Do Elevated PSA Levels Mean Prostate Cancer? Not So Fast

Considering that outside of skin cancer, prostate cancer is the most common cancer among men — it affects 1 in 8 men — you want to do what you can to stay one step ahead of this potentially serious disease. 

Each year in the United States, there are nearly 300,000 new prostate cancer diagnoses and the road to these diagnoses often entails prostate-specific antigen (PSA) testing. 

As a urology and men’s health specialist, Dr. Robert J. Cornell understands the benefits and limitations of PSA testing as a screening tool for prostate cancer, and we want to explore those here.

What is PSA?

PSA is is a protein that’s produced by cells in your prostate. This protein is produced by both malignant and benign cells, so having some PSA in your blood is perfectly normal. 

To determine your PSA level, we simply draw blood and test specifically for the presence of PSA, which is measured in nanograms per milliliter (ng/mL).

In very general terms, a PSA levels below 4 ng/mL isn’t usually cause for too much concern, while a level between 4 ng/mL and 10 ng/mL typically prompts us to investigate further. A level above 10 ng/ml raises our eyebrows even higher.

But it’s important to note that your PSA level can go up for any number of reasons, including:

• Prostatitis, which is inflammation in your prostate
• Benign prostate hyperplasia (enlarged prostate), which affects most men as they age
• Urinary tract infection
• As a normal part of aging

So, relying on your PSA level alone to determine whether you might have prostate cancer isn’t reliable, which is why we use PSA more as a guide.

Elevated PSA level — just one variable

If we find that your PSA level is elevated, the next steps depends upon a host of factors. For example, if you have no history of prostate cancer in your family and you measured between 4 ng/mL and 10 ng/mL, we may recommend more frequent PSA testing to watch out for any changes or increases. We will also add a digital rectal exam to your more frequent screenings. 

This active surveillance allows us to stay on top of your prostate health without taking any unnecessary steps.

Conversely, if you have a family history or you carry a genetic mutation that places you at higher risk for prostate cancer, we may jump to digital imaging or a prostate biopsy if your PSA level is in that 4-10 range, or even lower.

As for outcomes of biopsies related to elevated PSA levels, only about 25% of men who are biopsied because of high PSA levels are actually diagnosed with prostate cancer.

As you can see, PSA testing is just part of a much broader prostate screening effort that is dictated to a great degree by your unique circumstances.

If you’d like to learn more about screening for prostate cancer and whether PSA testing is a good first step for you, please contact our office in Houston, Texas, to schedule an appointment.