Prostate-specific antigen (PSA) is a protein produced by both normal and abnormal prostate cells. It is present in small amounts in the blood of all men with a functioning prostate. The PSA test measures the level of this protein in your blood and is the most widely used screening tool for prostate health in men.
An elevated PSA can indicate several things. Benign prostatic hyperplasia (BPH), where the prostate enlarges with age, is the most common cause of a raised PSA. Prostatitis (inflammation or infection of the prostate), recent ejaculation, vigorous cycling, and urinary tract infections can also push the number up. Prostate cancer is one possible cause, but an elevated result does not mean cancer is present. PSA is prostate-specific, not cancer-specific.
Age-specific reference ranges are used because PSA naturally rises as men get older and the prostate grows. For men under 50, a level above 2.5 ng/mL typically warrants discussion with a GP. For men in their 60s, the threshold is higher. Your GP will also consider PSA velocity (how quickly the number is rising over time), which can be more informative than a single reading.
Current Australian guidelines generally recommend that men discuss PSA testing with their GP from age 50, or from age 40 if there is a family history of prostate cancer. The decision to test is a personal one, as PSA screening involves trade-offs between the benefit of catching problems early and the possibility of follow-up procedures for results that turn out to be benign. Your GP can help you weigh these considerations.
Certain medications affect PSA levels. Finasteride and dutasteride, used for prostate conditions and hair loss, lower PSA by roughly 50%. If you take either of these, your practitioner needs to know, as the interpretation of your result changes accordingly.
To screen for prostate health issues in men, monitor known prostate conditions, and track PSA levels over time as part of ongoing prostate health surveillance.
