PSA Level

Normal, Borderline and Elevated PSA Levels

Is your PSA level elevated? It is essential to first confirm the presence of conspicuous tissue changes in the prostate before performing a biopsy.

When does a PSA score give cause for concern?

PSA levels of under 2 ng/ml are generally regarded as normal and PSA levels between 2 and 4 ng/ml are generally regarded as borderline, and therefore in need of regular monitoring. In some cases, however, patients with PSA levels of under 2 ng/ml may also be advised to undergo regular testing. Such testing is a means of determining whether intervention is warranted because it provides information pertaining to the development of a patient’s PSA level, i.e. the degree to which the level changes over time. Indeed, in the interest of promoting the early detection of cancer-related changes in the prostate gland, the latest urological guidelines in Germany specify regular PSA testing in all men starting at the age of 40. A simple blood sample is all that is required to check a patient’s PSA level.

An elevated PSA level may be an indication that something is wrong with the prostate. It is therefore advisable in such cases to attempt to determine what the cause of the elevation is.

Imaging procedures can be used to determine the presence of conspicuous tissue structures in the prostate. While ultrasound will usually not enable your doctor to distinguish between healthy and conspicuous or potentially cancerous tissue, MRI does offer the right degree of diagnostic precision:

(-> Prostate MRI)

In light of the fact that PSA levels tend to increase with age, many men have placed their trust in age-specific PSA reference ranges. Our experience shows that these age-specific reference ranges are misleading because they suggest that higher PSA levels are somehow acceptable in older men. The above table, with its specific threshold values, applies irrespective of a person’s age.


What does a PSA score tell us?

PSA test scores: total PSA, free PSA, and free-to-total PSA ratio

(PSA = Prostate Specific Antigen)

Elevated PSA levels are often discovered in the context of routine blood testing. Elevated PSA levels often indicate a problem with the prostate gland and that an attempt should be made to find out what the problem is. Indeed, PSA testing has proven to be a valuable means of monitoring the status of the prostate. PSA stands for Prostate Specific Antigen and is produced by cells of the prostate gland.

PSA is a protein that acts to liquefy the semen. The fact that certain quantities of PSA enter the bloodstream means that it can be detected by a blood test. PSA testing can be used, for instance, to monitor the development of prostate cancer or to detect a possible case of prostatitis (inflammation of the prostate).

Although PSA testing offers an excellent means of detecting and monitoring changes in the prostate gland, it does not tell us – even when the testing is repeated regularly – what the cause of an elevated PSA level is.

What is the free-to-total PSA ratio?

In addition to measuring total PSA in the blood, your doctor may have the laboratory determine the ratio of free PSA to total PSA (f/t). This value is derived from the level of free PSA and total PSA. Ratios below 20% are regarded as an indicator of prostate cancer.

The lower the ratio is, the more likely it is that prostate cancer is the reason for an elevated PSA level. In contrast, free-to-total PSA ratios of above 20% indicate the involvement of benign or less malignant disorders.

How often should PSA levels be tested?

Many urologists will encourage their patients to have their PSA levels checked regularly (once every 3 months) instead of attempting to determine the cause of the elevated levels. In our opinion, this watchful-waiting approach is like standing before a boiling pot without trying to determine whether the pot is likely to boil over. Merely waiting may mean accepting a risk of prostatic capsular invasion and the spreading of the cancer to other organs.

PSA levels can also fluctuate, i.e. rise and fall from test to test. Here too, the most important thing for patients is to learn why their PSA levels are elevated, i.e. whether cancerous tissue changes in the prostate are the cause.

Online Survey for PSA Level Analysis

Online PSA Level Survey


In general, an attempt should be made to determine the cause of all PSA levels that are higher than 4 ng/ml. There are various possible causes of an elevated PSA level:

If you would like us to evaluate your PSA level free of charge, just fill out and return the online survey:


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