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What Does PSA Results Mean? Ask for explanation

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.What Does PSA Results Mean?

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.


  • 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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