The results of your PSA test report the level of PSA detected in the blood. The results are usually reported as nanograms of PSA per milliliter (ng/mL) of blood.
In the past, most doctors considered PSA values below 4.0 ng/mL to be normal. However, recent research found prostate cancer in men with PSA levels below 4.0 ng/mL. Thus, many doctors are now using 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 elevated
- 20 ng/mL or more is significantly elevated.
There is no specific normal or abnormal PSA level. However, the higher a man's PSA level, the more likely it is that cancer is present. However, because various factors can cause PSA levels to fluctuate, one abnormal PSA test does not necessarily indicate a need for other diagnostic tests.
When PSA levels continue to rise over time, other tests may be needed.
A man should discuss elevated PSA test results with his doctor. There are many possible reasons for an elevated level, including:
- Prostate cancer
- Benign prostate enlargement (BPH)
If no other symptoms suggest cancer, the doctor may recommend repeating the digital rectal exam and PSA test regularly to watch for any changes. If a man's PSA levels have been increasing, or if a suspicious lump is detected during the digital rectal exam, the doctor may recommend other tests to determine if there is cancer or another problem in the prostate.
A urine test may be used to detect a urinary tract infection or blood in the urine. The doctor may recommend imaging tests, such as:
- Ultrasound (a test in which high-frequency soundwaves are used to obtain images of the kidneys and bladder)
- Cystoscopy (a procedure in which a doctor looks into the urethra and bladder through a thin, lighted tube).
Medicine or surgery may be recommended if the problem is BPH or an infection.
If cancer is suspected, a biopsy is needed to determine if cancer is present in the prostate. During a biopsy, samples of prostate tissue are removed, usually with a needle, and viewed under a microscope. The doctor may use ultrasound to view the prostate during the biopsy, but ultrasound cannot be used alone to tell if cancer is present.