What Does a High PSA Level Test Result Mean?

What does high PSA test mean?
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When a man goes to the doctor for a regular checkup, he may undergo a PSA test, which measures a protein called prostate-specific antigen in the blood. The PSA test is used as a screening tool for prostate cancer, meaning if it's high, it can indicate that a man has prostate cancer.

Even so, sometimes the result of a PSA test comes back high, even if a man does not have prostate cancer. In other words, there are other reasons besides cancer why a man may have an elevated PSA.

Learn more about how to interpret your PSA result, below, and why it's important to discuss your test and its potential and actual results with your doctor.

What a High PSA Test Result Can Mean

It used to be believed that in a healthy male, a PSA level should be less than 4 nanograms (ng) per milliliter (mL) of blood. So, anything higher than 4 would indicate an increased risk that prostate cancer is present and a prostate biopsy would be recommended.

Now, though, research shows that a man can have prostate cancer even if his level is less than 4 ng/mL, and that many men have PSA levels higher than 4.0ng/mL and do not have prostate cancer. Experts have learned too that other variables play a role in what constitutes an optimal PSA level like a person's race or ethnicity. 

This is why interpreting your PSA test can be a tricky process and may require not only the opinion of your primary care doctor but a doctor who specializes in the prostate (called a urologist).

Generally speaking, though, the higher a man’s PSA level is, the greater his chances are that he has prostate cancer. In addition, the increase of a man's PSA over time can also be a sign of prostate cancer. 

A High PSA Level Doesn't Always Signal Prostate Cancer

Again, keep in mind that PSA tests are notorious for producing false positive results.

In other words, test results may come back as "high" when there is no cancer present.

Other tests such as a prostate biopsy (when a tissue sample of the prostate gland is removed and examined under a microscope) or a digital rectal exam may be performed to further evaluate your risk for prostate cancer.

Factors or health conditions that may elevate a PSA level include:

Ejaculation

Ejaculation can increase your PSA level, which is why it's best to not have ejaculated for at least 24 hours before your blood test, and 48 hours may be a more cautious window. That said, if you have had an ejaculation, it may be wise to ask for the test to be postponed until you can have your blood drawn at an appropriate time.

Blood Drawn After a Prostate Exam or Procedure

Getting your blood drawn after a digital rectal exam, prostate biopsy, or a prostate surgery can raise the PSA level temporarily. So, it's important to have your blood drawn before you see the doctor, not afterward.

Inflammation or Enlargement of the Prostate Gland

Inflammation of the prostate (called prostatitis) or a noncancerous enlargement of the prostate gland (called benign prostatic hyperplasia or BPH) can cause a high PSA level.

The good news is that both of these conditions can be managed with medication, and there is no evidence that they cause or are linked to prostate cancer.

But it's important to keep in mind that a person can have both prostate cancer and prostatitis or BPH. In this situation, the PSA test can be tricky to interpret and why other tests are needed for your doctor to put the whole picture together and make the right diagnosis. 

Your Decision to Undergo a PSA Test

You may wonder what the risk is of undergoing a PSA test. Well, think of it this way. If you have an elevated PSA level, you may need to undergo further testing like a prostate biopsy which carries a small risk of pain, infection, and bleeding. Then, if you end up not having cancer, (while good), the unnecessary anxiety, cost, and time inflicted upon you can be harmful.

In addition, you may be surprised to learn that finding prostate cancer early may not be beneficial for all men. This is because some prostate cancers grow so slowly that they do not cause any problems and are not life-threatening. But treating them with surgery and radiation can cause problems with urination, having a bowel movement, and sexual function.

This is why most doctors now discuss the risks and benefits of undergoing PSA testing with their individual patients. This is quite different from what doctors did in the past, which was to recommend testing for every male starting around the age of 50. 

When deciding whether to undergo a PSA test and at what age, a doctor will look at factors like your family history of prostate cancer, your symptoms and physical examination, and your race. For instance, African-American men are at a higher risk of developing prostate cancer, so some medical societies recommend they get tested earlier, like at age 45.

A Word From Verywell

In the end, the PSA test is sort of like a double edge sword. While the test may detect a dangerous prostate cancer early and save a man's life, the test can also guide a person down the wrong path for three reasons:

  • False positive: The PSA level is high but there is no prostate cancer.
  • False negative: The PSA level is not high, but a person does have prostate cancer.
  • Cancer is present, but it is slow-growing and would not have caused any problems (but doctors do not usually know which are life-threatening and which are not).

This is why it's so important to have a thoughtful discussion with your doctor when deciding to undergo a PSA test. It's also sensible to read the American Cancer Society Recommendations for Prostate Cancer Early Detection

Sources:

American Cancer Society. (2016). Prostate Cancer Prevention and Early Detection. 

Carter HB et al. Early detection of prostate cancer: AUA guideline. J Urol. 2013 Aug;190(2):419-26.

National Cancer Institute. (2012). Prostate-Specific Antigen (PSA) Test. 

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