My PSA is High: Does That Mean I Have Prostate Cancer?

If you recently had a prostate-specific antigen (PSA) test that showed an elevated level of PSA, it’s not a confirmed indicator of prostate cancer. While prostate cancer is possible, several other non-cancerous conditions can cause an elevated PSA. In fact, 75% of men with an elevated PSA do NOT have prostate cancer. Let’s look at what your PSA test results mean and what to do if you have a high PSA level.

What is the PSA Test, and What Does it Tell Doctors?

Prostate-specific antigen (PSA) is a protein produced normally in prostate gland cells – both healthy and cancerous. A PSA blood test determines the amount of PSA in your blood. An elevated level can indicate the presence of a prostate condition. 

Initially, the PSA test was developed to monitor the progression of prostate cancer in men who already had a prostate cancer diagnosis. Eventually, it became a diagnostic tool, along with a digital rectal exam, to diagnose prostate cancer in men who weren’t having prostate cancer symptoms. 

What’s the Range of Normal PSA Levels?

According to the National Cancer Institute, there is “no specific normal or abnormal level of PSA in the blood.” A normal PSA level varies from person to person depending on age, race, and other lifestyle choices. 

• At any age, an increase of 0.35 ng/ml in one year may require further testing.
• A normal reading (under 4 ng/ml of blood) most often means cancer is not present, although this is not guaranteed.
• A PSA between 4 ng/ml and 10 ng/ml indicates a 25% chance that prostate cancer is present.
• A PSA level over 10 ng/ml increases the chances of having prostate cancer to 50%.

It is important to understand your prostate cancer risk and get screened to determine your baseline PSA.

• Average Risk: Begin cancer screening between the ages of 45 and 50 years old.
• Increased Risk (black ancestry, germline mutation, strong family history): Begin cancer screening between the ages of 40 and 45 years old.

Other Reasons Why Your PSA Level May Be Elevated

There are many reasons other than prostate cancer as to why your PSA test may be high. If you’re scheduled to have a PSA test, tell your doctor about all medications, supplements, activities, and symptoms you have had recently. Many factors can elevate your PSA levels, including:

• Normal aging can often cause PSA levels to rise.
• Recent ejaculation can elevate PSA levels, even 48 hours before the test.
• Enlarged prostate (benign prostate hyperplasia) is a non-cancerous condition that can elevate PSA levels.
• Prostatitis is an infection in your prostate gland that causes swelling and inflammation and should be treated by a doctor.
• Regularly riding a bicycle puts pressure on your prostate and can cause short-term PSA elevation.
• Taking testosterone leads to elevated PSA.
• Digital rectal exams (DRE), which put pressure on your prostate, can cause a short-term elevation. Have the PSA blood test before the DRE.

A single elevated result is not highly concerning, but it does mean you need to be retested in the next several months to see if it’s returned to a normal range. You should also watch for symptoms that could indicate you have a prostate condition, such as:

• Frequent urination, especially at night
• Trouble starting the stream of urine
• Decreased force in the stream of urine
• Blood in the urine or semen
• Pain during ejaculation

Next Steps if You Have an Elevated PSA

If your PSA level is consistently elevated after a few tests, it can indicate several things. In most cases, your doctor may take one or more of the following steps:

• Test the ratio of protein-bound PSA to free PSA (PSA not bound to other blood proteins). If the ratio of free PSA to protein-bound PSA is 25% or more, a non-cancerous condition is likely causing your increased PSA level. If your PSA is high, but the ratio of free PSA to protein-bound PSA is less than 10%, a biopsy is usually recommended to confirm a diagnosis of prostate cancer. Recently, cancer specialists have found that free PSA testing provides a more reliable indicator of prostate cancer in men who have a PSA between 4 ng/ml and 10 ng/ml. Testing your free PSA helps determine if you need a biopsy of your prostate gland.
• Recommend other tests to rule out non-cancerous prostate problems. Prostate health index (PHI) blood test helps determine if a biopsy can detect prostate cancer. A 4K score test combines test results from both protein-bound and free PSA tests with human kallikrein 2, which is a prostate tumor marker.
• Recommend a biopsy based on the above tests. Biopsy is the most accurate way to diagnose prostate cancer. 

What PSA Level Determines a Prostate Cancer Diagnosis?

The PSA blood test is not used alone to diagnose prostate cancer. It can help indicate the possibility of prostate cancer or another prostate condition. 

The only way prostate cancer is diagnosed is through a biopsy. This test takes several samples of tissue from throughout the prostate, which are then examined under a microscope to see if the cells are abnormal. The pathologist will assign a score to the most predominant cell pattern and an additional score to the second most predominant cell pattern. When added together, these scores create the patient’s Gleason Score. The Gleason Score is the grading method that is used to determine how aggressive a patient’s prostate cancer is.

Related reading: Understanding the Prostate Biopsy Gleason Score

What to Do Next if You’re Diagnosed with Prostate Cancer

It’s important for men who are newly diagnosed with prostate cancer to consult with a multidisciplinary team of medical professionals to review various treatment options, as there is a range of treatments available to patients. Your team may include your primary care physician, urologist, radiation oncologist, medical oncologist, or geneticist.  

Virginia Oncology Associates (VOA) provides comprehensive prostate cancer care. Our oncologists will create a personalized prostate cancer treatment plan using the latest treatment technologies. Request an appointment at one of VOA’s cancer treatment centers in Chesapeake, Hampton, Newport News, Norfolk, Suffolk (Obici and Harbour View), Virginia Beach, Williamsburg, Virginia, or Elizabeth City, North Carolina.