Do Elevated PSA Levels Always Mean Prostate Cancer?

Apr 09, 2024
The prostate-specific antigen (PSA) blood test checks for a certain protein produced within the prostate gland. When that level is elevated, it’s a cause for concern. But, does it mean you have prostate cancer? Not necessarily. Learn more here.

Many men assume that a high PSA level automatically means the worst case scenario: That they have prostate cancer. Although it’s true that men with a very high PSA level (over 10) are much more likely to have prostate cancer, it’s a common misconception that an elevated PSA always equals prostate cancer.

At David B. Samadi, MD, in Midtown Manhattan, New York City, board-certified urologist and robotic surgical oncologist Dr. Samadi provides attentive, individualized care for every patient. As a physician who specializes in the full spectrum of prostate and urinary system health, Dr. Samadi gets questions about elevated PSA levels often. 

Here’s what you need to know about PSA test result myths — and facts — so you feel more informed and confident about what your PSA results might mean for you.

PSA tests: What you should know 

PSA tests screen for prostate-specific antigen (PSA), a protein that’s mainly present in semen, but also found in small quantities in the blood. Your test shows how many nanograms of PSA you have per milliliter (ng/mL) of blood. A higher PSA level means you’re more likely to have prostate cancer.

Both the United States Preventive Services Task Force (USPSTF) and the American Urological Association recommend PSA testing as the first-line prostate cancer screening option. They no longer recommend digital rectal exams (DRE) for prostate cancer screening. 

What your PSA level means

Many medical professionals consider a PSA level of less than 4 ng/mL to be a good result. Dr. Samadi has unique expertise that allows him to evaluate your results and assess your prostate cancer risk in great depth. He may set that bar at 2.5 or 3 ng/mL based on your health, age, and other factors. 

Although a low number likely means you have a healthy prostate gland, it doesn’t guarantee you don’t have prostate cancer. About 15% of men with a PSA level under 4 ng/mL still have prostate cancer detectable through a biopsy (tissue sampling of the prostate gland). 

Additional testing, such as extra blood tests, imaging tests, and biopsy, are the next step for an elevated PSA level. Digital rectal exams, although not a stand-alone method of prostate cancer screening, can help monitor your prostate health as well. 

In general, the borderline range that triggers additional prostate testing is a PSA level of 4-10 ng/mL. Men in this group have a roughly 25% chance of having prostate cancer, proving that an elevated PSA is usually not prostate cancer. A PSA higher than 10 equates to a greater than 50% chance of prostate cancer. 

Regardless of your PSA level, Dr. Samadi may recommend additional monitoring or testing based on your unique situation. Many things can cause PSA level fluctuations, such as aging, certain medications, strenuous exercise, and recent ejaculation, so this additional evaluation can be important in establishing your true PSA level. 

Non-cancer reasons for elevated PSA levels

Up to 12% of men who have routine PSA tests experience a false positive (elevated PSA) at some point. Repeat testing can clarify your true PSA level. 

Although an elevated PSA level doesn’t always mean prostate cancer, it can indicate other problems. Examples include an enlarged prostate (benign prostatic hyperplasia, or BPH), prostate inflammation (prostatitis), or a urinary tract infection (UTI)

Regardless of what your PSA test reveals, we’re here to help you through any challenges ahead. Prostate cancer is treatable, especially when it’s detected early. So are the other problems that cause elevated PSA. 

Dr. Samadi welcomes patients in our Central Midtown Manhattan office during the week, and in East Hill, New York (Long Island) at St. Francis Hospital and Heart Center once a week. Call our office today for an appointment, or connect with us online anytime.