What Your PSA Test Results Really Mean

PSA, or prostate-specific antigen, is a protein made by the prostate gland. Most everyone with a prostate has some level of PSA in their blood, and PSA levels tend to rise with age.

Your PSA level gives doctors a window into your health, said Adam Weiner, MD, a urologist and urologic oncologist at Cedars-Sinai Urology. Sometimes, elevated PSA levels can indicate prostate cancer, though there are many other causes of high PSA.

“PSA doesn’t cause you any harm,” Weiner said. “It’s just a marker that we use to gauge your health, and your levels could be elevated for a number of reasons.”

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What Is a PSA Test?

A PSA test is a simple blood draw that measures the amount of prostate-specific antigen in your blood. The test is used to help screen for prostate cancer and monitor prostate health.

What Are Normal PSA Levels?

There is no single, universal, “normal” PSA number. PSA levels are typically in the single digits, beginning at less than one. A doctor or laboratory adjusts interpretation of PSA levels based on your age, because PSA levels tend to rise naturally as you get older.

PSA doesn’t cause you any harm. It’s just a marker that we use to gauge your health, and your levels could be elevated for a number of reasons.

While most laboratories flag a PSA level at around 4 or above, there’s no strict cutoff for an elevated PSA. There is also no PSA level that automatically means you have cancer. Your PSA trends matter more than a single reading.

For these reasons, it’s important for PSA results to be interpreted by a physician.

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When Should You Start PSA Screening?

Screening guidance varies depending on a person’s age and risk factors, such as race. Black men have an increased risk of developing prostate cancer and are recommended to begin PSA screening at age 40.

The American Urological Association recommends other men at higher risk, including those with a primary relative who had prostate cancer or those with specific genetic alterations, such as the BRCA-2 gene, should also begin screening at age 40.

Men at average risk of developing prostate cancer get PSA screening every two to four years from age 50 until age 69.

“The purpose of screening is to look for disease before it becomes symptomatic,” Weiner said. “We want to screen patients who are at higher risk for prostate cancer so that we can provide early intervention to prolong their life and benefit their health.”

How to Prepare for a PSA Test

Doctors generally recommend avoiding sexual activity, vigorous exercise and cycling for two days before a PSA test, since these activities can cause elevated PSA levels, Weiner said. Tell your doctor if you have any urinary symptoms or have recently undergone any medical procedures, which can also elevate PSA.

You should postpone your PSA test if you’re sick, even with a cold and especially with a urinary infection, because illness causes inflammation in the body that could skew the results.

It’s important to tell your doctor about your medications and supplements, including testosterone replacement therapy, since some can affect PSA levels. This might change how the doctor interprets the results.

What Causes an Elevated PSA Level?

Sometimes, an elevated PSA level can indicate prostate cancer.

There are also several benign conditions that can cause a high PSA level, including an enlarged prostate, prostatitis, asymptomatic inflammation or a urinary infection.

Other potential causes for an elevated PSA level include certain medications, recent ejaculation, cycling, trauma or recent prostate procedures.

What Happens After an Elevated PSA Result?

It can be concerning to hear from your doctor that your PSA level is elevated, but remember that the test is only the first step, Weiner said. After an elevated PSA result, doctors typically retest in about two to three weeks to ensure that the original level wasn’t falsely elevated.

After two elevated PSA blood tests, you will likely be referred to a urologist if you’re not already seeing one. The urologist might decide to add another blood test that checks your PSA level in greater detail. While the traditional PSA test usually tests just the total PSA, a more specific test might include a measure of “free PSA,” which is PSA that is not attached to proteins.

An MRI of the prostate might be ordered to determine additional factors, such as the size of the prostate, PSA density and any areas of concern in the prostate. These measurements help doctors determine who might need a biopsy.

“We’ve gotten so much better at screening,” Weiner said. “We have multiple ways of protecting patients from side effects of treatment or unnecessary biopsies.”

When to Talk to a Doctor About PSA Testing

Deciding when to begin PSA testing is a personal decision that should be made with your doctor. Talk with your doctor if you’re unsure when to begin screening or have questions about the process.

If you have risk factors for prostate cancer, experience urinary symptoms or have an elevated PSA, connect with a urologist, who can help you determine next steps.