Understanding PSA

This may be a normal fluctuation in your PSA level. An increase in your PSA of less than 0.75 ng/ml over one year is generally felt to be reassuring. Repeat testing in 3-6 months is a reasonable option. Discuss this with your doctor.

You have reached the end of this guide. What would you like to do?

• Go back to the beginning of this guide.
• Learn more about PSA testing.
• Learn more about prostate cancer.

Understanding

Understanding PSA

Knowing your previous PSA levels is helpful, but not necessary. Nonetheless, your PSA level is mildly elevated. Follow-up is needed. Keep in mind that your risk of prostate cancer is still less than 40 percent.

Your options include

• referral to a urologist (prostate specialist)
• repeat PSA testing in several months
• measuring your “free” PSA level — This special way of testing your PSA level may help to decide if a biopsy is needed. High levels of free PSA are reassuring, while low levels are worrisome for cancer.

Understanding PSA

The next thing to determine is how fast your PSA levels has been rising. You can figure this out if your PSA was checked within the past year or so. You should subtract your last PSA result from your current results. For example, if your PSA was 4.5 last year and is 5.0 this year, it has increased by 0.5 points (ng/ml) over the past year. A quickly rising PSA is worrisome, while a slowly rising PSA (or PSA level that goes down) is reassuring.

Has your PSA level been checked within the past year?

Understanding PSA

Ejaculation or vigorous bicycle riding can cause a small increase in your PSA level. Consider repeating your PSA test in two weeks, after you’ve avoided bicycle riding and intercourse for at least 48 hours. If your repeat PSA level returns to normal (less than four), this is excellent news. If your PSA test remains elevated, further evaluation is probably needed. Your options include:

• referral to a urologist (prostate specialist)

Understanding PSA

PSA levels can also go up for other reasons. For example, riding a bicycle can put pressure on the prostate and cause a temporary spike in your PSA level. The same is true for ejaculation during sex or masturbation. In general, these activities cause PSA levels to rise only a little, and the PSA should return to normal within several days.

Did you ride a bicycle, have sexual intercourse or ejaculate in the 48 hours before blood was drawn for your PSA test?

• Yes, I did.

Understanding PSA

Your PSA level may be falsely elevated. This means that although your PSA level is above normal, there is a good chance that you do not have prostate cancer.

Contact your doctor. You may need antibiotic treatment if you have evidence of a urinary tract infection or prostatitis. You should also talk to your doctor about repeating your PSA test in 1-2 months. If your repeat PSA level returns to normal (less than four), this is excellent news. If your PSA test remains elevated, further evaluation is probably needed. Your options include

Understanding PSA

Your PSA level is moderately elevated. About one in three men with a moderately elevated PSA level will be found to have early stage prostate cancer if a biopsy is performed. Early stage prostate cancer rarely causes symptoms, and your prostate may feel totally normal when examined by your doctor (digital rectal exam). One piece of good news is that early stage prostate cancer can often be cured.

Understanding PSA

Contact your doctor. Your PSA level is high. Your risk of prostate cancer is greater than 50 percent. Immediate follow-up is warranted. Speak to your doctor about referral to a urologist (prostate specialist) or arranging for a prostate biopsy.

You have reached the end of this guide. What would you like to do?

• Go back to the beginning of this guide.
• Learn more about PSA testing.
• Learn more about prostate cancer.

Understanding PSA

Your PSA level is moderately elevated. More than half of men whose PSA level is ten or above will be found to have prostate cancer if a biopsy is performed.

However, not all men with an elevated PSA level have prostate cancer. Instead, the PSA level can rise for another reason, such as

• benign growth of the prostate gland (also known as BPH or benign prostate hypertrophy)
• a prostate infection or urinary tract infection
• damage to the prostate caused by a surgery or trauma.

Understanding PSA

Your PSA level is below 4.0 ng/ml. This is generally a reassuring result, and your risk of having prostate cancer is low.

However, your PSA level is slightly higher than expected for someone less than age 50. Speak with your doctor about the following options

• referral to a urologist (prostate specialist)
• repeat testing in 3-6 months to make sure that your PSA level is not rising

Understanding PSA

Your PSA level is in the normal range. This is a reassuring result. You have a low risk of being diagnosed with prostate cancer within the next few years.

Consider having your test repeated in one to two years.

You have reached the end of this guide. What would you like to do?

• Go back to the beginning of this guide.
• Learn more about PSA testing.
• Learn more about prostate cancer.

Understanding PSA

Your PSA level is very low. This is a reassuring result. You have a very low risk of being diagnosed with prostate cancer within the next few years.

Recent research suggests that it’s probably safe to wait two years before having your PSA checked again.

You have reached the end of this guide. What would you like to do?

• Go back to the beginning of this guide.
• Learn more about PSA testing.
• Learn more about prostate cancer.

Understanding PSA

Your PSA level is in the normal range. This is a reassuring result.

Consider having your test repeated in one to two years.

You have reached the end of this guide. What would you like to do?

• Go back to the beginning of this guide.
• Learn more about PSA testing.
• Learn more about prostate cancer.

Understanding PSA

Your PSA level is above four ng/ml. In younger men, this is usually considered to be a worrisome level. However, your PSA level may be normal for someone in your age group.

Speak with your doctor about options for follow-up, including

• referral to a urologist (prostate specialist)

Understanding PSA

Your PSA level is in the normal range. This is a reassuring result.

Given your age or medical history, many doctors would question whether it makes sense to have your PSA tested regularly. This is because prostate cancer is often a slow-growing disease, especially in older men. Even if prostate cancer is detected, the risks of side effects from treatment may be greater than any potential benefits.

Speak with your doctor about whether it makes sense to continue being screened for prostate cancer on a regular basis.

Understanding PSA

Your PSA level is above the normal range. However, given your age or medical history, further evaluation may or may not be worthwhile. Speak with your doctor about appropriate follow-up.

Your options include

• a “watch and wait approach” with repeat testing in several months
• referral to a urologist (prostate specialist)

You have reached the end of this guide. What would you like to do?

• Go back to the beginning of this guide.

Understanding PSA

Next, we need to know your most recent PSA test result. Usually this is a number between 1.0 and 10.0 (PSA is measured in nanograms per milliliter, or ng/ml).

What was your most recent PSA level?

• Less than 1.0
• 1.0 to 3.99
• 4.0 to 6.49
• 6.5 to 9.99
• 10 or higher

Understanding PSA

Most doctors recommend waiting until age 50 to start PSA testing. That’s because prostate cancer is uncommon before this age. However, PSA levels are sometimes checked in men younger than age 50 because they have a risk factor for prostate cancer, such as having a close family member with the disease or being African-American (African American men are more likely than other men to develop prostate cancer and can develop an aggressive form of the disease at a young age).

Understanding PSA – Introduction

Welcome to this Decision Guide about PSA testing.

Prostate-specific antigen, or PSA, is a blood test used by many doctors to screen for prostate cancer. If you’ve had your PSA level checked, you may have been told that your results were “normal” or “abnormal.” However, some men would like to know more about what their PSA level means.

This tool provides more information about PSA levels, and what’s considered to be reassuring or worrisome for men of different ages.

This imaging technique, which uses a powerful magnet and a computer to generate pictures of the body’s organs and tissues, can be used to diagnose prostate cancer or pinpoint the tumor’s location.

Transrectal ultrasonography (TRUS) can create images of the prostate gland using sound waves. Doctors may recommend TRUS when they suspect prostate cancer based on an abnormal DRE or an elevated PSA.

Researchers are developing more screening tests for prostate cancer. Like the PSA test, they rely on biomarkers, such as antigens or proteins, which are elevated or may only be present in men who have prostate cancer. The hope is that these newer tests will better detect existing cancers (better sensitivity), and will not raise the alarm for cancer when it is not present (better specificity).

In this test, the doctor inserts a lubricated, gloved finger into the rectum and feels the surface of the prostate to determine whether it is swollen or has any lumps or abnormally textured areas (see Figure 1). This exam also helps doctors screen for diseases of the rectum, such as rectal cancer.