If you have had a PSA test recently and been told that your PSA is higher than normal, you may be a bit scared. After all, an elevated (above 4 ng/ml) PSA blood test result can mean that you have prostate cancer.

The good news is that there are limits to the PSA test and that even a high PSA does not necessarily mean that you have prostate cancer.

What Are The Limits Of The PSA Test?

If you want to understand the limits of the PSA test, you need to first understand the test itself. To begin with, all men have some level of PSA in their bloodstream. PSA or protein specific antigen is a protein produced by the tissue of your prostate. Some of this protein leaks into your bloodstream. So, even if you have a healthy prostate, you will have a PSA level. This can be anything from a very low level such as 0.60 or very high such as 10 or above.

However, there are non-cancerous conditions such as benign prostatic hyperplasia (an enlarged prostate), urinary tract infections and a condition called prostatitis that can cause the prostate gland to produce more PSA than normal. And a PSA test cannot differentiate between this PSA and the PSA created by prostate cancer. This is the major limitation of a PSA test because it means that a high PSA may or may not mean that you have prostate cancer.

High PSA Test Results

If your PSA level is between 4 and 10, your doctor will almost certainly do a procedure called a digital rectal exam (DRE). This consists of the doctor inserting his or her finger in your rectum to feel your prostate gland. If it is not inflamed, has no lumps and is not tender, your doctor may recommend “watchful waiting". What this means is that you will be watched and retested periodically. If your PSA continues to be higher than 4 but the number remains consistent, your doctor will probably recommend no treatments.

There are two other factors that can cause your doctor to order more tests. The first of these is a PSA higher than 10 as this results in means there is a 67% chance that you have prostate cancer. The second is whether or not your PSA level is changing dramatically – either up or down – as this can be a more reliable indicator of prostate cancer.

In either of these cases, your doctor will order more testing. This can include:

  • A urinalysis to rule out a urinary tract infection (URI)
  • X-rays
  • A cystoscopy where the doctor examines your urethra and bladder using a thin, lighted tube
  • Transrectal ultrasound
  • A biopsy

Of these tests, the biopsy is the most definitive. If it comes back positive, there is no question but that you have prostate cancer.

Is The PSA Test Controversial?

PSA tests have become very controversial over the past several years due to the test’s limitations. Also, a recent study of PSA testing for six years, along with annual DRE testing for four years, did not reduce the number of deaths from prostate cancer. This study included two control groups – the group that received the PSA screening and the DREs and a group that received “usual care”. At seven years of follow-up, only 23% more cancers were diagnosed in the screening group.

Get Your PSA Test

While there are limitations to a PSA test and to even digital rectal exams, they are just about the only game in town for spotting prostate cancer early on. This is why most doctors recommend an annual screening once your reach the age of 50 as this is then your chance of having prostate cancer increases substantially. The majority of prostate cancers are found in men age 65 and older. PSA screening is normally stopped when you reach the age of 75 and your life expectancy is 10 years or fewer. In fact, the U.S. Preventive Services Task Force does not recommend prostate cancer screening in men 75 and older.

The net effect is if you are 50 or older, it couldn’t hurt to have an annual PSA screening. Best case, your PSA will be 4 or lower. Worst case, if your PSA is higher, you may have to undergo further testing. But it is certainly better to catch prostate cancer and get treatment started before it can metastasize to other parts of the body.

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