Elevated PSA (Prostate-Specific Antigen) Level

What is elevated PSA?

Prostate-specific antigen (PSA) is a protein that your prostate gland produces. The prostate is a small gland in the male reproductive system. When some conditions affect your prostate — like prostate cancer — your prostate releases more PSA.

Healthcare providers use a PSA test to determine if you have elevated PSA.

What is considered an elevated PSA level?

Healthcare providers and medical researchers haven’t determined a single, normal PSA level. Previously, a level of 4.0 nanograms of PSA per milliliter of blood (ng/ml) would lead to more testing, such as a prostate biopsy.

Now, providers consider other factors along with your PSA levels. These include you:

• General health.
• Health history.
• Biological family health history.

This chart shows how providers determine normal and abnormal PSA levels:

Does my PSA level determine whether I have prostate cancer?

A healthcare provider looks at two factors that relate to your PSA to determine your prostate cancer risk:

• Your PSA level. A higher PSA level means you have a higher risk of prostate cancer.
• A continuous rise. PSA levels that continue to rise after two or more tests may indicate prostate cancer.

It’s important to remember that your PSA level alone doesn’t determine whether you have prostate cancer or not. Having an abnormal PSA level doesn’t mean you have prostate cancer. Two people can even have the same PSA levels but different risk levels for prostate cancer and other conditions that affect the prostate.

What is an alarming PSA level?

A PSA level of 10 ng/ml or higher means you have a greater risk of prostate cancer.

How serious is an elevated PSA?

It depends. Your PSA levels will vary according to your age. A PSA level that’s higher than expected for your age range may indicate you have a condition that affects your prostate. If you have an elevated PSA, a healthcare provider will order additional tests, including:

• Additional PSA tests.
• Digital rectal exam.
• Imaging tests, such as an MRI or transrectal ultrasound.
• Prostate biopsy.

How common is prostate cancer in people with an elevated PSA level?

You can have prostate cancer even if you have a normal PSA level. But you’re more likely to develop prostate cancer with an elevated PSA level. If your PSA levels are:

• Below 4.0, you have a 15% chance of prostate cancer.
• Between 4.0 and 10.0 (the borderline range), you have a 25% chance of prostate cancer.
• Above 10.0, you have a greater than 50% chance of having prostate cancer.

What is the main cause of elevated PSA?

The most common cause of elevated PSA is prostate cancer. However, PSA levels increase with age and can reflect different conditions that affect the prostate. Other conditions or factors that may raise your PSA level include:

• Enlarged prostate (benign prostatic hyperplasia).
• Prostate inflammation (prostatitis).
• Urinary tract infections (UTIs).
• Urinary catheter
• Certain medications, including betamethasone and testosterone replacement therapy.

A healthcare provider will also consider whether medications lower your PSA levels. For example, some medications, like 5-alpha reductase blockers, will lower your PSA levels.

Will elevated PSA cause other symptoms?

An elevated PSA level doesn’t cause other symptoms. But it may be a sign of certain conditions that affect your prostate. These conditions might cause other symptoms. Contact a healthcare provider if you have any of the following symptoms:

• Difficulty urinating (peeing).
• Peeing more than usual, including while you’re sleeping.
• Slow pee stream.
• Blood in your urine (hematuria).
• Difficulty holding your pee in (urinary incontinence).

How is elevated PSA treated?

You don’t need to treat elevated PSA. It doesn’t cause symptoms and it doesn’t cause a condition. But it may indicate a condition that needs treatment. A healthcare provider will determine the cause of your elevated PSA. They’ll then treat your condition.

If elevated PSA indicates prostate cancer and a prostate biopsy confirms the diagnosis, management options include:

• Active surveillance.
• Prostate removal surgery (prostatectomy).
• External radiation therapy.
• Internal radiation therapy (brachytherapy).
• High-intensity focused ultrasound (HIFU).
• Using extreme cold to freeze off cancerous tissue (cryotherapy).
• Hormone therapy (androgen suppression therapy).
• Chemotherapy.

These options aren’t available for everyone with prostate cancer. It depends on what your prostate biopsy shows. Your provider will talk to you about which options would work for you.

What can I do at home to treat elevated PSA?

Some research suggests you may be able to help lower your PSA by making diet or lifestyle changes, including:

• Eating more foods that contain lycopene. Lycopene is a chemical that gives certain fruits and vegetables their red or pink color. It may also help prevent cancer. Foods that have a lot of lycopene include grapefruits, watermelon and tomatoes.
• Following a plant-based diet. A plant-based diet that includes lots of fruits, veggies and legumes may boost your immune system and prevent cancer cells from growing.
• Taking vitamin D. Vitamin D helps increase your immunity and strengthen your bones. Your body makes vitamin D when you spend time in the sun. But you can also get vitamin D from certain foods, like milk, orange juice and cereal, or vitamin D supplements.
• Increasing physical exercise. Activities like lifting weights, walking and jogging can help reduce your PSA levels.

Can elevated PSA be prevented?

You may not be able to prevent elevated PSA levels. But routine screenings can detect prostate cancers that grow slowly and may not need treatment. You should get regular PSA tests every two years starting in your mid-50s. If you have a higher risk of developing prostate cancer, a provider may recommend getting regular PSA tests beginning in your early 40s.

When should elevated PSA be treated by a doctor or healthcare provider?

A healthcare provider will schedule additional PSA testing if you have an elevated PSA level for your age and/or it rises an abnormal amount in a single year. If repeat testing still shows elevated PSA levels, the provider may refer you to a urologist for additional testing.

What does a urologist do if your PSA is elevated?

Urologists specialize in diagnosing and treating conditions that affect your urinary and reproductive systems. If you have elevated PSA levels, a urologist may order imaging tests or a prostate biopsy. A prostate biopsy is the only way to diagnose prostate cancer.

When should I worry about elevated PSA?

It’s difficult not to worry if you have an elevated PSA level. But an elevated PSA level doesn’t mean you definitively have prostate cancer. Many people with elevated PSA levels — and even those who have prostate cancer — live long, healthy lives. Prostate cancer may not even need treatment, depending on how slowly the tumor is growing.

If you have a prostate, it’s a good idea to get regular PSA tests starting in your 50s. A healthcare provider will closely follow your PSA levels or refer you to a urologist if your PSA rises above the expected levels of your age group.

What are other risk factors for prostate cancer?

You may be at a higher risk of developing prostate cancer if you:

• Are older than 50.
• Are Black.
• Have a biological family history of prostate cancer.
• Have certain genetic changes that make it more likely that prostate cancer will develop.

At what PSA level should a biopsy be done?

There’s no specific PSA level at which a healthcare provider will order a biopsy. If multiple PSA tests, a digital rectal exam and imaging tests indicate prostate cancer, a provider will likely suggest a prostate biopsy.

What does an elevated PSA level mean if I’ve had prostate cancer in the past?

If you’ve received treatment for prostate cancer, you should schedule regular PSA screenings for the rest of your life. An increasing PSA level may mean the cancer is back. If prostate cancer returns, your healthcare provider will discuss treatment options with you.

If I have elevated PSA levels, what should I ask my healthcare provider?

If you have elevated PSA levels, symptoms of prostate cancer or a biological family history of prostate cancer, ask your provider:

• Should I have regular tests to check my PSA level?
• What can I do to lower my risk for prostate cancer?
• What other tests or monitoring do I need?
• What are my treatment options if I get prostate cancer?
• What other signs or symptoms should I look out for?