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The lab has given you one line: Total PSA \u2014 4.8 ng\/mL<\/strong>. Underneath it, in small print, „reference range: up to 4.0“. The number is above the limit. Nothing else has been explained to you.<\/p>\n\n\n\n If you went online from there, you have already read the word everyone is afraid to say out loud.<\/p>\n\n\n\n (The figure 4.8 is illustrative \u2014 chosen precisely because it is one of those numbers that say nothing on their own and therefore frighten the most. It could be 4.2. It could be 6.1. The logic below is the same.)<\/em><\/p>\n\n\n\n This article is about what a raised PSA actually means \u2014 and why, in most cases, it does not mean the thing that frightened you.<\/p>\n\n\n\n This is the first thing that needs saying plainly.<\/p>\n\n\n\n Prostate-specific antigen is a protein produced by prostate cells \u2014 by the healthy ones too, not only the diseased. Its job is to liquefy seminal fluid. Small amounts reach the bloodstream, and that is exactly what the test measures.<\/p>\n\n\n\n A raised PSA means one thing: the prostate is producing more than usual, or letting more through into the blood.<\/strong> The reasons for that are many, and cancer is only one of them \u2014 and not the most common.<\/p>\n\n\n\n The test does not distinguish between causes. It only counts.<\/p>\n\n\n\n The number 4.0 looks like a boundary between health and disease. It is not. It was chosen in clinical studies in the 1980s as a practical compromise \u2014 low enough to catch disease, high enough not to send everyone to biopsy.<\/p>\n\n\n\n In 2004, an American study showed something that changed the understanding: among nearly 3,000 men with a PSA below<\/strong> 4.0 who were biopsied with no other indication, cancer was found in 15.2%<\/strong> of cases. Roughly one in seven of those were aggressive forms.<\/p>\n\n\n\n The reverse is equally true. Most men with a PSA between 4 and 10 do not<\/strong> have cancer.<\/p>\n\n\n\n The conclusion is not that the test is useless. The conclusion is that there is no safe value, and no value that by itself makes a diagnosis.<\/strong> The number is the entrance to a conversation, not the answer.<\/p>\n\n\n\n
\n\n\n\nPSA is not a cancer test<\/h2>\n\n\n\n
\n\n\n\nThe 4.0 threshold is a convention, not a law of nature<\/h2>\n\n\n\n
\n\n\n\nWhat else raises PSA<\/h2>\n\n\n\n
Cause<\/th> What it does<\/th><\/tr><\/thead> Age<\/strong><\/td> Normal values rise naturally. What is high at 50 may be ordinary at 70.<\/td><\/tr> Prostate size<\/strong><\/td> Benign enlargement (adenoma) is the single most common cause of a raised PSA. More tissue \u2014 more protein.<\/td><\/tr> Inflammation or infection<\/strong><\/td> Prostatitis can raise the value several times over. Sometimes to numbers that look dramatic.<\/td><\/tr> Ejaculation<\/strong><\/td> Within 48 hours before the test it can add around 0.4.<\/td><\/tr> Cycling<\/strong><\/td> Prolonged riding before the test \u2014 a possible, though small, effect.<\/td><\/tr> Procedures<\/strong><\/td> Catheterisation and cystoscopy raise PSA, and biopsy raises it considerably. After a biopsy, several weeks of waiting are needed.<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n