What PSA value is deemed abnormal?

PSA testing for prostate cancer

Prostate cancer is the most prevalent type of cancer and ranks as the second leading cause of cancer-related deaths in men, following lung cancer. One in ten men will develop prostate cancer. However, it is unfortunate that conventional doctors rarely detect prostate cancer.

Most types of cancer do not show symptoms in the early stages, including prostate cancer. Symptoms typically appear in stages 2 and 3, making it important to screen and detect any abnormalities as a precautionary measure against cancer. One such screening tool is the prostate-specific antigen (PSA), which is a protein produced by the prostate gland cells. While it typically leaves the body during ejaculation, small amounts can enter the bloodstream.

Normal PSA levels

The normal range for PSA levels is between 4 to 10 ng/mL, although levels may vary depending on age. PSA levels should not exceed 10 ng/mL. After a prostatectomy to treat cancer, the PSA level should be 0, but follow-up tests are still required. If PSA levels are found to be elevated, it may indicate the presence of metastatic prostate cancer that cannot be fully eliminated.

Detected PSA levels indicate a different chance of developing cancer.

Level Standard PSA

Possibility of cancer

Free PSA level

Possibility of cancer

0-2 ng/mL

1%

0-10%

56%

2-4 ng/mL

15%

10-15%

28%

4-10 ng/mL

25%

15-20%

20%

>10 ng/mL

>50%

20-25%

16%

>25%

8%

What is the significance of PSA measurement results?

If the rectal examination and PSA values are normal, further examination may not be necessary. However, your doctor may still recommend an annual rectal and PSA exam. If the PSA level is high or if the rectal exam shows abnormalities in the prostate, a biopsy will be recommended for further examination.

It is important to note that relying solely on PSA measurements may not be sufficient, and additional rectal examinations may be necessary. Age should also be taken into consideration when assessing the risk of prostate cancer.

What causes PSA levels to change?

PSA values can sometimes be elevated or altered due to reasons other than cancer, such as an enlarged prostate gland, prostatitis, sexual intercourse, urinary tract infections, or intense exercise. These factors can affect PSA levels, including rectal exams. Additionally, taking certain medications can cause changes in PSA values, particularly those that affect hormones.

Should you get PSA tests?

Annual prostate exams are recommended in both the United States and Europe. Men over 50 who are expected to live disease-free for at least 10 years should have regular prostate cancer screenings. Men with a family history of prostate cancer should be screened starting at age 45, and those aged 75 and over should consult with their doctor for screening. If urinary symptoms appear, tests for prostate cancer in the early stages should be performed promptly.

While the PSA test is a valuable diagnostic tool for prostate cancer, regular physical exams are also important to avoid complications associated with the disease.

How frequent should PSA levels be checked?

If PSA and rectal examination results are normal initially, most experienced doctors will suggest having both tests every year.

PSA measurement in combination with rectal examination is a widely used method to solely detect prostate cancer. However, if one suspects having prostate cancer or not, the best way is to undergo screening at least once a year, particularly for men aged 40 and above.

Therefore, it is important not to be complacent and prioritize taking care of your health to avoid having to treat a serious illness.

Best wishes

From Dr. Chaiyasit Machriyakul, Urological Surgeon