Does a high PSA score always mean cancer?

The adoption of regular blood tests measuring the amount of prostate-specific antigen, PSA, in an older man's bloodstream has been instrumental in improving prostate cancer outcomes. PSA is a protein produced by the prostate gland. Test results are given to patients in the form of a number. While a high number could be indicative of cancer, that is not always the case. An elevated PSA could also be the result of another medical issue such as infection or prostate inflammation.

PSA testing started to become widely used as an early detection tool in the 1990s. Since that time, guidelines have fluctuated around who should seek annual PSA testing. Today PSA testing in men without a history of prostate cancer or other risk factors (i.e., genetic concerns) is recommended starting at age 55 until age 69. For men who undergo this annual testing, a trend of results over time can give a provider context to help interpret score changes.

Men who have had, or are in treatment for, prostate cancer will also undergo regular PSA testing. In these situations, an increase in score could indicate that cancer might have returned and/or that a change in treatment may be warranted.

Generally speaking, PSA levels of under 4.0 ng/dl are considered low; low scores are more likely to be "normal" meaning no evidence of cancer. But this is not always the case which is one of the challenges with PSA as a screening tool. Since PSA is a protein, levels can fluctuate in the human body. Level changes can stem from the effects of aging, other medical conditions, some prescription medications and possibly even an intense workout. But since it can also point to cancer, out of range or high PSA results will likely lead to the recommendation of additional testing. This could be a repeat of the PSA test to see if the result is confirmed, or it may involve a physical exam.

For patients with concerns over PSA testing or results, the best thing to do is talk with a physician. By fixating on a numerical result and what it could mean without the interpretation of a medical professional, one may grow anxious, and potentially needlessly so.  It is a good practice for patients to learn or confirm, prior to the testing visit, how results will be delivered. This may mean asking questions around when the result is expected back, and how it will be communicated. For example, will the report appear in the patient portal record, will there be a phone call, or will it be discussed at the next appointment? Being armed with this information can help reduce the worry that may be associated with PSA testing and it also sets the stage for open dialogue to address concerns.