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Prostate Specific Antigen Test - PSA

Results and Values

What do the test results mean?

When evaluating PSA results, the doctor must also take into account the results of the rectal exam, the patient's age, previous PSA results, and prostatic size. For example, findings on a rectal exam must be looked into even if the PSA result is normal.

Recent studies have suggested that the 4.0 level may be too high for younger men and too low for older men. Many researchers now use the following levels rather than the 4.0 used in the past. However, more time is needed to assure that these levels are more accurate.

  • age 40 to 50, normal range is 0 to 2.5
  • age 50 to 60, normal range is 0 to 3.5
  • age 60 to 70, normal range is 0 to 4.5
  • age 70 to 80, normal range is 0 to 6.5
  • If the rectal exam is normal then the following recommendations are suggested:

  • PSA of 4 or less. If the PSA level has been measured for the first time and is less than 4, repeat testing is recommended on a yearly basis. (This number may be dependent on age. See above for normal values).
  • PSA between 4 and 10. If the PSA level is greater than 4 but less than 10, a diagnostic ultrasound of the prostate is recommended. If the ultrasound shows no suspicious areas, the prostate can be monitored through regular testing and exams. Another option is to take random biopsies from various parts of the prostate. If observation alone is used, the PSA should be repeated in 4 to 6 months and no later than a year. If the ultrasound shows a suspicious area, then biopsy of the area needs to be performed. This can be done at the time of the ultrasound. The patient will need to take antibiotics ahead of time.
  • PSA greater than 10. If the PSA is greater than 10, diagnostic ultrasound of the prostate with biopsies is the recommended course. If the ultrasound shows no suspicious areas, then random biopsies of the prostate are taken. If the ultrasound shows suspicious areas, then biopsies of the areas along with random biopsies need to be done.
  • If previous PSA values are available, test results will be evaluated differently. The PSA level almost always rises if cancer is growing. Any PSA level that is rising is suspicious. However, a high PSA level may not mean that cancer is present. For example, a male with a stable PSA of 8 over a three-year period (8,8,8) is probably at less risk than a male with a PSA of 2, 4, and 6 over the same time frame. This is because the second patient's rising levels suggest growth. This makes it suspicious for cancer. If the first patient had a negative biopsy when the first high PSA value occurred, there may be no need to repeat the biopsies. If the PSA level jumped to 10 or 15 for no apparent reason, then repeat ultrasound and biopsies would be called for. Recent studies suggest that either a 20% rise or a measurable rise of 0.75 in PSA in one year should prompt a closer look. Ultrasound and biopsy may be needed.