What are the reasons cause false PSA high levels and false low PSA results, which means you have no cancer in your prostate at all and your PSA level was relatively incorrect, come to know and tell your doctor you’re a cancer Free.
A matter of concern for whom deal with prostate cancer testing with PSA blood test as an early cancer marker, you must be aware of things can alter your PSA interpretation, however the professional lab tech must ask you about them before taking a blood sample for prostate specific antigen test.
If you don’t understand the PSA just read> what is the PSA blood test meaning?
What do cause False positive PSA results?
PSA false results mean that’s unlikely you have a prostate cancer and may come from:

• Lab errors: wrong sample, improper handling, storage, inadequate sample as wells as the invalid QC values. To avoid that just take your test in a qualified laboratory.
• Advanced age: cause high normal PSA levels, increasing levels over the time may be interpreted as cancer.
• Prostate biopsy or resection: Prostate biopsy “can lead to a dramatic increase of PSA in serum and keep the PSA value high in one week.” After biopsy, it takes a month or more for PSA to return to baseline. Do PSA test before surgery or must wait for six weeks after surgery to avoid false PSA elevations.
• Indwelling Catheter cause high elevation in PSA results, so that PSA is not useful blood test for prostate cancer when a man has a catheter.
• Injury to pelvic region or prostate
• Prostatitis cause mild elevation but with no clinical significance until it gets worth.
• Riding a bicycle: Physical activities such as riding bicycle, exercise biking, spinning, etc., can cause temporary increase PSA level.
• Sexual intercourse within 24 hours: After ejaculation must wait 24- 48 hours to do the PSA test, ejaculation can produce temporary elevation.
• Testing PSA after prostatic massage for DRE cause false increase in PSA level.
• Drugs of prostatic enlargement: Drugs known as 5-alpha reductase blockers (finasteride or dutasteride), which can be used to treat an enlarged prostate, will lower PSA levels.
• Supplements that effect testosterone: cause high PSA and inverse effect on testosterone results which impacts on seminogram and shows low sperm counts.
• Urinary tract infection cause mild PSA elevation.
• Ultrasensitive PSA blood test (USPSA test) has high sensitivity to detect trace PSA for prediction of the persistence or return of cancer, but can produce false positive PSA results as well.

Don’t miss interpretation of high PSA at: What does elevated PSA mean?
Understanding False Low PSA Results
In general, a low PSA is a good result. However, there are several reasons a PSA test level may be artificially low including:

• Taking statins to lower cholesterol, anti-inflammatory drugs and obesity: that’s because body fat decreases the amount of PSA circulating in the blood stream.
• Over doses of some chemotherapeutic drugs, for instance; cyclophosphamide and methotrexate, can cause false PSA increase or false PSA levels decrease.

What to do when your results show false PSA results?

• Don’t forget to mention what drugs and supplements do you have to your doctor.
• Repeat strange PSA results on another trustful lab.
• When follow up multiple PSA testing, it’s preferred to do blood work with one laboratory, because minimum increase in PSA values can be a clinically significant.
• PSA is a screening test useful as early tumor marker but confirmation is done through DRE and Biopsy.

Other blood tests for cancer detection can help make decision:

1. Free PSA/total PSA ratio: the high values are correlated with prostate cancers.
2. The percentage of [-2] proPSA test: is relative to the total PSA level as free PSA is used.
3. PCA3 test in urine: increasing are produced by 95% of prostate cancer cells,
4. Urine test for TMPRSS2-ERG gene fusion: over expressed in 50% of prostate cancers.
5. Biopsy from prostate is the best indicator to confirm prostate cancer is present or not, as the most tests used to decide if the biopsy is needed or not.

In this topic you understand the appropriate interpretation for your blood test results.
PSA Chart by age:
PSA Levels are explained well in other topics but here are fast notes on PSA Chart by age and in general.
General PSA level guidelines
• 0 to 2.5 ng/mL is considered safe
• 2.6 to 4 ng/mL is safe in most men but talk with your doctor about other risk factors
• 4.0 to 10.0 ng/mL is suspicious and suggest the possibility of prostate cancer
• 10.0 ng/mL and above is dangerous and should be discussed with your doctor immediately
Age-specific PSA ranges
These reference ranges refer to using different PSA levels to help the physician make a recommendation for a biopsy. The age ranges are as follows:
• 40-49: 2.5
• 50-59: 3.5
• 60-69: 4.5
• 70 and up: 6.5
Understand what’s is the level should PSA be at: What is the normal PSA levels?
Recommendations:
Some people say caffeine affects PSA and others ask if physical activities which rubbing prostate elevates PSA. Recent studies showed that there is no connection has been found to caffeine and tests of strenuous bike riding (13 hours on a mountain bike) showed no PSA rise at all. Although a person has to mention to his doctor all his suspicious matters before doing tests, if doctor and lab tech. say it’s OK, then It’s Ok.
Another thing to know is that PSA test has a normal standard deviation and that may show some slight changes in your results from time to time and from lab to lab. So that slight increase over time should be handled carefully and not to get interpretation but from a special lab consultant or from your specialist doctor.
Do my PSA results mean I have a cancer?

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I have got PSA lab results, what Does PSA Results Mean, what is a normal PSA reading?, what should psa level be?
Does a regular blood test PSA mean a Prostate cancer?
PSA is the specific prostate agent used as an early cancer marker in the prostate gland, not for direct diagnosis but for better prognosis and instead of hurrying up to taking biopsy, PSA is done with no surgery, only a blood sample from your arm.
Normal PSA results have explained.
Elevated PSA means:
An enlarged prostate can be a result of prostatitis, advancing age, or Prostate cancer.
Studies have shown that about 75% of men with an elevated PSA do not have prostate cancer.
High PSA results explained here.

Interpretation of PSA Results Chart for men age 40-49

Low Total PSA with Low Free PSA
Means that total PSA reading is between 0.0 – 3.5 and the Free PSA percentage is below 10% of the total.
A case results: Total PSA level of 2.5, free PSA reading of 0.12, Free PSA percent is 5%
Interpretation: if no pain and no symptoms, then your prostate is good and nothing to worry about., the low results in both test can show if you’re on a treatment course.
Cancer recurrence due to biochemical reason is when PSA levels rise to a certain threshold after prostate cancer treatment, it means that some cancer cells have survived and are producing complexed PSA. Recommended for further tests and exams to confirm recurrence.
Don’t prompt a biopsy.
Real Cases reported their results is under 4.0 and diagnosed as BPH or Cancer, read carefully to understand What Does PSA Results Mean?
1. Male 70 diagnosed for BPH
My total PSA has been around 1.9- 2.5 for several years
PSA % Free= 28%
PSA Free: 0.39 (ng/ml)
Gleason 6
Onotype DX test and it came back at a good and low 15.
2. 58 years old, and my blood test revealed the following:
Total PSA = 0.76 ng/ml
Free PSA = 0.42 ng/ml
Free/Total Ratio = 0.55
Results suggest BPH, Free-Total PSA ratio > 25%.
3. I am 72 years old, diagnosed with adenocarcinoma in one lobe of the prostate, size of the tumor is 1.3mm, Gleason score of 6, enlarged prostate make frequent urine flow, my PSA done and the total PSA is 2.55 with free PSA at 1.30 and a percentage of free PSA at 49.9%.
My testosterone Lab result is 0.20, I am on the Lucrin hormone therapy, I have a biopsy scheduled in 2 weeks.
Normal Total PSA with Normal Free PSA
Means that total PSA level is between 4.0 and 9.0, Free PSA Percentage is about 10% of the total PSA value. Some textbooks may label the results in this PSA range as “grey zone” or “watchful period”.
And as the free PSA is in the normal percentage, if there is increase in levels might be due to increased complexed PSA which is from inflammation by bacterial infection, from the advanced age, other non-pathological reasons as explained in “False positive” section.
Finger exam to the lower rectum spot is normal and no pain
Require repeating the PSA blood test for 2 weeks or so, to watch the PSA results are going to be higher or reduced or still around the first result.
Doesn’t prompt a biopsy until the repeated results become higher.
A case have Normal results of both PSA forms:
Total PSA of 5.1, and a free PSA of 0.49, and a Percent Free PSA of 10%
Interpretation: the PSA result is on its way to increase, need watching repeated results and DRE to confirm, the mild prostatitis or physiological reasons are more suspected unless the PSA start to be higher and higher with time.
Borderline Total PSA and High Free PSA
When free unbound PSA is high it means the prostate abnormally produce large amounts of PSA, and the increase in the total amount of prostate specific antigen is due to the increase in free PSA level, thus the clinical reasons are:
Benign prostate hyperplasia: a common non-neoplastic hormone induced hyperplasia, prostate massage during DRE test can support the prognosis of BPH, which is soft or hard enlargement, etc.

1. When PSA total reading show slight increasing over 10 and free PSA value is over 25% the BPH is more suspected especially for those men over 70 years old,
   Rare before age of 40
   75% among men aged from 70 – 80 years.
   Over 80% of men 80 years.
   Benign tumor found in central and periurethra zones, morphological characteristics after DRE are nodular hyperplasia, firm, smooth median grove. Note that the nodular hyperplasia is not a precursor to carcinoma. BPH can cause stones and promote infections but not cancers
   Acid phosphate test shows normal results.
   Making a biopsy is unnecessary.
   BPH is clinically suspected if free PSA is higher than 25% with the specific sign and symptoms whether the PSA total is in the grey zone or above 10.
2. When Total PSA result is slightly greater than 10.0 with less than 25% free PSA, then there is inflammation due to UTI or STI. Remember that physiological reasons shouldn’t show PSA over 10.

Real Patients have PSA results as have explained:

1. A man 55 years old, Total PSA is 3.532ng/ml, low
   Free PSA is 0.918 ng/ml, higher than 10% of total.
   PSA ratio is 0.26, while the PSA is still under 4.0 the BPH is suspected due to high ratio, recommended for DRE and Ultrasound imaging to confirm.
2. PSA 9,1 and PSA free 3,6 ng/ml, PSA ratio is 0.39. Interpretation: BPH or bacterial prostatitis are suggested as the free PSA and its percentage go high with borderline total value.
3. I am a 63 years old man.
   Total PSA: 5.4 ng/ml and Free PSA:1.13 ng/ml. ratio is 0,20, U/S prostate followed by Trus Guided Prostate Biopsy were performed within two weeks from PSA test. U/S showed enlarged Prostate gland measurement 6.1×3.4×4.1 cm (TDxAPxCC). There was mainly hypertrophy of the central zone, suggesting benign prostatic hyperplasia. No focal lesion is seen in the peripheral zone. The contour of the prostate gland appears smooth.
   I am 57 years old. I have a TPSA of 4.18, FPSA of 14.0. Interpretation: the PSA result must be repeated because it is doutable. Total PSA must be higher in all values than Free values as the free value is a part of the total.

Borderline Total PSA with Normal Free PSA
Men with a total PSA in the same range and a free PSA below 10% need to have a biopsy. More likely than not, they have prostate cancer
Prostatitis is more suspected because the free PSA which comes from benign cells are normal or below 10% of the total level. However, the BPH/cancer is still not excluded. DRE may come with a clue.
Further causes:
Inflammation, Edema, rectal pain, urinary obstruction.
Acute suppurative prostatitis due to E-coli or rarely due to Staph or N. gonorrhoeae.
Chronic non-specific prostatitis.
Granulomatous prostatitis due to BPH, infarction, post TURRP (transurethral resection of prostate which is the removal of prostate by resectoscope), idiopathic, TB, or Allergic (eosinophilic).
High Total PSA High Free PSA
What Does PSA Results Mean when Both are high?
The higher levels of total PSA correspond to an increased risk of prostate cancer, however high Free PSA than 25 % with heigh PSA over 25 is a clue for BPH.
While high PSA total over 25 with free percentage below 25% is a clue for prostate cancer.
A previous discussion about what PSA level considers a prostate cancer?
High Total PSA and Low or normal Free PSA
Higher total PSA in levels around 100 with free PSA under 10%, is a very strong prostate cancer marker, may be at advanced stage.
Adenocarcinoma is the most common cancer in elderly males, rare before 50, 70% seen after 70, second common cause of death due to cancer in males (the first is lung cancer), caused by unknown etiologies, hormones, genes and environment most likely, prostate Adenocarcinoma is not BPH.
PSA blood test for Occult cancers: Adenocarcinoma may consist of small cancers (incidental ca) and still in situ or latent for long period and thus no blood test or exam can early detect such small cancers which called in medical terms “clinically insignificant”.
DRE exam show hard, gritty, fixed tumor, loss of fixed grove.
Biopsy by TURP: pathologist report can reveal if there is malignancy or not and nodular or not, PSA test can’t determine malignancy or nodularity alone, but PSA score (Gleason score or grading) can categorize prostate neoplasms differentiation (well or poorly differentiated).
Real Case Follow up show PSA results as explained:
A man of 67 yrs old
T-PSA Result is 73.90, high
F-PSA Result is 5.9
Free PSA Percentage is 7% of the total count.
Now it’s clear What Does PSA Results Mean?
Low Total PSA High Free PSA
Means PSA total count is around 4.0 and free PSA ratio is higher than 0.1 (10%).
BPH is the common reason in such levels, DRE is to confirm.
Recommendation:

• Not to worry about expecting cancer from the first PSA test results as it can be tricky.
• It’s correct to repeat abnormal lab results to be reassured.

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If you want to be a prostate cancer survival, just learn the meaning of elevated PSA levels and how to deal with them carefully to lower the time of waiting and monitoring the cancer, get your prostate to a workable level and safe your life.
PSA is just a blood test that shows that a specific agent is present in your blood, PSA is one of the best early tumor marker till now, it comes up with accurate results. see more blood tests for cancer
By reading the next paragraphs you must be able to recognize What is elevated PSA levels? and What does it mean? How to differentiate between elevated PSA by Prostatitis and High PSA by BPH or Adenocarcinoma.

High Elevated PSA Levels Chart

1. The meaning of borderline PSA results:

Moderate risk for cancer can be shown at any PSA level over 4, that’s why PSA never be made as a diagnostic test for prostate cancer, but to identify men in whom a prostate biopsy would be appropriate.
The PSA values over 10 is a moderate cancer marker and moderate indicator of prostatitis, benign prostatic hyperplasia, or hepatitis A, the presence of an indwelling catheter can come with slightly elevated PSA results too. So that elevated PSA can be in many prostate diseases. Usually prostate enlarged when PSA is highly elevated, but borderline PSA and Slightly increased PSA show a normal sized prostate, diagnosis is confirmed only after biopsy report (Benign or Malignant).
Level of PSA means the chances of prostate cancer
When prostate feels normal on examination of a man rectum and PSA result is lower than 4.0, there’s a 15% chance of having prostate cancer. While men got a PSA between four and 10 there’s a 25% chance of having prostate cancer and if PSA result is higher than 10, the risk increases up to 70%, and so on.
What is meaning of elevated PSA levels and no cancer?
Rigorous activities such as riding bicycles can result in grey PSA counts 4, 5, etc. or slightly high PSA results such as 10.5, 11, or 12. After examination of rectum the PSA levels show a bit higher than normal, after catheter in men PSA come up with increased counts, after prostate surgery it’s common to see elevated levels for a period.
2. The meaning of moderate elevated PSA
Does high PSA test results means cancer or not?
In other queries, what is a high PSA level for prostate cancer?, does a high PSA always mean cancer?
Studies told us that elevated PSA does always mean a prostate malignancy and here is:
A PSA levels chart against Free PSA percentages:
High PSA total and high PSA free mean either abnormally produced (complexed PSA) or the normally produced Free PSA. But the facts tell us the free PSA is the benign form produced by the prostate gland cells and exists in the blood circulation in a very low amount, thus the increase in both free and total may be due to cancer or another abnormality in production excretion functions as in BPH.
High PSA total and normal PSA free mean the increase in total PSA is from increased complexed PSA. Very likely to predict prostate cancer.
Low PSA total and low Free PSA together mean; you are on treatment from a cancer or have a cancer which preventing the production function of prostate cells.
Borderline PSA total and borderline PSA free, mean a suspicion of cancer at early stage or just an inflammation can go away with a course of medication.
What does it mean when PSA level 12 or 14? is it high?
As PSA level 10 is the baseline of PSA blood test results, any value over 10 is considered suspicious and need another confirmation by a blood test named “Free PSA”, then DRE, then the doctor has to decide whether to wait and watch the PSA levels until it back to normal range or decide to take a prostate biopsy.
If the results show a higher free PSA percentage means that the PSA elevation is due to benign tumor of prostate gland not a cancer.
Similarly, with PSA 16 it’s a marker of prostatitis than a marker of cancer unless the values increases steadily and the Free PSA is reduced.
Total PSA is 25, is it a cancer in my prostate?
As all studies said, PSA level 25 means a strong cancer marker but no further decisions until the biopsy confirm that. Note that, free PSA test at such levels of total PSA will not be as useful as the biopsy process.

       3. The meaning of Very highly Elevated PSA

PSA 1000, is it possible, does it mean the man’s death?
First you have to confirm the lab result when it is above the normal limits.
PSA levels 100+. Often show when Patients have advanced or metastatic prostate cancer.
Very high PSA level usually mean strong indicator of multinodular prostate cancer and removal after biopsy.
What is the PSA level to remove prostate?
Prostate cancer removal depends on the pathological report of a biopsy taken from your prostate gland to decide the extension, shape, volume, and properties of the suspected cancerous cells, PSA are only used to monitor the progress of suspicious cells, then decide a biopsy procedure. However, highly elevated PSA total with low free PSA levels is a strong prostate cancer marker and a result required fast medical decision.
Elevated High PSA after prostatectomy?
A careful handling of PSA values after prostate removal is must,
after prostatectomy you must wait for about six weeks to take a blood PSA test, because PSA levels are commonly show elevated after surgery, but it’s a false PSA result, however repeating the test after some weeks can declare if it’s just false or it may a cause of incomplete surgery or dangerous remnants of cancer cell.
Now I think you understanding what does a high PSA test mean?
Don’t miss, What should my PSA level be in my previous interpretation about Normal PSA Levels
 

We are talking about what is considered from normal PSA levels and what is considered abnormal PSA test results.
What should a man’s PSA be?
Remember that PSA is a blood test for cancer of prostate, and the most specific early tumor marker for prostate, PSA results is accurate 99.99%.
What is the safe acceptable PSA range?
Prostate gland cells produce prostate specific antigen for liquefying the human semen, all PSA amount is excreted into seminal fluid except very small amount which escape to the blood stream, normally PSA found in the blood with a steady low level, the Normal PSA physiologically is to show PSA results less than 4.0, the less is better, and this means healthy production and healthy excretion of Prostate specific antigen by the prostate gland.
What is Normal PSA levels and normal range?
Normal range for PSA results in young men is 4 – 10, in elder men is slightly higher.
In order to know the correct interpretation of PSA blood test results, you must know the values caused by a cancer and the values caused by other reasons.
There is agreement on the normal PSA levels of men as follows:
Normal PSA level is from 4.0 – 10.0 ng/ml, sometimes called “the grey zone”.
Is an indicator of prostate cancer (25% chance, according to the ACS), or other benign condition in the elderly such as benign prostate hyperplasia (BPH), or just inflammation of the prostate.
Free PSA blood test is required for confirmation whether it’s a cancer or not.

What should my free PSA level be?

Free PSA is the form of prostate specific antigen that is produced by benign cells of prostate gland, finding 10% of total PSA as Free is acceptable for healthy men. The lower the riskier.
Benign prostate tumors normally show Free PSA percentage higher than 10%.
Carcinogen cells reducing free PSA percentage to less than 10% and raise the values of total PSA due to the increasing of complexed PSA by cancer cells, from PSA blood test explained
Low PSA level, what does it mean?
The normal PSA level is 0 but it can rise to up 4 with infection or other minor issues.
A PSA of 0.6 is good and would not normally need further blood tests.
PSA 1.0 is lower than men limit of PSA but is still not a cancer marker.
If you have prostate cancer already and have had treatment, then 0.5, 1.0, or 2.0 is still nothing serious to worry about.
The same is applied for PSA 2.0 or 3.0: means you’re a cancer free or have your treatment course succeeded and lowered the PSA percentage.
A problem with prostate production of prostate specific antigen can lead to very low PSA level.
Diminished free PSA with normal PSA total is not fully understood.

Normal PSA levels chart by numbers and age

Here is simple explanation of normal values of prostate specific antigen, according to many studies on men with cancers and other men without a cancer. Show list of: blood test for cancer?
PSA level 4, what does it mean?
PSA 4 is a cutoff value for men, and the lower limit of normal PSA levels, usually means nothing.
PSA level 4 is either normal or abnormal level and it could mean many things, including:
You’re a normal, and your PSA level is acceptable, nothing to worry about.
Men who have their prostate gland feels normal on digital examination and their PSA level 4, they are likely to have prostate cancer with a percentage less than 15% and non-cancerous causes with a percentage of more than 85%
You are on cancer treatment which lowering your PSA results.
You have a mild infection to your prostate gland, a course of antibiotics is recommended to exclude UTI causes.
PSA level 5, what does it mean?
Men who have a prostate gland that feels normal after digital rectal examination and a PSA from four to ten have a 25% chance of having prostate cancer. And more than 75% chances of another non-cancerous causes.
Is a PSA level of 5 high?
Firstly, testing procedure is preferred to done at one laboratory at each time, as the normal value may vary among different assays.
Secondly, to evaluate the meaning of PSA count 5, we must look to the age of the man, if older than 40 then level 5 may be normal for such age
But values above 4.0 are considered suspicious PSA count as the normal PSA values does not exclude cancer.
A watchful period starts, and you are recommended to do PSA blood testing periodically to ensure that the results stay at this low level or increasing.
Now you know that is PSA 5 is form the normal PSA levels and not a high PSA level, and you have not to be concerned about getting cancer, especially when you under age 40 and has no cancer history in your family.
If Yes, then confirm the test results by repeating the PSA test many time over 3 months, then free PSA test to confirm the increasing numbers of total PSA test, if ALL that say Yes, then a biopsy sent to a pathologist is must.
What is the meaning of PSA level 6?
The PSA level 6 is a grey zone number, however the men over 50 may show PSA 6 as their normal value due to their advanced age.
PSA 6 has many other possibilities:
Infection to prostate gland, as the PSA still under level 10.
PSA 6 after repetition of the blood test mean physiological causes and not a cancer marker.
Bacterial infection which begins in the urinary system can cause slightly elevated PSA results, a urine test and DRE is recommended.
PSA level 7 and PSA level 8 meaning:
PSA levels over 6 and under 10 including the PSA 9.0 is very tricky results, need to be handled carefully, a clever doctor must order both free PSA test and PSA test, the laboratory report come with a calculated FREE PSA/total PSA ratio, a ratio which used as a strong marker for prostate cancer and help to decide if biopsy is needed or not?
However benign prostate hyperplasia (BPH) in elders may show PSA level of 7 or 9 as well in early stage.
Non-pathological causes show raised PSA levels as after sexual ejaculation which normally increase the chance of PSA entering blood circulation.
After DRE also a sensitization is made on the gland to excrete semen, which not a marker of a disease and can be mistaken.
Catheter installation or removal can cause slightly raised serum prostate specific antigen and thus a false result.
Conclusion:
Normal PSA levels are values that must be taken carefully, interpretation of normal ranges must be with the correlation of other confirmatory tests and exams. however annual checkup is recommended.
Low PSA level below 4.0 ng/ml does not indicate the presence of prostate cancer or not.
High PSA levels over 10.0 ng/ml is an indicator of the presence of prostate cancer with 50% chance according to ACS.
A PSA level of 10-14 may be due to an inflamed prostate and not a cancer marker unless the biopsy results show other than that.
The explanations in this article written for ordinary people who need help to understand their blood test results, while they are on their way for diagnosis or treatment by a specialist, not for medical student.
Next is: What does borderline PSA levels mean?
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