Elevated prostate-specific antigen (PSA) levels can be a sign of prostate cancer. It can also indicate noncancerous problems such as prostate enlargement and inflammation. Your healthcare provider will work with you to figure out the next steps if you have a high PSA level.
Prostate-specific antigen, or PSA, is a protein produced by the prostate gland. When there’s a problem with the prostate gland, it releases more PSA. High levels of PSA can be a sign of prostate cancer.
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Researchers haven’t settled on a single normal PSA level. Previously, a level of 4.0 ng/mL or higher would lead to more testing, usually a prostate biopsy. During the biopsy, a healthcare provider removes a small sample of prostate tissue to check it for cancer.
However, healthcare providers now consider other issues together with the PSA level to decide whether to perform a biopsy. Your age, general health, family history and health history factor into the decision.
Does my PSA level determine whether I have prostate cancer?
Your provider looks at two factors related to your PSA:
But the PSA level alone doesn’t determine if you have cancer or not. Two men can even have the same PSA levels but different risks of prostate cancer. And a high PSA level may reflect prostate problems that aren’t cancer.
You may be at higher risk for prostate cancer if you:
Men can have prostate cancer even if they have a normal PSA level. But cancer is more likely with an elevated PSA level. When PSA levels are:
Prostate cancer is the main cause of an elevated PSA level. But PSA levels increase with age and can reflect different prostate conditions. Other factors that may raise a person’s PSA level include:
Your healthcare provider will also consider whether your medications affect PSA levels. For example, 5-alpha reductase blockers treat enlarged prostates and will lower PSA levels.
An elevated PSA level does not cause symptoms, but it may be a sign of prostate problems like cancer. If you have any of these symptoms, your provider may want to do a PSA test:
Healthcare providers use a blood test to measure PSA levels.
You may have a digital rectal exam (DRE) together with a PSA test to check for signs of prostate cancer. During a DRE, your provider inserts a gloved finger into the rectum to check for bumps or other irregularities.
Depending on the results of your initial test, your provider may want you to repeat the test. PSA levels can change. A second test gives your provider more details about your prostate health.
If you have a high PSA level, you will need ongoing PSA tests and DREs so your provider can look for any changes. If the PSA level continues to increase or if your healthcare provider finds a lump during a DRE, you may need other tests, including:
A biopsy can tell you definitively if you have prostate cancer. The biopsy results also affect your treatment. For example, if the biopsy shows a lot of cancer cells, you might need more aggressive treatment.
Treatment options for prostate cancer include:
You may continue to have PSA level tests during and after prostate cancer treatment. These tests check that the treatment is working.
The PSA test was first developed to observe prostate changes in men who had a history of prostate cancer. Then it became more widely used in the general population as a way to detect and prevent prostate cancer before symptoms developed. But routine screening can find prostate cancers that grow slowly and do not need treatment. Talk to your healthcare provider to see if you should have regular PSA tests.
If your provider finds an elevated PSA level, you’ll have repeat tests to check your prostate. Many men with elevated PSA levels — even those who have prostate cancer — live long, healthy lives. Prostate cancer may not need treatment, depending on how slowly the tumor is growing. Keep up with your regular appointments and tests so your care team can keep tabs on your health.
If you’ve ever had treatment for prostate cancer, you’ll have regular PSA screenings for the rest of your life. An increasing PSA level may mean the cancer has returned. Your care team may use other tests, including imaging scans and biopsies, to check for signs of cancer. If cancer returns, your team will discuss your treatment options with you.
Regularly visit your healthcare provider for PSA tests and digital rectal exams. If you notice any change in how you feel or function, especially problems with urination, talk to your provider.
If you have any symptoms of prostate cancer, or if it runs in your family, ask your provider:
A note from Cleveland Clinic
An elevated PSA level can be a sign of prostate cancer, but it doesn’t always mean you have cancer. Your healthcare provider will watch you and do more tests to arrive at a diagnosis. Prostate cancer is often slow-growing and may never become life-threatening. If you have symptoms of prostate problems, such as difficulty urinating, don't hesitate to let your provider know.
Last reviewed by a Cleveland Clinic medical professional on 04/06/2021.
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