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If PSA is abnormal

A PSA Test chart to help detect prostate cancer

Before accepting a diagnosis of prostate cancer make sure your urologist has eliminated benign disease (BPH) as well as prostatitis and other inflammatory conditions.

But also keep in mind, aggressive prostate cancer may occur in both younger and older men even if the PSA looks normal.

In the past, most doctors considered PSA values below 4.0 ng/ml as normal. Recent research has found prostate cancer in men with PSA levels below 4.0 ng/ml.

There is no specific normal or abnormal PSA level. Rate of rise is more important, even below PSA 2.5. However, the higher a man's PSA level, the more likely it is that cancer is present. According to the National Cancer Institute, many doctors use the following ranges, with some variation:

  • 0 to 2.5 ng/ml is low
  • 2.6 to 10 ng/ml is slightly to moderately elevated
  • 10 to 19.9 ng/ml is moderately high
  • 20 ng/ml or more is high

Several factors may cause PSA levels to fluctuate.One abnormal PSA test does not necessarily indicate a need for a full diagnostic workup. A followup PSA test and rectal within a month will probably indicate whether it is time for free PSA test and beyond that ultrasound guided biopsy.


What tests do you need
to start with?


Prostate-specific antigen (PSA)


Digital rectal exam (DRE)

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  Test results  

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If one or more results is



If both test results are


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Possible causes:
BPH (benign prostate growth)
prostatitis (inflammation)
prostate cancer.

Do you have urinary frequency, urgency,
pain or burning?

Urologist may treat you with antibiotics and repeat PSA before deciding if biopsy is necessary.


Return regularly for
PSA and DRE testing

If biopsy was negative after abnormal PSA or DRE, consider color doppler ultrasound from a specialist.

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Ask for "free-PSA" test (to find ratio of free to bound PSA) see next chart


For definitive (best) diagnosis:

Get prostate biopsy

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Biopsy negative
(NO sign or evidence of cancer)

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If biopsy shows signs of prostate cancer

Ask for Gleason score and get biopsy slides examined by a specialist in pathology of prostate cancer; move forward with cancer staging.

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Select Treatment

Learn about all your options
Discuss side-effects and longterm survival with urologists, radiation oncologists and medical oncologists who specialize in treating prostate cancer.
Adapted from a chart in Prostate Specific Antigen (PSA) Best Practice Policy, American Urological Association, Inc. (AUA) March 1, 2000. Not intended as medical advice. Consult your doctor(s) about prostate cancer and any other prostate and health problems.


Another way of using the PSA test is laid out in our chart about USING "free" PSA.

Find Life-Threatening Prostate Cancer by Measuring PSA Velocity During "Window of Curability" Nov 1, 2006.

This page made by J. Strax December 26 2006. Last modified December 26, 2008


Related news

Find Life-Threatening Prostate Cancer by Measuring PSA Velocity During "Window of Curability" Nov 1, 2006


If you are diagnosed with prostate cancer:

  • Take time for second and third opinions about your biopsy Gleason score and any markers of aggressive disease
    • your staging
    • your treatment options
  • Compare long term survival rates and side effects of various treatment options.
  • Ask for clear information, as detailed as you wish.
  • Make your own informed decisions based on evidence and your personal values and goals.

Prostate Cancer Treatment Guidelines (USA) Version III, October 2007 The National Comprehensive Cancer Network. English or Espagñol. Cáncer de la próstata Guías de la NCCN para el tratamiento de los pacientes Transferencia directá Sept 2005


Prostate & Cancer Family Guide book cover

Prostate & Cancer:
A Family Guide to Diagnosis, Treatment & Survival

by Sheldon Marks MD. $12.57 Paperback Perseus Publishing; 3rd edition (2003)

General Disclaimer: PSA Rising is designed for informational purposes only and is not engaged in rendering medical advice or professional services. News and information provided through PSA Rising should not be used for diagnosing or treating a health problem or a disease. It is not a substitute for professional care. If you have or suspect you may have a health problem, consult your healthcare provider.

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