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What Is Elevated Psa Level In Prostate

What Does It Mean To Have An Elevated Psa

What if my PSA levels are high? | Norton Cancer Institute

According to, a low PSA level is a sign of good prostate and overall health, while a high PSA level is a sign of risk of prostate cancer. As such, a low PSA level is ideal.

Among men who do not have prostate cancer, typical PSA levels under 4 ng/mL of blood, according to the American Cancer Society . As PSA levels rise, so does the risk for prostate cancer. For those with a PSA level over 10, the chance of having prostate cancer is more than 50 percent.

That being said, heightened levels do not always indicate that cancer is present. There is also no guarantee that PSA levels below 4 ng/mL means there is no prostate cancer.

What Happens If My Psa Level Is Elevated

If you have a high PSA level, you will need ongoing PSA tests and DREs so your provider can look for any changes. If the PSA level continues to increase or if your healthcare provider finds a lump during a DRE, you may need other tests, including:

  • Transrectal ultrasound and prostate biopsies.
  • Prostate MRI.
  • Iso PSA or 4Kscore® .

A biopsy can tell you definitively if you have prostate cancer. The biopsy results also affect your treatment. For example, if the biopsy shows a lot of cancer cells, you might need more aggressive treatment.

What If My Biopsy Results Are Negative

A negative biopsy does not definitively exclude the presence of cancer. After a negative result, you will have a PSA test every three to six months. If the PSA remains elevated, the physician will recommend a second biopsy.

The closer you follow the patients with negative biopsies, the less likely you are to miss a clinically significant cancer.Dr. Herb Ruckle

For a second biopsy, MRI imaging is typically performed. An MRI-guided prostate biopsy uses advanced, more accurate imaging to take a biopsy and detect a cancer missed in the first ultrasound-guided biopsy. If this second biopsy comes back as negative, the physician will continue to keep a close eye on your PSA levels with the variety of tests, and you may need to undergo additional biopsies. The closer you follow the patients with negative biopsies, the less likely you are to miss a clinically significant cancer, Ruckle says.

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What Is Psa Screening

PSA is a protease, a group of enzymes that break down proteins into smaller peptides or amino acids.

It is released by the prostate gland, promoting the movement of sperm. However, a small amount escapes into the bloodstream and can be used to monitor prostate activity. Healthy men have low levels of serum PSA but they often elevate in the presence of prostate disorders, including:

  • Developed exclusively by our nutritionist
  • Helps reduce prostate size and symptoms

The Prostate & Psa Levels

David Samadi, MD

If you ever test for elevated PSA levels, please do NOT go into panic mode. Weve seen several men with a high prostate PSA levels that are on testosterone therapy. These men get their yearly check up, and are absolutely fine or free of prostate cancer. Early detection of prostate cancer currently relies on screening with the PSA test, which does not clearly distinguish between prostate cancer and less severe conditions. As a result, many men are subjected to unnecessary prostate biopsies. There are over 1 million prostate biopsies performed in the US each year. Only 20% detect aggressive prostate cancer. Furthermore, 80% of prostate biopsies are either negative or detect a low-grade, non-life threatening form of prostate cancer.

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Psa Level Risk Analysis

  • 15% of men with a PSA level less than 4 ng/ml go on to develop prostate cancer.
  • 31% of men with PSA levels between 4 10 ng/ml have shown to develop prostate cancer.
  • 50% 65% of men with psa scores over 10 ng/ml develop prostate cancer.

An important part of the your results is finding both the

1. Total amount of PSA in your blood.

2. Ratio of free vs bound PSA.

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The prostate is a walnut-sized gland found between the bladder and the rectum in males. Its primary job is to produce seminal fluid. The prostate creates a protein, the prostate-specific antigen, or PSA. A PSA screening test is a blood test approved by the FDA in 1994 to measure the levels of PSA in a mans blood.

Small amounts of PSA ordinarily circulate in the bloodstream and can be measured by a PSA test to monitor the health of the prostate. This test is intended to screen for prostate cancer, find other prostate-related conditions, or monitor PSA levels in those in treatment for prostate cancer. This is a simple blood test which reports PSA levels as nanograms of PSA per milliliter of blood.

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What Does It Mean

In greatest series about BCR after RP there was no man with local or distant clinical disease without an increase in PSA at the time of progression. Rising PSA is the first sign of disease progression after RP, however it does not necessarily lead men to metastatic disease or cancer mortality in few years . This is the key to understand variation among BCR definition. BCR defined as PSA 0.2ng/mL presents higher rates of biochemical progression, while clinical progression, assessed by metastatic disease or cancer specific mortality, was more associated with PSA 0.4ng/mL . Regardless the BCR definition, it shoud not be used as a landmark to start treatments. Although better oncologic outcomes were observed when salvage treatment was administrated at lower PSA levels, the correct timing of its administration depends on pathologic features, functional status, quality of life effects and patients preferences .

Han and colleagues evaluated 2.091 men submited to RP without adjuvant radiotherapy for a median follow-up of 5.9 years. Recurrence was noted in 17% of patients. Overall actuarial 5, 10 and 15 year BCR rates were 16%, 28% and 39%, respectively. Same years rates for metastatic disease were 4%, 11% and 19% and for PCa specific mortality 1%, 4% and 11%, respectively .

What Should You Do If Psa Levels Happen To Fall In This Percentage

The ExoDx Prostate Test: Use in Men With Elevated PSA levels 2-10ng/mL

First and foremost, do not panic once again, and start doing some investigation as to the cause of it, like: Do you have a strong family history of prostate cancer? Do you have signs and symptoms of testosterone deficiency? Are you experiencing signs of an enlarged prostate? Once youve identified these questions, take action on them, and get to the bottom of it until the problems are taken care of.

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Psa And Prostate Cancer: What Do My Numbers Mean

The prostateis a walnut-sized gland that sits below the bladder in men. It is responsible for creating semen, the milky liquid that carries sperm out of the body when a man ejaculates.

A PSA test is a blood test used to screen for prostate cancers. PSA is a protein produced in the prostate by both cancerous and noncancerous tissue. Elevated PSA levels can indicate the presence of cancer, but high PSA levels can also be a result of non-cancerous conditions like benign prostatic hyperplasia , or an infection. PSA levels also rise naturally as you age.

Elevated PSA levels do not necessarily mean that you have prostate cancer. PSA tests arent always accurate: many men who have prostate cancer have normal PSA levels. Alternatively, some men have high PSAs but dont have cancer. Or they have a slow growing form of cancer that would never have had symptoms or caused them any harm.

What Does Prostate Specific Antigen Really Mean

Is a measurement of protein produced by the prostate, usually measured in ng/dl. PSA elevates with enlarging prostates, either from inflammation, infection, or testosterone deficiency. Prostates look for more testosterone, thus all aging men have lower levels of testosterone than they did as youths and the prostate enlarges to suck up more testosterone to convert to the active form of it. This form is called dihydrotestosterone.

If your PSA is elevated then you must also have your percent free PSA measured. The amount free or unbound by protein in the blood serum is the percentage of how much PSA circulates free compared to the total PSA.

  • Men with 15-25% of their PSA free are considered within normal limits.
  • Over 25% PSA free usually indicates an enlarged prostate.
  • Less than 15% free PSA is suspicious for dysplasia or early cancer.
  • Less than 7% is highly suspicious of cancer.

If you happen to be in the 15% or lower bracket, we strongly recommend the 4K score prostate test. The 4Kscore combines four prostate-specific biomarkers with clinical information to provide men with an accurate and personalized measure of their risk for aggressive prostate cancer. The 4Kscore can be used prior to biopsy, or after a negative biopsy. As a result, it can predict the likelihood of cancer spreading to other parts of the body in the next 20 years.

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Psa And Prostate Cancer Staging

Prostate cancer stages run from 1 to 4, with 4 being the most advanced stage and 1 being the least advanced stage. PSA levels can help doctors to determine the stage of prostate cancer, as follows:

  • Stage 1: The cancer is limited to one half of the prostate and has not spread to other tissues. PSA levels are below 10.
  • Stage 2A: The cancer is limited to one half of the prostate and has not spread. PSA levels are between 10 and 20.
  • Stage 2B: The cancer has affected both sides of the prostate, PSA levels are greater than 20, or both.
  • Stages 3 and 4: The cancer has spread to other tissues. The extent to which this has occurred determines the stage. PSA levels are no longer considered.

What Is The Test To See If I Have Elevated Psa

Overview of the Prostate

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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How Is The Psa Test Used In Men Who Have Been Treated For Prostate Cancer

The PSA test is often used to monitor patients who have a history of prostate cancer to see if their cancer has recurred . If a mans PSA level begins to rise after prostate cancer treatment, it may be the first sign of a recurrence. Such a biochemical relapse typically appears months or years before other clinical signs and symptoms of prostate cancer recurrence.

However, a single elevated PSA measurement in a patient who has a history of prostate cancer does not always mean that the cancer has come back. A man who has been treated for prostate cancer should discuss an elevated PSA level with his doctor. The doctor may recommend repeating the PSA test or performing other tests to check for evidence of a recurrence. The doctor may look for a trend of rising PSA level over time rather than a single elevated PSA level.

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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How Psa Results Are Used For Diagnosis

In the past, many doctors wanted men with elevated PSA and/or an abnormal digital rectal examination to undergo a prostate biopsy. Today, this is not a course of action recommended by the American Urological Association. In such cases, multiparametric prostate MRI is now recommended as the best front-line test to detector rule outprostate cancer.

If a mpMRI shows a suspicious finding, a MRI-guided biopsy is the most accurate way to perform a biopsy of the prostate. If this is not possible, an MRI can be used with an ultrasound-guided biopsy. This is referred to as a fusion biopsy, and is more accurate than an ultrasound biopsy alone.

PSA level

Problems With The Psa Test

What does an elevated PSA test result mean? (Kenneth Jacobsohn, MD)

There are reasons doctors donât agree on whether you need this test:

  • Finding prostate cancer early doesnât always protect you. The PSA test often finds small, slow-growing tumors that arenât life-threatening. Treating them anyway, whether itâs with surgery or radiation, can expose you to harmful side effects and complications. Also, finding cancer early may not help if you have an aggressive tumor or if it spread to distant body parts before you found it.
  • The results arenât always accurate. If you have a high level but you donât have cancer, the test results can create a lot of worry and lead to medical procedures you donât need. A negative result if you really do have cancer can prevent you from getting treatment you do need.

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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.

Who Should Have Regular Screening Tests For High Psa

The PSA test was first developed to observe prostate changes in men who had a history of prostate cancer. Then it became more widely used in the general population as a way to detect and prevent prostate cancer before symptoms developed. But routine screening can find prostate cancers that grow slowly and do not need treatment. Talk to your healthcare provider to see if you should have regular PSA tests.

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Questions To Think About Before Having A Psa Test

To help you make your decision, you could think about the following questions:

  • What would you do if your PSA level is high?
  • What would you do if further tests find that you have an early prostate cancer?
  • What difference will it make for you to know about an early prostate cancer?

Before you decide whether to have the PSA test, you may want to talk to your GP about it. You can also call our cancer support specialists on 0808 808 00 00. They can discuss the options with you and send you more information.

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.

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What Factors Can Falsely Elevate Your Psa Level

There are other factors that can affect the PSA level besides prostate cancer. The following conditions can lead to increased PSA levels:

  • Increasing age

  • Benign prostate hyperplasia , a condition that commonly develops as those assigned male at birth age and causes the prostate to grow in size

  • Inflammation or infection of the prostate, like prostatitis or a urinary tract infection

  • Hormone medications, like testosterone

  • Ejaculation, which can raise the PSA level for a short period of time

  • Riding a bike, or anything that puts pressure on the area near the prostate

  • Trauma to an area near the prostate


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