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Prostate-specific antigen (PSA) is a protein produced by cells in the prostate gland. The PSA test measures the level of this protein in the blood and is commonly used as a screening tool for prostate cancer and other prostate conditions. While PSA is normally present in small quantities in the blood, elevated levels may indicate the presence of prostate problems, including benign prostatic hyperplasia, prostatitis, or prostate cancer. However, it is important to understand that an elevated PSA level does not automatically mean cancer is present, as many factors can influence PSA levels.

The PSA test is typically performed through a simple blood draw from a vein in the arm. No special preparation is usually required, though some healthcare providers may recommend abstaining from sexual activity for 24 to 48 hours before the test, as ejaculation can temporarily raise PSA levels. Certain medical procedures involving the prostate, such as a digital rectal exam, prostate biopsy, or cystoscopy, may also temporarily elevate PSA levels, so the test may be scheduled before these procedures or several weeks afterward. The blood sample is sent to a laboratory where PSA levels are measured in nanograms per milliliter.

Normal PSA levels can vary depending on age, with levels naturally increasing as men get older. Generally, PSA levels below 4.0 nanograms per milliliter are considered normal for most men, though some experts now use age-specific reference ranges. Levels between 4.0 and 10.0 are considered borderline and may warrant further investigation, while levels above 10.0 are more likely to be associated with prostate cancer. However, interpretation of PSA results should always be done in conjunction with other factors such as age, family history, ethnicity, and results from a digital rectal examination.

When PSA levels are elevated or borderline, healthcare providers may recommend additional testing to determine the cause. This might include a free PSA test, which measures the ratio of free PSA to total PSA in the blood, or a repeat PSA test to track changes over time. Other diagnostic procedures such as a prostate biopsy, MRI, or other imaging studies may be recommended based on the overall clinical picture. Men should discuss the benefits and limitations of PSA testing with their healthcare provider to make informed decisions about screening, as the test has both supporters and critics within the medical community regarding its use for routine screening in asymptomatic men.