PSA blood test: what your PSA level means

What PSA levels mean

PSA is reported in ng/mL. There is no line that separates cancer from no cancer. Higher levels make cancer more likely, a high level can happen without cancer, and a low level doesn't rule it out. PSA also rises with age as the prostate grows.

Clinicians care about the trend more than a single value. A PSA that keeps rising over time matters more than one borderline number. Gabriel's optimal band (under 1 ng/mL) is a strict functional target, not a cancer threshold.

What to avoid before a PSA test

• Ejaculation. Avoid sex and masturbation for 24 to 48 hours. Semen release can raise PSA for a short time.
• Vigorous exercise, especially cycling, for about 48 hours.
• Testing too soon after a prostate procedure. A prostate biopsy can raise PSA for a month or two; tell your clinician about a recent biopsy, catheter or urinary tract infection.
• Fasting. None of the major patient guides we reviewed list fasting for a PSA test on its own. If other tests are drawn at the same visit, you may need to fast, so follow your lab's instructions.

Tell your clinician if you take finasteride or dutasteride, for an enlarged prostate or hair loss. They lower PSA, so your result is read against a lower cutoff.

What raises PSA besides cancer

• Benign prostatic hyperplasia (BPH), a non-cancerous enlarged prostate, common with age.
• Prostatitis, inflammation or infection of the prostate.
• Urinary tract infections.
• Recent ejaculation, cycling or a prostate procedure.
• Certain medicines.

After a high result, the usual first step is to repeat the test, often in 6 to 8 weeks. If it stays high, a clinician may follow it over time or order a urine test, imaging such as an MRI, or a biopsy. Only a biopsy can diagnose cancer.

Deciding about screening

PSA screening can find cancer earlier and may slightly lower the risk of dying from prostate cancer. It can also lead to false alarms, biopsies with risks of bleeding and infection, and treatment of slow-growing cancers that would never have caused harm, which can bring urinary, bowel and sexual side effects.

• Ages 55 to 69: the U.S. Preventive Services Task Force says screening is an individual choice after talking through benefits and harms.
• Age 70 and older: the Task Force recommends against routine PSA screening.
• Higher risk (Black men, a father or brother with prostate cancer, or BRCA1 or BRCA2 variants): some groups suggest talking about testing from age 40 or 45.

See a clinician promptly for trouble urinating, a weak stream, blood in urine or semen, pain with urination, or new bone pain in the back or hips, whatever your PSA.