Elevated PSA

Prostate specific antigen (PSA) is a naturally occurring protein, which is produced by the prostate gland and secreted in the ejaculate.  The function of PSA as a protein is to liquefy semen so that the sperms can be “released” and swim toward the egg allowing fertilisation.

Normally only low levels of PSA enter the blood stream. However if the prostate gland is diseased in any way, disrupting the normal structure of the tissue, large amounts of PSA can leak into the circulation and cause raised PSA levels in the blood.

Causes of elevated PSA

Prostate cancer

The higher the PSA the higher the risk of prostate cancer:

PSA level (µg/L)

Risk of prostate cancer

4.0 to 10


10 to 20


More than 20


Non-cancerous causes

PSA can also be elevated from non-cancerous causes e.g.:

  • Benign prostatic hyperplasia (BPH) - enlargement of the prostate that happens to all men. The bigger the prostate the higher the PSA level.

  • Urinary tract infection or prostatitis.

  • After intercourse – PSA can be slightly elevated in some men for 2-3 days after sex.

  • Strenuous physical activity such as bike riding may elevate PSA for a few days.

  • Extended bed rest can alter PSA levels.

  • Insertion of a catheter or cystoscopy procedure can cause a transient PSA elevation.

Age-related PSA Levels

It is important to remember that the PSA level increases as the prostate grows. As all men get older, so the prostate grows and subsequently the PSA increases. This is a perfectly normal occurrence and there are guides to appropriate levels of PSA according to your age:

AGE (years)

PSA Level (ng/ml)


< 2.5


< 3.5


< 4.5


< 6.5

≥ 80

< 9.0

It is important to note that prostate cancer can occur even if the PSA is in the normal range. Whilst this is not a common occurrence it is the reason a DRE (digital rectal examination) is recommended as well as the PSA to be performed annually in men.

If you have been found to have an elevated PSA your GP will take a history and perform a digital rectal examination to feel you prostate gland. Additional tests should be conducted such as a urine test to exclude a urinary tract infection and a repeat PSA test to confirm the level is elevated.

Referral to a urologist for further investigation is indicated if you have a persistently elevated PSA level and/or an abnormal feeling prostate on digital examination.

The urologist may recommend a prostate biopsy and / or a MRI of your prostate. He will discuss this with you at the time of consultation.

More information on PSA testing is available for download from the Andrology Australia website.  Visit Andrology Australia - Download "PSA test" Factsheet.