If PSA is abnormal

A PSA Test chart to help detect prostate cancer

Before accepting a diagnosis of prostate cancer make sure your urologist has eliminated benign disease (BPH) as well as prostatitis and other inflammatory conditions.

But also keep in mind, aggressive prostate cancer may occur in both younger and older men even if the PSA looks normal.

In the past, most doctors considered PSA values below 4.0 ng/ml as normal. Recent research has found prostate cancer in men with PSA levels below 4.0 ng/ml.

There is no specific normal or abnormal PSA level. Rate of rise is more important, even below PSA 2.5. However, the higher a man's PSA level, the more likely it is that cancer is present. According to the National Cancer Institute, many doctors use the following ranges, with some variation:

• 0 to 2.5 ng/ml is low
• 2.6 to 10 ng/ml is slightly to moderately elevated
• 10 to 19.9 ng/ml is moderately high
• 20 ng/ml or more is high

Several factors may cause PSA levels to fluctuate.One abnormal PSA test does not necessarily indicate a need for a full diagnostic workup. A followup PSA test and rectal within a month will probably indicate whether it is time for free PSA test and beyond that ultrasound guided biopsy.

	What tests do you need to start with?
Prostate-specific antigen (PSA)	+	Digital rectal exam (DRE)
	Test results

If one or more results is abnormal		If both test results are normal
Possible causes: BPH (benign prostate growth) prostatitis (inflammation) prostate cancer. Do you have urinary frequency, urgency, pain or burning? Urologist may treat you with antibiotics and repeat PSA before deciding if biopsy is necessary.		Return regularly for PSA and DRE testing If biopsy was negative after abnormal PSA or DRE, consider color doppler ultrasound from a specialist.
Ask for "free-PSA" test (to find ratio of free to bound PSA) see next chart
For definitive (best) diagnosis: Get prostate biopsy		Biopsy negative (NO sign or evidence of cancer)
If biopsy shows signs of prostate cancer Ask for Gleason score and get biopsy slides examined by a specialist in pathology of prostate cancer; move forward with cancer staging.		Select Treatment Learn about all your options Discuss side-effects and longterm survival with urologists, radiation oncologists and medical oncologists who specialize in treating prostate cancer.
Adapted from a chart in Prostate Specific Antigen (PSA) Best Practice Policy, American Urological Association, Inc. (AUA) March 1, 2000. Not intended as medical advice. Consult your doctor(s) about prostate cancer and any other prostate and health problems.

Another way of using the PSA test is laid out in our chart about USING "free" PSA.

Find Life-Threatening Prostate Cancer by Measuring PSA Velocity During "Window of Curability" Nov 1, 2006.

This page made by J. Strax December 26 2006. Last modified December 26, 2008

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Find Life-Threatening Prostate Cancer by Measuring PSA Velocity During "Window of Curability" Nov 1, 2006

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Prostate & Cancer:
A Family Guide to Diagnosis, Treatment & Survival
by Sheldon Marks MD. $12.57 Paperback Perseus Publishing; 3rd edition (2003)