PSA or prostate specific antigen is a type of protein released by the prostate gland present in men. Younger men have lower levels of PSA as compared to older men. This is due to the fact that PSA levels naturally rise as a man grows older.
A PSA test is an easy blood test which helps measure the levels of PSA in the blood. A PSA test report that shows very high levels of PSA in blood may occasionally be a sign of conditions such as prostate cancer and/or BPH/benign prostatic hyperplasia. The test can thus help diagnose prostate cancer in the early stages. Subsequent treatment can help cure it. According to studies, the mortality rates associated with prostate cancer have gone down by nearly six percent, which is substantial, since 1992. This is because more men are opting for PSA tests.
It may however be noted that the detection of high levels of PSA via the blood test may not be enough to confirm an underlying case of prostate cancer. Doctors may occasionally carry out a biopsy as well as a digital rectal exam to verify the diagnosis. Also, elevated levels of PSA may also occur due to other non-malignant or benign conditions.
It is important to know the PSA normal range so to as to be able to understand and interpret the results of a PSA test. The information is provided below.
PSA normal range in men
- Most doctors consider PSA levels of under 4 nanograms per milliliter of blood (ng/mL) as the normal PSA level in men. The normal PSA range in men who have undergone surgery to remove the prostate gland is 0 ng/mL.
- Some labs however consider PSA levels of under 2.5 ng/mL or under 3 ng/mL as being in the normal range.
- A PSA level that is higher than the normal values is an indication of an underlying instance of prostate cancer. Hence, some medical experts maintain that having a low normal PSA range value can help in increased detection of early-stage prostate cancer instances. Some other doctors however feel that it may lead to over diagnosis. They are of the opinion that treatment of conditions which may never cause health complications at a later stage is not just wrong, but also redundant.
- Thus, the standard and widely accepted normal PSA range in men aged between 50 and 70 years is 4 ng/mL and below.
The table presented below will help in interpreting and understanding a PSA test report and the normal PSA range.
|Under 4 ng/mL||Normal|
|Between 4 and 10 ng/mL||Between 20 to 30 percent risk of cancer|
|Between 10 and 20 ng/mL||Between 50 to 75 percent risk of cancer|
|Over 20 ng/mL||90 percent risk of cancer|
It is important to note that higher than normal levels of PSA may not always be a symptom of prostate cancer. Higher than normal PSA readings can also occur due to a variety of prostate abnormalities, other than the presence of cancer.
Age-wise classification of normal PSA range
The standard normal levels of PSA tend to vary slightly in young and older men. This is because the PSA blood volume tends to differ according to the age of the individual. An age-wise categorization of normal PSA range is provided below:
|PSA value||Normal reading as per age|
|2.4 ng/mL or less||For men younger than 50 years|
|3 ng/mL or below||For men younger than 60 years|
|4 ng/mL or below||For men aged between 60 and 69 years|
|5 ng/mL or below||For men older than 70 years|
Causes of high levels of PSA in blood
Besides prostate cancer, elevated blood PSA levels may also occur due to the following causes:
- The size of prostate gland: Higher PSA levels may be reported due to the presence of a larger than normal prostate gland. Hence, doctors also measure the density of PSA when calculating its levels. PSA velocity is also used to verify the reasons for high PSA levels.
- Enlargement of prostate: Benign Prostatic Hyperplasia/BPH is a prostate disorder marked by an enlarged prostate. It is a non-cancerous condition and naturally occurs in a majority of elderly men. Also, BPH does not metastasize to other parts of the body like cancer.
- Certain diagnostic tests: The PSA levels may also rise above normal if the patient has undergone a prostate biopsy or a digital rectal exam/DRE in the recent past.
- Prostate infection: Prostatitis is a condition marked by inflammation and infection of the prostate gland. It can result in high PSA readings.
- Intake of certain medications: Some types of medications can cause the PSA levels in blood to rise above normal. It is therefore essential to inform the doctor about all the drugs being consumed by the patient, including routine medicines, so that the health of the gland can be properly evaluated.
- Other causes: Elevated levels of PSA can also occur due to recent instances of cycling or ejaculation.
A DRE or Digital Rectal Exam
As discussed above, elevated levels of PSA in blood can occur due to many different factors. Hence, a health care provider will recommend a digital rectal exam if a PSA test reports abnormally high levels of PSA.
- The overall health of the prostate gland can be evaluated with a DRE. In this procedure, the physician will insert a gloved finger into the anus and examine the rectal walls for the presence of any irregular growth of the prostate.
- The presence of bumps in the walls of the rectum can be considered as a sign of enlarged prostate. The doctor will then advise certain self-care measures and perform another PSA test after about 3 to 4 weeks. If the second PSA test also shows high PSA blood levels, then the doctor will confirm the diagnosis of prostate cancer via a biopsy.
- The health care provider may sometimes ask the patient to wait and watch if the rise in PSA levels is minimal. He/she may also recommend undergoing PSA tests at regular intervals.
Men with a family history of prostate cancer as well as African American men are at increased risk to developing prostate cancer. Hence, they need to undergo PSA tests at regular intervals after age 40 years. Regular PSA testing is required in all men over age 50 years as well as by those who have already undergone a prostate surgery. Consult the doctor to clear any doubts about the PSA report readings.