What Does A High PSA REALLY Mean?


PSA, or prostate-specific antigen, is often thought of as an immediate signal of prostate cancer—but is it really? Doctors have discovered that a high PSA level does not necessarily correlate to prostate cancer. There could be other health and lifestyle factors impacting your PSA test results.

What do PSA levels mean and what could cause an elevated level that isn’t prostate cancer?

What is PSA?

Prostate-specific antigen (PSA) is a protein produced by the prostate cells. The PSA test is used as a simple blood test to screen for prostate cancer. It’s also used to monitor men who have previously undergone prostate cancer treatment to reevaluate where they stand.

At your yearly checkup after age 50, your doctor will likely run a PSA test in your blood panel. PSA is generally reported as nanograms of PSA per milliliter of blood (ng/mL). Often, a PSA test will be performed in conjunction with a digital rectal exam (DRE) to test for potential prostate cancer.


There seems to be a link between PSA level and incidence and aggressiveness of prostate cancer. However, there are still small amounts of PSA found in the blood of healthy men, and doctors don’t yet have evidence of what a “normal” PSA looks like.

If you have “high” PSA levels, your doctor may want to do a biopsy to check for cancer. However, elevated or rising PSA doesn’t necessarily mean prostate cancer—as we’ll explore further below.

Read: Does My Husband Have Prostate Cancer?

What is considered a “high” PSA level?

The average PSA level that is a “cause of possible concern” is above 3 ng/mL. Some studies have shown that biopsy-detected prostate cancer is “not rare” in men with PSA levels over 4.0 ng/mL. For younger men, PSA levels should be much lower.

However, an elevated PSA doesn’t automatically mean you have prostate cancer. In fact, 13% of men over 55 have a PSA level of greater than 4 ng/mL without necessarily having prostate cancer.

One study wanted to better understand what a “normal” PSA looks like. Researchers followed 4,383 healthy men for 28 years. They found the 10-year absolute risk for developing prostate cancer was 11-22% for men with PSA of 4.01-10.0 ng/mL and 37-79% for those with PSA of greater than 10.0 ng/mL.

In this case, 10.0 ng/mL seems to be the significant point at which PSA could prove a higher incidence of prostate cancer.

This study insinuated that PSA level is directly correlated to prostate cancer risk, especially at a higher PSA.

But does this always hold true?

This link between PSA and prostate cancer is good to keep in mind as you follow your health. Knowing that there’s a correlation between PSA and prostate cancer risk, aggression, and mortality rates can help you catch possible cancer while it’s small and less aggressive.

More importantly than even the PSA level is the PSA velocity. Your PSA levels shouldn’t rise more than 0.5 year to year. If so, this could indicate a change in the prostate—like prostate cancer.

Does PSA cause prostate cancer?

PSA doesn’t cause prostate cancer. PSA is simply a protein made in the prostate.

However, PSA could be a result of prostate cancer. Cancer might cause the prostate to create this protein at a higher rate, leading to higher PSA levels.

But cancer is not the only thing that causes the prostate to make this protein, thus raising PSA levels. Also, cancer doesn’t necessarily boost PSA levels.

This means that PSA and prostate cancer are not causal. Although prostate cancer and PSA are linked, there could be other factors going on that we don’t yet understand.

It’s important to note the difference between correlation and causality here because an elevated PSA does not always mean prostate cancer and prostate cancer will not always result in increased prostate levels.

Your PSA test can result in a false positive or a false negative.

A “high” PSA test is a good cancer warning sign, but it is not a death sentence.

So what other factors can cause an elevated PSA and what can you do about it?

What are the reasons for an elevated PSA?

There are only three reasons for an elevated PSA: BPH, prostate infection, or cancer.

Benign prostatic hyperplasia (BPH) is one of the most common causes of an elevated PSA level. BPH is an enlarged prostate, and it’s a common concern for older men. This prostate enlargement causes the prostate to make more protein cells and raise PSA levels. There is no proven link between BPH and prostate cancer.

Learn more about BPH here.

Prostatitis, an infection in the prostate, can cause the prostate to create more PSA to help fight off the bad bacteria. Prostate infection also often leads to prostatitis, which is an inflammation of the prostate gland (similar to BPH).

Prostatitis is a common problem, especially for men under age 50. It is generally from an infection or bacteria that irritate the prostate. Symptoms include pain with urination, fever, pressure in rectum, difficulties ejaculating, and change in sexual function. Thankfully, prostatitis is usually treated with a round of antibiotics.

Read: Prostate Health Foods For Men – Add These 3 To Your Diet

And then there’s prostate cancer.

There may be other “influencers,” like trauma or medications, but these don’t typically raise the PSA enough to influence testing.

How do you know if it’s BPH, prostate infection, or cancer?

First, your doctor will try to figure out if you have BPH or a prostate infection. You can diagnose these much easier than prostate cancer. For example, you can usually tell from blood or a urine sample if there’s an infection in the system.

However, it’s not always easy to diagnose BPH. You could show up clean as a whistle with no sign of infection, and your doctor may not be able to determine if it’s BPH or cancer.

That’s when additional testing may be necessary.

Thankfully, “additional testing” isn’t as scary as it used to be. Learn more about our updated prostate cancer screening methods here.

Do I need a PSA test?


The PSA test won’t tell you why your levels are increased. Thus, a lot of men get unnecessarily worried or stressed after a “high” PSA result. A high PSA often calls for a biopsy, which can have unpleasant side effects.

To avoid this, the United States Preventative Services Task Force (USPSTF) used to recommend against testing for PSA in healthy men. (“Healthy” men are those with no known risks, symptoms, or family history of prostate cancer.)  
However, the USPSTF made a few changes to this position in 2017. The new USPSTF screening draft encourages doctors to discuss the benefits and harms of the PSA test to allow men to determine whether or not they would like to include it in their workup.

If you are above 50, I recommend a PSA test on a yearly basis. I discuss with my patients how an elevated PSA does not necessarily mean cancer and there is no need to worry. Nevertheless, it can be a useful means of potential detection in the early stages of prostate cancer.

As Benjamin Franklin said, “an ounce of prevention is worth a pound of cure.”

Testing your PSA levels is an ounce of prevention that can help stop prostate cancer in its tracks.

If you have an elevated PSA level, follow-up with a doctor but do not assume you have cancer.

When do I need a PSA test?

I recommend a PSA test for all men over age 50 at your yearly checkup. It’s a simple, minimally invasive blood test just like your other screenings.  

You should also get your PSA levels tested if you show any symptoms of prostate cancer:

However, it’s important to note that a lot of the symptoms of prostate cancer are also symptoms of BPH, urinary tract infection, or prostatitis.

If you’re showing the above symptoms, it’s time to see a doctor—but it’s not time to stress.

Did you know you can reduce your risk of prostate cancer with lifestyle changes and diet?

Bottom line

The PSA test is not 100% accurate in its ability to predict risk or aggression of prostate cancer. It can be a sign of infection or BPH, and it’s no use worrying about—yet.

Nevertheless, a PSA test is a harmless way to get an idea of where your sexual health stands. Don’t be afraid of a PSA test…and don’t be afraid of the results.

If you want support with a recent PSA result, check out our Male 90X program to learn how to handle stress and change your lifestyle for ultimate health and wellness!

It’s time to take control of your physical and mental wellbeing. Don’t wait to live— GET MALE 90X today!

 

Want more tips to optimize your health and testosterone?

Listen to the latest podcasts. Click HERE

 

Tracy Gapin, MD, FACS – Board Certified Urologist in Sarasota, Men’s Health Optimization Expert and Medical Director of Sarasota Apeiron Center for Human Potential. Founder of www.SmartMensHealth.com    

 

Does My Husband Have Prostate Cancer?


1 in 7 men will be diagnosed with Prostate Cancer in his lifetime. As a concerned partner, you worry that your husband or companion could be that one. Maybe your partner doesn’t go to the doctor enough or maybe he has a mindset of invincibility. Maybe you’ve noticed a shift in his health and behavior.

You ask him to go to the doctor, but in true husband fashion, he won’t go.

So what should you be on the lookout for to know if your husband is at risk of prostate cancer? What do you need to know about prostate cancer to be alert for your partner’s health?

What Is Prostate Cancer?

The prostate is a walnut-sized gland in the man’s pelvis. It sits between the penis and bladder, wrapped around the urethra (the urine tube). There’s one main purpose of the prostate: to make thick white fluid that mixes with sperm to create semen. The fluid is important so that the sperm can “swim” and ultimately impregnate a partner.


Prostate cancer happens when the cells in the prostate grow at an uncontrollable rate. When localized, it usually only affects the prostate and the bladder. In fact, prostate cancer wouldn’t even be that dangerous—if it stayed in the prostate. Some men have prostate cancer and never know because it remains localized to the prostate.

But for other men, prostate cancer can quickly and aggressively spread to other parts of the body. When this spreading happens, it can impact glands, organs, the bones, and the blood.

Thankfully, you can take simple steps to detect prostate cancer before it spreads.

What Are The Symptoms Of Prostate Cancer?

As a concerned partner, you’re likely trying to look for signs or symptoms that your husband is developing prostate cancer. I hate to say it, but most men with prostate cancer have no symptoms. Most of the time, you wouldn’t be able to tell by looking at him or talking to him.

Moreover, the typical symptoms of prostate cancer tend to be “personal.” The symptoms usually appear when the tumor has grown so big that it causes blockage in the bladder. So usually most of his symptoms will appear when he’s in the bathroom—and you’re often not there with him.


These symptoms include:

  • Difficulty stopping or starting urine stream
  • Pain while urinating
  • Increase in urination frequency
  • Diminished urinary stream
  • Sensation of incomplete emptying
  • Blood in urine
  • Painful ejaculation
  • Blood in semen

The most common symptom is waking up often in the middle of the night to urinate. A man (and his partner) will often reflect back and realize that he was going more often more in the middle of the night than he had in the past. If he’s constantly waking you up all night taking trips to the bathroom, send him to the doc—for both of your health!

These symptoms may not be a sign of prostate cancer, though. Often these are also related to BPH, which is prostate enlargement. BPH is less serious than prostate cancer—although a doctor can help your husband treat this naturally as well. Thus, if you know your husband is suffering from bathroom problems, it’s time for him to visit a doctor.

If the prostate cancer has spread, there may be other types of symptoms to be on the lookout for:

  • Fatigue
  • Bone pain
  • Malaise (general feeling of illness)
  • Weight loss
  • Deep pain or stiffness in hips, lower back, pelvis
  • Easy fracture of bones
  • Shortness of breath
  • Swelling of legs (tumor obstructing lymph tissue)

If symptoms of prostate cancer are inconsistent and often absent, how can you better understand if your husband is at risk for prostate cancer?

What Are The Risk Factors of Prostate Cancer?

  1. Age

The most common risk factor for prostate cancer is age. Most men who develop prostate cancer are over age 50—and more often, age 65. About 6 of 10 prostate cancer cases are diagnosed in men over age 65, with the average age around 66. In fact, the number of men over 65 affected by prostate cancer is on the rise.

  1. Family History

A man is at higher risk for prostate cancer if other men in his family have had the disease. Men with one affected relative are twice as likely to develop the disease; men with two or more affected relatives are 4x as likely to be diagnosed. The risk increases with the number of relatives affected. Moreover, the younger the family member is when diagnosed, the higher the risk his male relatives will develop prostate cancer as well. If your husband has had a brother, uncle, or father with a history of prostate cancer, he should be screened early and often.


Some researchers suggest there is also a higher risk of prostate cancer if there is a family history of other cancers as well. If your partner has a number of relatives with cancer, it could indicate a genetic mutation somewhere in the family line. Genetic mutations are a key cause of different types of cancer in the body.

Individual genetic factors may also play a role. If there is a known mutation in his genes, he should be more aware of his risk for cancer and other diseases.

  1. Race

African-American men have 60% higher incidence of prostate cancer than Caucasians. They also have a prostate cancer mortality rate that is two to three times higher than the average. The reason for this difference isn’t fully understood yet, but the proof is there. African-American men should be screened twice as often to ensure they do not develop an aggressive form of the cancer.

Asian and Hispanic men are the least likely to develop prostate cancer, likely due to their nationality (see below). Note: this doesn’t mean they’re immune from the disease!

  1. Nationality

Prostate cancer is more common in North America, Europe (northwestern especially), the Caribbean, and Australia. It’s less prevalent in Asia, Africa, and South and Central America. Researchers believe this has to do with diet and lifestyle; the “Western diet” tends to be a higher risk factor for prostate cancer, as discussed further below.

  1. Sedentary Lifestyle

If your husband tends to sit a lot with low activity, he’s at a higher risk for prostate cancer. A review of studies found a significant decrease in the risk and incident of prostate cancer in active men. This is likely because physical exercise balances hormone levels, prevents obesity, enhances immune function, and reduces oxidative stress—all of which are cancer-fighting benefits.

  1. Diet

Diets high in red meats, dairy, and fatty foods with a low intake of fruits and vegetables are linked to an increase in prostate cancer incidence and mortality. Some studies suggest that a lack of veggies in the diet can actually cause a more aggressive form of prostate cancer as well.

  1. Calcium

Although not completely proven, some researchers suggest that a high calcium intake could be a risk factor for prostate cancer. Dairy is a primary source in Western diets, while the Asian diet has no dairy—and Asians are at the lowest risk for prostate cancer.

Just some “food” for thought…

  1. Obesity

Moreover, being overweight or obese has significant effects on prostate cancer. Although studies haven’t proven that obesity causes prostate cancer, “what is clear is that obese men are at significantly greater risk for dying of prostate cancer.” Obese men have a higher prostate cancer mortality rate than healthy and fit men.

Thus, a sedentary lifestyle and poor diet can further contribute to aggressive prostate cancer. Click here to learn about the link between obesity and metabolic syndrome—which can also cause a number of diseases.

It’s important to note that some research has shown that PSA test results in obese men can appear low… even if they have prostate cancer. Often this can lead to a delay in diagnosis and treatment, in which time the cancer can spread and worsen. If your husband is overweight, it’s time to sign him up for my 4-week Transformation Vitality Course to bring back his health and reduce his risk of prostate cancer.

  1. Beer

Research in Australia found that two pints of beer daily increased a man’s risk for prostate cancer by nearly 23%. They also found that the risk of mortality increased with even low alcohol consumption levels. We need more studies to prove this, but the findings were nevertheless significant.

This is likely because beer is highly estrogenic, which can unbalance hormone levels. Moreover, alcohol can damage the cells in the body, creating a toxic overload when consumed in excess.

  1. Smoking

Although smoking isn’t linked to prostate cancer (yet), studies show that smoking is associated with more aggressive forms of prostate cancer. Plus, the chemicals in cigarettes are highly toxic and can damage your cells—which can ultimately cause a variety of cancers and diseases.

  1. Height

There may be some link between taller height and prostate cancer incidence. But just because your husband is tall doesn’t mean he has prostate cancer.

  1. Agent Orange

Agent Orange was an herbicide sprayed during the Vietnam War. Research is inconclusive about whether Agent Orange is fully cancer-causing, but ultimately studies have found that AO exposure is linked to more aggressive prostate cancer.

Okay. So you think your husband may be at risk because he’s overweight and his brother and dad both had prostate cancer.

What’s next?

What can you do as his partner?

How Can You Talk To Your Partner About Prostate Cancer Risk?

There’s really only one thing you can do: equip your husband with the knowledge you now know about risk factors. Hopefully, this can help convince him to see the doctor.

You can start by telling him some of these prostate cancer statistics:

That’s the scare tactic.

But what if now he’s too scared to go to the doctor and “face the facts.” It’s not uncommon for men to avoid going to the doctor if they think something is wrong, because they don’t want to deal with the negative consequences of it.

Your husband doesn’t want to hear he has cancer.

So you could also try the encouraging tactic:

  • Between 2007 and 2013, the average survival rate of prostate cancer was 98.6%.
  • Even though there’s a 12.9% probability of developing prostate cancer, there’s only a 2.5% chance of dying from it.

Maybe he’s more willing to go now. He won’t die! But he’s still a little fearful of the tests. (“You know I don’t like needles, honey!”)

The preliminary tests for prostate cancer are easy peasy.

First, the doctor will start with a digital rectal exam. Yes, the doc will put a lubricated finger in your husband’s rectum to feel for the prostate. Your husband may not love the idea of this, but it lasts only a few seconds and it’s a great indicator of any lumps or hard areas in the prostate.

The doctor may also run a PSA (prostate specific antigen blood) test. This measures the blood level of the protein produced by the prostate gland. If elevated, it can indicate prostate cancer. However, some people with prostate cancer come back with low PSA levels in some cases.

It’s important to track PSA over time. Consistent tests can track how fast the level is increasing or changing. The change in PSA is often more important than the number.

Yearly visits are crucial to keep an eye on these changing PSA levels. Doctors recommend testing once or twice per year after age 50. If your husband hasn’t been tested, now’s the time to get him to the doctor.

If the doctor suspects prostate cancer based on the rectal exam and PSA test, he’ll take a biopsy. This is a sample of prostate tissue to see what the prostate cancer cells look like.

How Can You Prevent Prostate Cancer?

You can prevent prostate cancer before it strikes. Check out some of my other resources about prostate cancer prevention to learn more:

Can We Reduce Prostate Cancer Risk Through Lifestyle Change?

Prostate Healthy Foods For Men: Add These 3 To Your Diet

Can You Prevent Prostate Cancer Through Diet?

The Bottom Line

You’re a caring partner, concerned for the wellbeing of your loved one. But it’s important that you not stress yourself out worrying. Most men don’t die from the disease, and the survival rate is one of the highest of all cancers.

But it’s important to catch prostate cancer early before it spreads or becomes more aggressive. That’s why it’s crucial that you and your partner know the risk factors of prostate cancer and the cadence at which you should be visiting the doctor.

Want to help your husband regain his health (without harassing him too much)?

Sign him up for our Male 90X program!

This is a genetic-based report and consultation that will give him the tips, tricks, and resources to lower his risk for prostate cancer and minimize any other sexual health concerns. He’ll also learn how to make a few lifestyle changes that will drastically impact his entire wellbeing.

Reduce the risk, make the change and get Male 90X now!