Elevated PSA value – do I have prostate cancer?

The PSA value is a very important blood value for the early detection of prostate cancer. However, it is difficult to interpret, and its significance is repeatedly the subject of controversial debate. On this page, Prof. Dr. med. Sven Lahme, medical director of the Goldstadt Private Clinic in Pforzheim, explains where the PSA value comes from, what needs to be considered when determining it and what role it plays in early detection.

What is the PSA value?

PSA stands for prostate-specific antigen. This protein normally only occurs in the prostate, more precisely in the excretory ducts of the glands that contain the seminal fluid. Its task is to keep the seminal fluid liquid. A very small proportion enters the bloodstream, where it is measured as the PSA value.

Total PSA and free PSA

In the blood, PSA occurs in two forms: bound to protein and free. Either total PSA or only free PSA can be measured. A ratio in percent can be calculated from the two values, which gives an indication of the risk of a malignant cause.

Ratio of free PSA / total PSA	Tendency
above 20%	rather no malignant cause
below 20%	increased risk of prostate cancer

Is there a normal value for PSA?

There is no fixed normal value. It depends, among other things, on age and the size of the prostate and is therefore defined in an age-adjusted manner. In younger men, even a comparatively low value can be abnormal. In older men, a normal PSA value can certainly be above 4.0 to 4.6 ng/ml.

PSA density: the influence of prostate size

To factor out the size of the prostate, the PSA density can be determined. This relates the PSA value to the prostate volume. If the PSA density is above 0.2, prostate cancer may be assumed; below that, a benign cause is more likely. However, PSA density is also a relatively unreliable parameter and must be interpreted with caution.

Other causes of an elevated PSA value

The PSA value is not specific to prostate cancer. It can also be elevated for other reasons:

• Prostatitis: one of the most common causes. After appropriate treatment, the PSA value falls back into the normal range.
• Examinations of the prostate before the blood sample is taken: for example, the digital palpation examination or the transrectal ultrasound.
• Cycling: In individual cases, the pressure on the pelvic floor and prostate can artificially increase the value.

When a PSA value should be investigated

What counts for the assessment is not only the individual value, but above all the trend over time. Prof. Lahme distinguishes between three typical patterns:

Trend	Assessment
all values above the age-adjusted normal range	requires investigation
values in the normal range, but rising continuously	requires investigation, as prostate cancer is sometimes associated with steadily rising values
strongly fluctuating values, normal again in between	usually no malignant cause

Why fluctuating PSA values are usually benign

A malignant tumour never produces less PSA, but always more. If the PSA value falls again and again after an increase, the high values cannot be caused by prostate cancer alone. In the case of fluctuating values, the lowest values in each case are therefore what count. Only if these rise or are permanently above the normal range is investigation needed.

How often should the PSA value be determined?

Scientific studies recommend the following intervals:

PSA value	next check
up to 1.5 ng/ml	after 5 years
1.5 to 3 ng/ml	after 2 years
over 3 ng/ml	at short notice, e.g. after 3 months

Prof. Lahme also recommends having the PSA value determined once a year if possible. The more regularly it is measured, the more reliably fluctuating values can be distinguished from continuously rising values. In the case of a particular risk, for example if a brother has prostate cancer, even a six-monthly check may be advisable.

Who is the PSA test useful for?

Between the ages of 45 and 75, PSA testing is a useful measure for the early detection of prostate cancer. It is particularly worthwhile if life expectancy is more than ten years. There is no fixed age limit, as aggressive tumours can occur in individual cases even at an older age. In older men, testing should be discussed individually.

Overdiagnosis and overtreatment: is the criticism justified?

Critics fear that too many PSA tests lead to overdiagnosis and overtreatment. Prof. Lahme makes a clear distinction here: PSA testing is purely a blood test. Whether a tissue sample is taken if the value is abnormal is decided together with the patient, taking into account concomitant diseases, fitness and life situation. The tissue sample, too, is initially only diagnostics.

In his assessment, there is no risk of overtreatment with a responsibly advising urologist, as the criteria for a treatment decision are clearly defined.

The key facts in brief

• The PSA value is an important but non-specific blood value for the early detection of prostate cancer.
• There is no fixed normal value; it is assessed in an age-adjusted manner.
• The trend is decisive: permanently elevated or steadily rising values should be investigated.
• Fluctuating values usually speak against a malignant cause.
• Prof. Lahme recommends annual testing, which is particularly useful between the ages of 45 and 75.

Elevated PSA value? Investigation at the Goldstadt Private Clinic in Pforzheim

Men with an elevated or rising PSA value can have the finding investigated at the Goldstadt Private Clinic. Prof. Dr. Lahme and his team discuss the trend of the values and the further procedure, from monitoring to prostate biopsy. Appointments can be made via the contact form or by telephone on 07231 41 99 20.

This page does not replace medical advice. The assessment of a PSA value requires an individual examination.