What is a normal Prostate-Specific Antigen (PSA) level?

Normal PSA Levels by Age and Ethnicity

Normal PSA levels vary by age and ethnicity, with age-specific reference ranges being 0-2.0 ng/mL for Asian-Americans and African-Americans aged 40-49, and 0-2.5 ng/mL for Whites in the same age group, with progressive increases in normal ranges for older age groups. 1

Age-Specific Normal PSA Ranges

Age-specific reference ranges for serum PSA vary by ethnicity:

• 40-49 years:

  • Asian-Americans: 0-2.0 ng/mL
  • African-Americans: 0-2.0 ng/mL
  • Whites: 0-2.5 ng/mL 1

• 50-59 years:

  • Asian-Americans: 0-3.0 ng/mL
  • African-Americans: 0-4.0 ng/mL
  • Whites: 0-3.5 ng/mL 1

• 60-69 years:

  • Asian-Americans: 0-4.0 ng/mL
  • African-Americans: 0-4.5 ng/mL
  • Whites: 0-4.5 ng/mL 1

• 70-79 years:

  • Asian-Americans: 0-5.0 ng/mL
  • African-Americans: 0-5.5 ng/mL
  • Whites: 0-6.5 ng/mL 1

Median PSA Values by Age

For context, median PSA values in cancer-free men are:

• 40s: 0.7 ng/mL
• 50s: 0.9 ng/mL
• 60s: 1.2 ng/mL
• 70s: 1.5 ng/mL 1

Cancer Risk at Different PSA Levels

Even at PSA levels considered "normal," there is a continuum of prostate cancer risk:

• PSA 0-0.5 ng/mL: 6.6% risk of prostate cancer, with 12.5% of these being high-grade 1
• PSA 0.6-1.0 ng/mL: 10.1% risk of prostate cancer, with 10.0% of these being high-grade 1
• PSA 1.1-2.0 ng/mL: 17.0% risk of prostate cancer, with 11.8% of these being high-grade 1
• PSA 2.1-3.0 ng/mL: 23.9% risk of prostate cancer, with 19.1% of these being high-grade 1
• PSA 3.1-4.0 ng/mL: 26.9% risk of prostate cancer, with 25.0% of these being high-grade 1

PSA Velocity Considerations

PSA velocity (rate of change over time) is also important:

• A rise of 0.75 ng/mL or greater in a year is concerning for men with PSA levels ≤4.0 ng/mL 1
• Age-adjusted PSA velocity thresholds:
  • Ages 40-59: 0.25 ng/mL/year
  • Ages 60-69: 0.5 ng/mL/year
  • Ages 70+: 0.75 ng/mL/year 1
• For accurate PSA velocity calculation, at least three PSA values over at least 18 months are recommended 1

Important Clinical Considerations

• Traditional PSA cutoff of 4.0 ng/mL has low sensitivity (only 20.5% of prostate cancers detected) but high specificity (93.6%) 2
• Laboratory variability can range from 20-25% depending on the standardization method used 1
• For longitudinal monitoring, the same PSA assay should be used as there is no acknowledged conversion factor between different assays 1
• Factors that can affect PSA levels:
  • Prostatitis, benign prostatic hyperplasia, urethral/prostatic trauma can elevate PSA 1
  • Finasteride and dutasteride lower PSA by approximately 50% 1
  • Prostate biopsy causes substantial PSA elevation; testing should be postponed for at least 3-6 weeks after biopsy 1

Decision-Making for Prostate Biopsy

The American Urological Association does not recommend a single threshold value for prostate biopsy. Instead, decisions should be based on:

• PSA level and digital rectal examination results
• Additional factors including free and total PSA, patient age, PSA velocity, PSA density, family history, ethnicity, prior biopsy history, and comorbidities 1

This individualized risk assessment approach helps characterize the risk of both prostate cancer and clinically significant prostate cancer 1.