PSA: Values by Age and What a Raised Result Means
PSA is a protein made by the prostate and it is normally present in every man's blood. A raised result therefore does not automatically mean disease: a prostate that has enlarged with age, inflammation, a bicycle ride or sex the day before all raise PSA just the same. What PSA is good for is starting a conversation with a urologist and deciding what comes next. This article explains the usual values by age, why the ratio of free to total PSA is looked at, what falsely raises the result and when the test is repeated before any further step is taken.
Usual PSA values
| Age | The value usually considered expected |
|---|---|
| 40 to 49 | up to 2.5 ng/mL |
| 50 to 59 | up to 3.5 ng/mL |
| 60 to 69 | up to 4.5 ng/mL |
| 70 and above | up to 6.5 ng/mL |
What is looked at besides the number itself
- The ratio of free to total PSA: when the total PSA is between 4 and 10 ng/mL, a ratio below 15 % shifts suspicion towards the prostate as the source, while above 25 % points more often to benign enlargement.
- PSA density: the same PSA means different things with a small and with a large prostate, so the number is divided by the volume measured on ultrasound.
- The movement over time: a fast rise from year to year says more than one high result.
- Digital rectal examination: feeling the prostate and PSA answer different questions and go together.
What falsely raises PSA
This is the most common reason the test is repeated before any conclusion is drawn:
- ejaculation in the last 48 hours,
- riding a bicycle or a motorcycle just before the blood draw,
- inflammation of the prostate or a urinary infection, which can raise PSA several times over,
- a digital rectal examination, a cystoscopy or a catheter just before the blood draw,
- urinary retention and a recent biopsy.
In the other direction: medicines for benign prostate enlargement from the 5-alpha-reductase inhibitor group halve PSA after a few months, so in men taking them the result is read as doubled. That must always be mentioned to the urologist.
How the blood should be drawn
No ejaculation and no cycling for two days beforehand, no prostate examination that same day, and not during or immediately after a urinary infection. If the first result is raised, it is repeated after 4 to 6 weeks, as a rule in the same laboratory, because results from different methods are not compared with one another.
When a PSA test makes sense
The conversation about testing usually starts around the age of fifty, and earlier, around forty-five, in men whose father or brother has had prostate cancer. PSA is not a test done “just in case” without a conversation: the result pulls the next steps along with it, so what would be done if it comes back raised is agreed in advance. Symptoms that call for an appointment in their own right are a weak stream, frequent night-time urination, a feeling of incomplete emptying, blood in the urine or semen and pain in the pelvis. You can book a urology appointment at the Miren Medic clinic.
What a urology appointment looks like
The urologist takes a history of your urination, examines the prostate, reads the PSA together with your age and earlier results and, if needed, asks for an ultrasound and a measurement of residual urine. One of three decisions comes out of that: the result is normal and will be monitored, the result is the consequence of something treatable, or further investigation is needed. No referral is needed for an appointment with us.
Prices
| Service | Price |
|---|---|
| Urology appointment (Dr Aleksandar Lazić) | 6.000 RSD |
| Abdominal ultrasound (Dr Uroš Miladinović) | 6.000 RSD |
| Internal medicine appointment (Dr Andreja Kovačević) | 6.000 RSD |
Check it now
- IPSS prostate symptom test and PSA interpreter: enter your age and PSA and rate your urinary symptoms.
Frequently asked questions
What is a normal PSA value?
The classic cut-off is 4 ng/mL, but it is read by age: up to 2.5 ng/mL in your forties, up to 3.5 in your fifties, up to 4.5 in your sixties and up to 6.5 after seventy. The decision is never made from one number.
Does a raised PSA mean cancer?
No. The most common reasons for a raised PSA are benign enlargement of the prostate and inflammation. That is why the test is repeated first, and only then, together with an examination, the free to total PSA ratio and an ultrasound, is it decided whether further investigation is needed.
How long before the test should sex be avoided?
Two days. The same goes for riding a bicycle. A prostate examination is not done just before the blood draw but after it or on another day.
From what age should PSA be tested?
The conversation usually starts around fifty, and around forty-five in men whose father or brother has had prostate cancer. Before the test, what the next step would be if the result is raised is agreed.
Do prostate medicines change PSA?
Yes. After a few months 5-alpha-reductase inhibitors lower PSA to roughly half, so the result is interpreted as doubled. The treatment is always stated alongside the result.
Book an appointment
If your PSA is raised or you have trouble passing urine, book a urology appointment at the Miren Medic clinic. The examination, the ultrasound and the interpretation of the result come from one place, without a referral, with a clear agreement on when the test is repeated.
