PSA (prostate-specific antigen) levels are measured in nanograms per milliliter (ng/mL) of blood. While PSA is a protein produced by the prostate, its levels can vary based on multiple factors, including age, prostate size, and overall health.
PSA Levels Guide
- Under 4 ng/mL – Considered normal.
- 4-10 ng/mL – Borderline, requiring further evaluation.
- Above 10 ng/mL – Considered high, increasing the risk of prostate cancer.
If your PSA tracks over 4, you enter a kind of medical no-man’s land. It’s not necessarily cancer, but it warrants further investigation. At this stage, a Free PSA test is triggered to provide more context.
Total PSA vs. Free PSA
- Total PSA includes both PSA bound to proteins and PSA freely floating in your blood.
- Free PSA measures only the unbound portion.
In this case, a higher Free PSA percentage is better because lower percentages are associated with an increased risk of prostate cancer.
Free PSA and Cancer Risk
The risk of prostate cancer increases as Free PSA decreases. The table below outlines the probability of prostate cancer for men with total PSA between 4 and 10 ng/mL and a non-suspicious DRE (Catalona et al., JAMA 1998, 279:1542):
| % Free PSA | 50-64 years | 65-75 years |
|---|---|---|
| 0.00-10.00% | 56% | 55% |
| 10.01-15.00% | 24% | 35% |
| 15.01-20.00% | 17% | 23% |
| 20.01-25.00% | 10% | 20% |
| >25.00% | 5% | 9% |
My PSA Journey
✔ Initial test: PSA 4.1, Free PSA 8% – My digital rectal exam (DRE) didn’t reveal any abnormalities. My doctor reassured me that no urologist would be in a hurry to investigate further, suggesting we test again in a month.
✔ One month later: PSA 4.3, Free PSA 8% – Stable. Maybe I’m OK?
✔ Six months later: PSA 4.9, Free PSA 8% – That’s not good. I should have followed up sooner, but I was too afraid.
At this point, I’m staring at that 8%, frequently looking up information online, trying to find reasons why I might still be on the safe side of the fence.
✔ April 2023: PSA 7.2, Free PSA 7.8% – Now I’m panicking.
“You need to see a urologist now,” my doctor said.
The Next Steps
With my PSA rising and Free PSA staying low, I had no choice but to face reality. A referral to a urologist was now inevitable. The waiting, the uncertainty, and the realization that I had avoided testing for too long weighed on me. I wasn’t ready to confront the possibility of cancer, but I also knew that early detection could be life-saving.
My Advice: Don’t Wait
If your PSA is rising and your Free PSA is low, take action now. And with cancer rates increasing in younger people, if you’re over 50 and haven’t had a PSA test in a while, go get one.