There is considerable confusion about the significance of the PSA (Prostate Specific Antigen) blood test for prostate disease. This blood test is a very sensitive indicator of medical problems affecting the prostate gland, but unfortunately it cannot distinguish between benign conditions and cancer. The generally accepted normal value is usually four or less. PSA levels greater than four may be considered suspicious for some type of prostatic disease but do not necessarily or even usually mean cancer. The overwhelming majority of men with elevated PSA levels will not have prostate cancer. Abnormally high PSA levels are frequently due to benign prostatic enlargement, infection or inflammation without any cancer being present at all! And some patients with prostate cancer will have totally normal PSA levels.

PSA is most useful as one of several tools your doctor has to monitor your health and identify early prostate disorders. If the PSA is rising quickly or if it seems unusually high based on the estimated size of your prostate and doesn’t respond to treatment for infection and inflammation, further examination of the prostate, including a biopsy, will be needed. If you already have prostate cancer, an increase in PSA levels can suggest the need for further therapy.

The best way to detect prostate cancer early is a yearly digital rectal examination and PSA blood test for all men over fifty years of age. Those men at high risk, such as Blacks and those with a family history of prostate cancer, should begin these yearly examinations at age forty-five. If the PSA blood level is prostate us elevated or the rectal examination is abnormal or unusual, the next step will be an ultrasound evaluation of the prostate and needle biopsy. This prostatic needle biopsy will also be recommended if the PSA is increasing at a rate greater than one point or 25% per year. If the biopsies do not show any cancer, we may recommend that the PSA levels be rechecked frequently, usually every three or four months. Should an unexplained increase in PSA be found, a repeat biopsy will be necessary.

In some cases, a "Free Versus Total" PSA blood test will be requested. A high percentage of Free PSA in the blood increases the chances for benign prostate enlargement, infection or inflammation without cancer.