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PSA levels between 4.0 and 10.0 ng/mL might suggest the possibility of prostate cancer (in about 25 percent of cases) or BPH.

Prostate-specific antigen (PSA) is a protein produced by the glandular tissue of the prostate (a walnut-sized gland just below the bladder and in front of the rectum in males). PSA levels can be detected in the blood, urine, or semen. Blood PSA testing is used as a screening test for prostate cancer.

Prostate-specific antigen (PSA) levels by age remain the same across most populations. A PSA level above 4.0 ng/mL in any age group must be investigated. However, PSA levels can spike in noncancerous conditions, such as benign prostate hypertrophy (BPH), urinary tract infections, prostatitis, consumption of testosterone supplements, recent catheterization, and injuries to the pelvic region.

Start screening for PSA to rule out prostatic cancer starting at age of 55 years. However, you may require PSA screening between the ages of 40 and 54 years in the following situations:

• A first-degree relative (such as your father or brother) or extended family member who has had prostate cancer
• African American ethnicity is at a higher risk of developing aggressive cancers

Points to remember

• PSA levels between 4.0 and 10.0 ng/mL might suggest the possibility of prostate cancer (in about 25 percent of cases) or BPH.
• The PSA levels above 10.0 ng/mL should be urgently discussed with your doctor because these are associated with a 50 percent chance of having prostate cancer.
• The levels from 0.25 ng/mL to 4 ng/mL along with symptoms of prostate enlargement (urinary retention, ejaculation problems, and inability to maintain urine flow) must be investigated further with sonography, a digital rectal examination, and patient history.

Normal PSA level by age chart

Table. PSA chart Age PSA level Digital rectal examination (DRE) Course of action

45 to 75 years
PSA is below 1 ng/mL
Normal
Repeat testing every two to four years

1 and 3 ng/mL
Normal
Repeat testing every one to two years

Greater than 3 ng/mL or your
Indicates abnormality
The doctor may suggest additional testing or a biopsy

You are over 75 years
Continue testing, and if PSA is less than 3 ng/mL
Normal
Repeat testing every one to four years

If PSA is greater than 3 ng/ML
Indicates abnormality
The doctor may suggest additional testing or a biopsy

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What is PSA velocity?

The amount by which the prostate-specific antigen (PSA) levels rise in a year is called PSA velocity. Thus, if the initial PSA reading is about 10 ng/mL and it rises rapidly year on year, this can point to early-stage prostate cancer.

• Most research indicates that an increase of 0.75 ng/mL a year is an early indicator of prostate cancer if a man has a total PSA result between 4.0 and 10.0 ng/mL.
• An increase of 2.0 ng/mL over a year predicts a higher likelihood of death due to aggressive prostate cancer.
• PSA velocity may help predict survivability from prostate cancer.
• Men with a PSA increase of 0.35 ng/ML or less over a year have a 92 percent survival rate.
• Men with PSA levels of more than 0.35 ng/mL over a year have a 54 percent survival rate.

3 other tests for prostate cancer

Early diagnosis and regular screening can aid in both the diagnosis and decision on treatment when it comes to prostate cancers.

1. Phi test: The Prostate Health Index (PHI or Phi) combines three blood tests for prostate-specific antigen (PSA), total PSA, free PSA, and pro-PSA. These are different fractions of PSA antigens found in the blood. Experts believe that these values give a more accurate Phi score and better determine the probability of finding cancer during a biopsy.
2. PCA3: This is a urine test that accurately detects the risk of prostate cancer by examining the expression of the PCA3 gene, a gene-specific to prostate cancer.
3. 4KScore: Another blood test measures total PSA, free PSA, intact PSA, and certain enzymes called kallikrein. A special computer-based algorithm used with the patient’s age and physical exam gives a probability of having aggressive prostate cancer.

However, none of these tests are conclusive on their own. When performed in addition to a PSA test, a digital rectal exam and biopsy can provide more information about specific cancer.