If you’re a man over 50, or younger if you are considered to be high-risk, your doctor may have recommended that you get a PSA test.
Prostate-specific antigen (PSA) is a protein made by the prostate gland. While its primary function is to help liquefy semen, PSA levels in the blood are an important indicator of prostate health. A PSA test is a routine blood test used as a screening tool to assess the risk of prostate conditions, including prostate cancer. A high PSA score can indicate a benign condition, or it could signify prostate cancer, but a biopsy would be needed for diagnosis.
What Is a PSA Test and What Does It Measure?
A PSA test is a blood test that measures the amount of prostate-specific antigen in the bloodstream. While some PSA naturally circulates in the blood, higher-than-normal levels may indicate an issue with the prostate. This test helps doctors evaluate prostate health and detect conditions such as prostate enlargement, inflammation or cancer.
Andres Peralta, an Family Nurse Practitioner with Riverside Urology Specialists, explains, “The PSA test is an essential tool in monitoring prostate health, but it’s only part of the equation. Elevated levels don’t always mean cancer, but they do signal the need for further evaluation.”
Understanding PSA Test Results
PSA levels are measured in nanograms per milliliter (ng/mL). Although there is no strict threshold, a PSA level under 4.0 ng/mL is typically considered within the expected range. However, PSA results must be interpreted in context—some men with low PSA levels may have prostate cancer, while others with high PSA may have benign conditions.
Several factors can influence PSA levels, including age, prostate size, recent infections, or medical procedures. “Generally speaking, a single elevated PSA test result does not provide enough evidence to obtain a prostate biopsy, which is used to diagnose prostate cancer,” says FNP Peralta. “However, other laboratory studies in addition to PSA trends over time can help determine if there is a cause for concern.”
Conditions Associated with Elevated PSA Levels
An elevated PSA level does not automatically mean cancer. Several other conditions can cause higher PSA readings, including:
- Benign prostatic hyperplasia (BPH): A common non-cancerous enlargement of the prostate.
- Prostatitis: Inflammation or infection of the prostate, often causing discomfort and urinary symptoms.
- Recent sexual activity or medical procedures: Ejaculation, a digital rectal exam (DRE), or prostate biopsy can temporarily raise PSA levels.
- Prostate cancer: While PSA elevation is a potential indicator of prostate cancer, further testing is required to confirm a diagnosis.
What to Do If Your PSA Levels Are Elevated
If your PSA test results are higher than expected, your health care provider will assess additional factors such as age, medical history and prior PSA levels. Depending on the situation, they may recommend:
- A repeat PSA test to monitor levels over time.
- A digital rectal exam (DRE) to check for abnormalities in prostate size and texture.
- Advanced imaging or biopsy if there are concerns about prostate cancer.
- Molecular and genomic analysis (4K Score) is a blood test used to detect the risk of aggressive forms of prostate cancer.
“It’s crucial to discuss your results with a health care provider,” advises FNP Peralta. “PSA is a helpful tool, but it must be interpreted alongside other clinical findings.”
How Often Should You Get a PSA Test?
The frequency of PSA testing depends on individual risk factors. The American Urological Association (AUA) and the Riverside Cancer Care Network provide the following general recommendations:
- Men at a higher risk (aged 40-45): Should discuss PSA testing with their health care provider if they are at a high risk of developing prostate cancer. This includes African Americans and men who have one or more first-degree relatives – a father or brother - who have been diagnosed with prostate cancer at age 65 or below.
- Men aged 50-69: Should discuss PSA testing with their health care provider to determine if it’s right for them.
- Men over 70: Routine PSA testing is generally not recommended unless there are specific concerns.
Take Charge of Your Prostate Health
Regular PSA screenings can help detect potential prostate issues early, but it’s not a definitive diagnostic tool. If your PSA levels are elevated, don’t panic—many factors can contribute to this result. Talk with your health care provider about the next steps and whether additional testing is needed.
By staying informed and proactive, you can take control of your prostate health. If you have questions about PSA testing or prostate conditions, schedule a consultation you’re your primary care provider to explore your options.
