA—which stands for prostate-specific androgen—is a protein made by the prostate gland that is detected in the blood. A normal value is generally between 0 to 4.0 ng/mL. However, the 4.0 ng/mL threshold is not applied consistently and may need to be tailored based on specific patient characteristics. For example, although the evidence is not perfect, many urologists will use an “age-based PSA normal range”. In general:
- For men in their 40s and 50s, a PSA score of more than 2.5 ng/mL may be considered abnormal, as the average PSA in this age range is 0.6 to 0.7 ng/mL
- For men in their 60s, a PSA of more than 4.0 ng/mL may be considered abnormal, as the average PSA in this age range is 1.0 to 1.5 ng/mL
- For men in their 70s, a PSA of more than 6.0 ng/mL may be considered abnormal, however, this threshold may be even higher based on a man’s overall health
It is important to understand that, while we use PSA testing to look for early signs of prostate cancer, there are many reasons why PSA levels in your blood may be elevated. These include prostate cancer, benign growth of the prostate with male aging (so-called benign prostatic hypertrophy, BPH), inflammation or infection in the prostate, or changes in prostate blood flow. Thus, PSA testing is only the first step.
Especially for men that do not have a life expectancy of more than 10 years, an elevated PSA must be taken into the context of a man’s overall health. The harms of prostate cancer screening among these men are secondary to the increased stress/burden of a possible prostate cancer diagnosis that is highly unlikely to be life-threatening. Additionally, PSA thresholds for African American or Black men (discussed in more detail in another article) are generally lower (~0.5 ng/mL lower, although this number is debatable) than for Caucasian men given the increased rate of high-grade prostate cancer often found in these men.
What are other terms for an “Elevated PSA”?
Because of the commonality of PSA screening in men over the age of 50, many of your friends are likely also undergoing PSA screening for prostate cancer. Combined with a variety of different doctors that may provide PSA screening (i.e., urologists, family physicians/general practitioners, internal medicine doctors, etc.) the lay language surrounding an elevated PSA may be confusing. As a result, men and their physicians may use any of the following terms to discuss an “elevated PSA”:
- My “blood work” isn’t right
- My “blood test” is up
- My “number” is up
- My “prostate test” is up
- My “cancer screening test” is up
- My “cancer test” isn’t right
Each man should have their doctor explain to them what an elevated PSA means in their specific situation, as an elevated PSA for one man that may lead to a conversation about a prostate biopsy is not as concerning (or even “normal”) for another man. It is important that each man understands what his PSA value means in the context of his own health. Just as importantly, he must know what the PSA threshold is for a prostate biopsy. Men that undergo PSA screening typically will have a blood test every year or two during recommended screening ages to assess the trend in PSA values over time. However, the urologist may check the PSA more frequently if they have concerns. Ultimately, intervals for screening should be individualized for each patient and based on the baseline PSA level. As mentioned, be sure that you “know your number” both what it is and what it means in the context of your health, PSA surveillance schedule, and the threshold for a prostate biopsy.