Prostate Cancer: Interpreting PSA Results

An elevated PSA may result from either benign enlargement of the prostate (BPH) or prostate cancer.

Some general guidelines follow:

  • There is not a “normal” PSA that excludes prostate cancer or an “abnormal” PSA that is diagnostic of prostate cancer.
    • 15% of men with a PSA <4.0 will have prostate cancer.
    • 25% of men with a PSA between 2.5 and 4.0 will have prostate cancer.
  • 10% of men over 50 will have a reading above 4.0. Roughly 30–40% of these men will have prostate cancer.
  • 25% of men of all ages who have a PSA between 4.0 and 10 will have prostate cancer. Cancers in this range have been shown to be clinically important and potentially curable.
  • 50% of men with a PSA over 10 will have prostate cancer.

In addition to assessing the PSA value at a given time, your doctor will also take into consideration the rate at which your PSA is increasing each year, if you have had annual PSA tests.

When is further evaluation needed?

Further evaluation, in the form of a biopsy, is recommended for:

  • Men under age 60 with a PSA greater than 2.5
  • Men over age 60 with a PSA greater than 4.0
  • Any man with PSA rising more than 25% per year or 0.75 ng/ml per year