Second of three parts

Cancer of the prostate is one of the most common types of cancer among American men.

Treatment for prostate cancer works best when the disease is found early.

Prostate-Specific Antigen (PSA) is a protein produced by the cells of the prostate gland.

The PSA test measures the level of this protein in the blood. It can be detected at a low level in the blood of all adult men.

A fundamental problem with the PSA test is that, while elevated levels can indicate the presence of cancer, they can also be caused by other benign problems such as infection.

Another major problem with the PSA test is defining what is “abnormal.” Older men usually have higher PSA measurements than younger men.

Historically, a total PSA level below 4.0 nanograms per milliliter (ng/mL) was viewed as standard across all age groups.

However, because the prostate naturally enlarges as men age, doctors today generally interpret total PSA using age-specific reference ranges and by tracking how quickly PSA levels rise over time.

The typical age-specific PSA ranges are:

40 - 49 years: 0 to 2.5 ng/mL

50 - 59 years: 0 to 3.5 ng/mL

60 - 69 years: 0 to 4.5 ng/mL

70+ years: 0 to 6.5 ng/mL

A level under 4.0 ng/mL is often considered normal, but levels between 4.0 ng/mL and 10.0 ng/mL are considered a borderline range where further evaluation may be recommended.

PSA Velocity: PSA velocity is the term doctors use to describe the rate of change in the PSA. An increase of more than 0.35 to 0.75 ng/mL in a single year may prompt a urologist to investigate, even if the total number remains within the expected age range.

Free vs. Total PSA: If total PSA is elevated or borderline, doctors often test Free PSA, which is the percentage of PSA unattached to proteins. A higher percentage of free PSA generally points toward benign conditions, while a lower percentage can indicate a higher risk of prostate issues.

Non-Cancerous Causes of Elevated PSA: An elevated total PSA does not automatically mean prostate cancer is present. Common non-cancerous causes include: benign prostatic hyperplasia (BPH), a natural, non-cancerous enlargement of the prostate; prostatitis, which is inflammation or infection of the prostate, and urinary tract infections, recent catheter insertion, a bowel movement, bicycling or sexual activity within 48 hours before the blood draw.

The American Cancer Society (ACS) recommends that men make an informed decision with their healthcare providers about whether to be screened for prostate cancer using a PSA blood test. Rather than advising routine screening for everyone, ACS emphasizes first discussing the potential benefits, risks and limitations of testing.

ACS guidelines state that men who do not have symptoms and have less than a 10-year life expectancy should not be offered prostate cancer screening, because the risks of over-diagnosis and treatment side effects generally outweigh the potential benefits.

Another problem with the PSA is a false test result.

If you have an elevated PSA but no cancer, you get what is called a false positive. This type of result can lead to medical procedures such as a biopsy, anxiety, health risks and expense. Most men with an elevated PSA don’t have cancer.

When you have prostate cancer and your PSA test comes back in the normal range, you get a false negative. It’s important to understand that most prostate cancers are slow-growing; they can be around for many years before they cause symptoms.

Next week: Series concludes

Have a question? Email: fred@healthygeezer.com. Order “How To Be A Healthy Geezer,” 218-page compilation of columns: healthygeezer.com

All Rights Reserved © 2026 Fred Cicetti

The Times News, Inc. and affiliates (Lehigh Valley Press) do not endorse or recommend any medical products, processes, or services or provide medical advice. The views of the columnist and column do not necessarily state or reflect those of the Lehigh Valley Press. The article content is not intended as a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician, or other qualified health-care provider, with any questions you may have regarding a medical condition.