Prostate cancer is a serious health problem that affects men all over the world. According to the Centers for Disease Control (CDC), in the United States, 224,733 new cases[1] were reported in 2019 with 70% of the cases being diagnosed at the local stage. Prostate-specific antigen (PSA) levels have emerged as a critical marker for screening, diagnosing, and monitoring prostate cancer and can help immensely in the treatment. By understanding the intricacies of PSA levels and what is a normal level by age, healthcare professionals and patients alike can make informed decisions and embark on a proactive approach towards managing prostate cancer and even preventing the diagnosis from occurring.

What are Prostate and Prostate Cancer?

The prostate is a small[2], walnut-shaped gland located just below the bladder in men It protects the urethra, the tube that transports urine and sperm from the body. The primary function of the prostate is to produce and secrete a fluid that nourishes and protects sperm. This fluid, combined with sperm cells from the testicles, makes up semen.

Prostate cancer[3] is a disease that occurs when abnormal cells in the prostate gland start to grow uncontrollably. These cancerous cells can form tumors and potentially spread to other parts of the body, including nearby organs and bones. Prostate cancer is the second most common cancer among men worldwide, with higher incidence rates in older men.

Although the precise origin of prostate cancer is unknown, various risk factors have been discovered. Age is a significant factor, as the risk of developing prostate cancer increases with age, especially after the age of 50. Family history and genetics also play a role, as men with a family history of prostate cancer are at higher risk. Certain ethnicities, such as African-Americans, have a higher incidence of prostate cancer compared to other populations. Obesity is another important factor playing a role in prostate cancer as well.

Early-stage prostate cancer may not cause noticeable symptoms. As the disease progresses, symptoms can include difficulty urinating, weak urine flow, blood in the urine or semen, erectile dysfunction, losing weight without trying and bone pain. If not diagnosed and treated early enough, prostate cancer can metastasize or spread to other organs throughout the body and which will cause further complications. Therefore, early detection and prompt treatment are crucial for better outcomes in prostate cancer. Regular screening and discussions with healthcare professionals can help men make informed decisions about their prostate health and manage any potential risks effectively.

What is Prostate Cancer Screening?

Screening for prostate cancer[4] typically involves a combination of a digital rectal exam (DRE) and a blood test called the prostate-specific antigen (PSA) test. The DRE allows the doctor to feel the size and shape of the prostate, while the PSA test measures the levels of PSA in the blood. Elevated PSA levels may indicate the presence of prostate cancer, but further diagnostic tests, such as a prostate biopsy, are necessary to confirm the actual diagnosis as higher levels of PSA can also indicate other conditions, such as benign prostate hypertrophy (BPH). The American Cancer Society[6] encourages most men to begin screenings in their fifties, however, depending on risk level, it is better to begin screening as early as 40.

What is a PSA Test and What is it Used For?

PSA Test

The PSA blood test measures[7] the levels of prostate-specific antigen, a protein produced by the prostate gland, in the bloodstream. The PSA test is primarily used for screening and monitoring prostate cancer. It is one of the main tools available to detect prostate cancer in its early stages, even before symptoms appear. Elevated PSA levels can indicate the need for further evaluation, such as a prostate biopsy, to confirm or rule out the presence of prostate cancer.

However, it’s important to note that a high PSA level does not automatically mean a person has prostate cancer. Other non-cancerous conditions, such as benign prostatic hyperplasia (BPH)[5] or prostate infections, can also cause PSA elevation. Therefore, the PSA test is not definitive for diagnosing prostate cancer but serves as an important marker to guide further investigation.

The PSA test is also used for monitoring individuals who have already been diagnosed with prostate cancer. It helps track the progression of the disease, assess the effectiveness of treatment, and detect potential recurrence. Serial PSA measurements over time can provide valuable information to healthcare professionals regarding the course of the disease and the need for additional interventions.

Interpreting PSA test results can be complex. Usually, healthcare professionals consider various factors when assessing PSA levels, including age, race, family history of prostate cancer, and the constant increase of PSA levels over time. They may also use additional tools, such as the PSA level trends and the PSA density[8] (PSA levels adjusted for prostate size), to aid in the interpretation and decision-making process.

Ultimately, the PSA test plays a significant role in prostate cancer screening and monitoring, but it should be used in conjunction with other clinical factors and follow-up tests to make informed decisions about prostate health and potential treatment options.

Who Should Get a PSA Test?

The decision to undergo a PSA test should be made based on an individual’s risk factors, age, and discussions with healthcare professionals.

  • Men aged 50 and above: The American Cancer Society recommends that men at average risk consider discussing PSA testing with their doctor starting at age 50. However, for men at higher risk, such as those with a family history of prostate cancer or of African American descent, discussions may begin earlier, around age 45.
  • Men with a family history of prostate cancer: Individuals with a first-degree relative (father, brother) diagnosed with prostate cancer may have an increased risk. In such cases, healthcare professionals may suggest starting PSA testing earlier, typically around age 40 or 45.
  • Individuals with certain risk factors: Other risk factors that may prompt consideration of PSA testing include a personal history of prostate abnormalities, obesity, certain genetic mutations, or exposure to environmental factors associated with an increased risk of prostate cancer.

What is a Normal PSA by Age?

While there is no universally agreed-upon normal PSA level for each specific age group, there are general guidelines that can provide a normal reference range for PSA levels[9] based on age. It’s important to note that PSA levels can vary among individuals, and factors such as race, family history, and prostate health should also be considered.

  • Under 50 years old: PSA levels should be below 2.5 ng/mL are typically considered normal.
  • 50 to 59 years old: PSA levels should be below 3.5 ng/mL are generally considered normal.
  • 60 to 69 years old: PSA levels below 4.5 ng/mL are typically considered normal. However, the risk of prostate cancer increases with age, so further evaluation may be necessary if levels are closer to the upper range.
  • 70 years old and above: PSA levels below 6.5 ng/mL are generally considered normal for this age group. It’s important to consider age-related changes in the prostate gland and the potential for benign prostate enlargement.

Regular monitoring of PSA levels over time can provide valuable information about trends and changes, which may help in identifying any concerning patterns that require further investigation. It is important for individuals to discuss their PSA levels and any concerns with a healthcare professional to determine the best course of action based on their specific circumstances.

What Are the Benefits and Risks of PSA Testing?

Risks of PSA

Although screening is important and can help prevent men from dying from prostate cancer (3 out of 1,000)[10], PSA testing has both potential benefits and harms that should be considered when making decisions about screening.
The benefits of PSA testing include:

  • Detecting PSA testing can detect prostate cancer at an earlier stage, allowing for timely intervention and potentially improving treatment outcomes.
  • PSA levels can help place individuals into higher or lower risk categories, allowing healthcare professionals to tailor further evaluation and treatment plans accordingly.
  • PSA testing is useful for monitoring individuals who have been diagnosed with prostate cancer, helping to track disease progression, assess treatment response, and detect potential recurrence.

Some risks of PSA testing include:

  • False-positive results can occur in PSA testing which can indicate elevated PSA levels without the presence of prostate cancer. This can lead to unnecessary anxiety, additional tests, and potentially invasive procedures, such as biopsies, which carry risks of complications.
  • Overdiagnosis and overtreatment based on PSA testing may identify slow-growing or benign prostate cancers that may never cause harm during a person’s lifetime. The detection of these cancers can lead to overtreatment and expose individuals to unnecessary risks and harmful side effects of treatments such as surgery, radiation, or hormone therapy.
  • Impact of a prostate cancer diagnosis, even if it is not aggressive, can cause significant psychological distress and anxiety for individuals and their families.

How are PSA Results Used For Diagnosis?

The PSA is made by the prostate gland[11] in males and can be detectable through the blood. The more the prostate grows, the more PSA is secreted, and this especially happens as men get older. PSA results are an important factor in the diagnosis of prostate cancer, but they are not definitive on their own. When PSA levels are elevated, further evaluation is necessary to confirm or rule out the presence of prostate cancer. Additional tests used are DREs, imaging tests and a biopsy may be done as well to confirm the diagnosis and the staging of the disease.

PSA results, along with the findings from additional tests help healthcare professionals determine the extent of the disease, guide treatment decisions, and monitor the progression of prostate cancer over time. It is important to work closely with healthcare professionals to interpret PSA results in the context of an individual’s overall health and make informed decisions about further diagnostic steps and treatment options.


Should I Get Screened for Prostate Cancer?

The decision to get screened for prostate cancer should be made based on a careful consideration of multiple factors. It is recommended to have an open and informed discussion with your healthcare professional to assess your individual risk factors, values, and preferences. Factors to consider include your age, family history of prostate cancer, overall health status, and potential benefits and risks of screening.

While screening with PSA testing can potentially detect prostate cancer at an early stage, it can also lead to false-positive results, overdiagnosis, and overtreatment. Treatment for prostate cancer can have significant side effects, impacting quality of life. It is important to weigh the potential benefits of early detection against the potential harms and uncertainties associated with screening. Additionally, considering your personal values and priorities regarding potential treatment options and the potential impact on your quality of life is crucial.

Does PSA level indicate stage of cancer?

PSA levels alone do not indicate the stage of prostate cancer. PSA levels primarily reflect the activity of prostate cells, including both cancerous and non-cancerous cells. While higher PSA levels can suggest the possibility of prostate cancer, they do not provide specific information about the stage of the disease.

The staging of prostate cancer typically involves additional tests, such as imaging scans (e.g., bone scans, CT scans, MRI) and a prostate biopsy. These tests help evaluate the extent of the cancer, including whether it has spread beyond the prostate gland to nearby tissues or distant organs. Once prostate cancer is diagnosed, the staging process provides information about the tumor's size, location, and potential spread.

Therefore, while PSA levels are an important marker in prostate cancer diagnosis and monitoring, they need to be interpreted in conjunction with other clinical information and diagnostic tests to accurately determine the stage of the cancer.

Can PSA levels go down with prostate cancer?

PSA levels can potentially decrease in individuals with prostate cancer, depending on various factors. In some cases, treatment interventions such as surgery, radiation therapy, or hormone therapy can lead to a reduction in PSA levels. The goal of these treatments is to target and eliminate or control cancer cells, which can result in lower PSA levels over time.

However, it is important to note that a decline in PSA levels does not always indicate a cure or complete eradication of the cancer. In some instances, PSA levels may decrease but not reach undetectable levels, suggesting the presence of residual cancer cells. Additionally, PSA levels can fluctuate and may increase again in the future, requiring ongoing monitoring to assess treatment response and disease progression.

What PSA level indicates advanced prostate cancer?

There is no specific PSA level that definitively indicates advanced prostate cancer. The interpretation of PSA levels in relation to the stage of prostate cancer requires consideration of various factors. In general, higher PSA levels are associated with a higher likelihood of advanced or aggressive prostate cancer. However, PSA levels alone cannot determine the stage of the cancer.

The staging of prostate cancer involves additional tests, such as imaging scans and a prostate biopsy, to assess the extent of the disease. These diagnostic tools, along with PSA levels, and other clinical factors, help determine if prostate cancer has advanced beyond the prostate gland and the specific stage of the disease. It is crucial to consult with a healthcare professional who can evaluate the overall clinical picture and guide appropriate diagnostic and staging processes based on individual circumstances.


PSA levels play a crucial role in the detection, monitoring, and management of prostate cancer. While elevated PSA levels can be an indication of prostate cancer, further evaluation through additional tests, such as a biopsy, is necessary to confirm the diagnosis. PSA testing helps identify individuals at risk and their risk category, and guide treatment decisions. However, it is important to consider the limitations and potential harms associated with PSA testing, such as false-positive results, overdiagnosis, and overtreatment. In addition it is important to share any symptoms you might be experiencing with a healthcare provider even after taking medications or supplements to aid in prostate issues such as Prostara. Overall, PSA testing, when used judiciously and in conjunction with other diagnostic tools, contributes to the comprehensive management of prostate cancer and supports personalized care for individuals.