What Does a High PSA Level Test Result Mean?

Is It Prostate Cancer or a False Positive?

What does high PSA test mean?
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When a man goes to the doctor for a regular checkup, he may be given something called a PSA test, a test that's used to measure a substance called prostate-specific antigen in the blood. It is used as a screening tool for prostate cancer. 

Sometimes the result of a PSA test can come back high, even if a man has no prostate cancer symptoms. If the result of your PSA test came back high, you may be wondering what that means for your health.

Does it mean that you have prostate cancer? 

Learn more about how to interpret the result, below, and ask your doctor any further questions that you might have about what it signifies and what to do about it.

What a High PSA Test Result Can Mean

In a healthy male, the PSA level should be less than 4 nanograms (ng) per milliliter (mL) of blood. Anything higher than 4 can indicate an increased risk that prostate cancer is present. This increased risk is about 25% for levels between 4.0 ng/mL and 10.0 ng/mL.

This means if your PSA level is 5.1, you may have as much as a one in four chance that it is due to a tumor in your prostate gland. But you have three out of four chances that it is high due to something else. This makes the 4 to 10 ng/mL the gray zone.

A higher PSA level that's 10.0 ng/mL or above shows a 50% chance that you are at risk of having prostate cancer, according to the American Cancer Society.

But because the PSA test often reveals a high number when cancer isn't present, its use as a screening tool is limited and there is some debate among medical professionals about how often it should be used. Your doctor will decide—based on your age and other factors—what the next step should be if you have a high PSA level.

A High PSA Level Doesn't Always Signal Prostate Cancer

Keep in mind that PSA tests are notorious for producing false positive results—in other words, being high when there is no cancer present. Other tests such as a biopsy or a digital rectal exam may be performed to further evaluate your risk for prostate cancer.

Factors that can elevate a PSA level:

  • Ejaculation: The test instructions should tell you to not have an ejaculation for at least 24 hours before the blood test, and 48 hours may be a more cautious window. 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 that's drawn after a digital rectal exam: This can raise the PSA level temporarily, so it is important to have your blood drawn before you see the doctor, not afterward.
  • Age: Your PSA level can naturally increase with age.
  • Inflammation: Inflammation of the prostate gland can cause a high PSA level.
  • Enlargement: A noncancerous enlargement of the prostate can raise PSA.

A High PSA Level After Cancer Treatment

After treatment for prostate cancer, the PSA level will usually drop and even become undetectable. Your doctor will continue to monitor your PSA level after cancer treatment.

If it begins to rise, a recurrence of the cancer is suspected.

Sources

Prostate-Specific Antigen (PSA) Test, National Cancer Institute, July 24, 2012

PSA, Lab Tests Online, American Association for Clinical Chemistry, December 16, 2015.

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