Prostate-specific antigen (PSA), a protein produced by the prostate gland, is often regarded as an indicator of prostate health. But elevated PSA levels can arise from different causes and are not specific to one type of prostate condition. As such, it is important that patients with elevated levels of PSA consult a urologist to determine the exact cause of these abnormal levels.

The levels of PSA are considered normal when they fall between the range of 1.0 and 4.0 ng/mL. Above 4.0 ng/mL, PSA levels are considered abnormal or elevated and several tests, such as a urinalysis test, post-void residual, assessment of medical and family history, and biopsy or cystoscopy can be used to determine the actual cause of such elevated PSA blood levels.

The most common causes for elevated PSA can include natural biological reasons, such as age or ethnicity. As men grow older, their prostate naturally becomes bigger without any medical reason, and the larger organ produces more PSA. Ethnicity also plays a role in a man’s PSA levels. Other causes include prostatitis, a prostate infection that leads to inflammation and is the most common prostate condition in men under 50, benign prostate hyperplasia (BPH), the enlargement of the prostate gland and the most common prostate condition in men over 50, and urinary tract infection, which can cause the inflammation of the prostate gland and elevate PSA levels.

However, high PSA levels can also be indicative of prostate cancer, and doctors usually do a digital rectal exam to assess the existence of lumps. If cancer is suspected, a biopsy is generally recommended. PSA level fluctuation is also a diagnostic tool because a continuously rising PSA level is indicative of prostate cancer. It is also used as a tool to guide treatment and the level of cancer aggressiveness stage, and for monitoring and successful assessment of the chosen treatment (radical robotic prostatectomy and/or radiation).

In less serious conditions, PSA levels usually go down or, in case of an infection, antibiotics can be used. However, more serious conditions such as BPH or prostate cancer require further testing.

Men should be aware of the importance of having their PSA levels tested, especially when they fall within the known risk factors, namely age over age 50, of African-American ethnicity, a family history of prostate cancern and obesity or high-fat diet. Early detection increases the available treatment options, leads to better outcomes, fewer side effects, and increases the chances of survival.