PSA Test: Understanding Prostate Cancer Screening & Levels

What Is PSA?

Prostate-specific antigen (PSA) is a serine protease produced by prostate epithelial cells. It liquefies semen. Small amounts enter bloodstream; elevated levels suggest prostate pathology.

PSA Elevation Causes

Prostate cancer (most concerning)
Benign prostatic hyperplasia (BPH) – most common cause in older men
Prostatitis (acute/chronic)
Urinary retention, catheterization, recent ejaculation, prostate manipulation (DRE, biopsy, cystoscopy)
Medications: 5-ARIs (finasteride, dutasteride) lower PSA ~50%.

Screening Guidelines (US)

Interpretation & Next Steps

PSA 4–10 ng/mL: "Gray zone" – consider % free PSA, PSA velocity, density, MRI, then biopsy.
>10 ng/mL: High suspicion → biopsy.
Age-specific cutoffs sometimes used (e.g., <2.5 at 40–49, <3.5 at 50–59, <4.5 at 60–69, <6.5 at 70–79).

Shared Decision-Making Is Essential

Discuss benefits (early detection, mortality reduction) vs. harms (false positives, overdiagnosis, biopsy complications, overtreatment of indolent cancer) with your clinician.

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Organization	Recommendation
USPSTF (2018)	Age 55–69: Individualized decision (Grade C). <70: No routine screening.
ACS	Discuss at 50 (avg risk), 45 (high risk: Black, family hx), 40 (higher risk).
AUA	Shared decision-making 55–69; interval 2–4 yrs. <40 or >70: not routine.