What is a normal vs abnormal PSA test score?

Overview by Mr Ahmed Ali
Consultant Urological Surgeon
Frimley Health NHS Foundation Trust

What is a normal vs abnormal PSA test score? – understanding a PSA test result

Urologists will take into account both  your age and the size of your prostate, if known, when trying to interpret what a PSA score means. Roughly speaking the following is the rule of thumb:

• For men in their 40s and 50s: A PSA score greater than 2.5 ng/ml is considered abnormal. The median PSA for this age range is 0.6 to 0.7 ng/ml.
• For men in their 60s: A PSA score greater than 4.0 ng/ml is considered abnormal. The normal range is between 1.0 and 1.5 ng/ml.

However, as stated in Simon Bott’s previous page, PSA tests are notoriously unreliable as they can suggest prostate cancer when no cancer exists (a false-positive result).  Alternatively, around 1 in 7 those with prostate cancer have normal PSA levels (a false-negative result), so many cases will be missed. Finally, the PSA test can find aggressive prostate cancer that needs treatment, but it can also find slow-growing cancer that may never cause symptoms or shorten life.

Nevertheless, with an abnormal PSA, a referral to a Urologist, whether privately or via the NHS should result in a patient being put on the diagnostics pathway.

However some NHS authorities are instructing GPS not to refer patients unless they have scores higher than above. if this is the case you need to insist. It is your right.

Finally, if your GP does not wish to give you a PSA blood test as you do not fit his criteria, the Graham Fulford Foundation will organise a test for you.

There are  further refinements of PSA tests that can be more indicitive of prostate cancer that needs to be treated. They are:

• Free versus total PSA. The amount of PSA in the blood that is “free” (not bound to other proteins) divided by the total amount of PSA, (free plus bound) is denoted as the proportion of free PSA. Some evidence exists that a lower proportion of free PSA may be associated with aggressive cancer.
• PSA density. The blood level of PSA divided by the volume of the prostate gland, which can be measured bu ultrasound or MRI. Once again there is some evidence that this measure may be more accurate at detecting  cancer than the standard PSA test. This is certainly the case when combined with mpMRI which is used to detect cancer lesions and prostate volume (See section on Diagnosis of prostate cancer).