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

Normal PSA Levels

Normal PSA levels vary by age and ethnicity, with median values being 0.7 ng/mL for men in their 40s, 0.9 ng/mL for men in their 50s, 1.2 ng/mL for men in their 60s, and 1.5 ng/mL for men in their 70s. 1, 2

Age-Specific Reference Ranges by Ethnicity

The American Urological Association provides age-specific reference ranges that account for the natural increase in PSA with aging: 1, 2

For men aged 40-49 years:

• Asian-Americans and African-Americans: 0-2.0 ng/mL 1, 2
• Whites: 0-2.5 ng/mL 1, 2

For men aged 50-59 years:

• Asian-Americans: 0-3.0 ng/mL 1, 2
• African-Americans: 0-4.0 ng/mL 1, 2
• Whites: 0-3.5 ng/mL 1, 2

For men aged 60-69 years:

• Asian-Americans: 0-4.0 ng/mL 1, 2
• African-Americans and Whites: 0-4.5 ng/mL 1, 2

For men aged 70-79 years:

• Asian-Americans: 0-5.0 ng/mL 1, 2
• African-Americans: 0-5.5 ng/mL 1, 2
• Whites: 0-6.5 ng/mL 1, 2

Critical Context: Cancer Risk Exists Across All PSA Ranges

A crucial pitfall is assuming that PSA levels below 4.0 ng/mL are completely "safe"—cancer risk exists even at traditionally low values. 1, 2 The continuum of risk includes:

• PSA ≤0.5 ng/mL: 6.6% cancer risk (12.5% high-grade) 1, 2
• PSA 0.6-1.0 ng/mL: 10.1% cancer risk (10.0% high-grade) 1, 2
• PSA 1.1-2.0 ng/mL: 17.0% cancer risk (11.8% high-grade) 1, 2
• PSA 2.1-3.0 ng/mL: 23.9% cancer risk (19.1% high-grade) 1, 2
• PSA 3.1-4.0 ng/mL: 26.9% cancer risk (25.0% high-grade) 1, 2

This data demonstrates that using a single PSA threshold of 4.0 ng/mL misses nearly 80% of prostate cancers. 3

Important Clinical Considerations

Laboratory variability can range from 20-25%, so always use the same PSA assay for longitudinal monitoring. 2 There is no acknowledged conversion factor between different assays. 2

Factors that artificially affect PSA levels include: 2

• Prostatitis and benign prostatic hyperplasia (increase PSA)
• Urethral or prostatic trauma (increase PSA)
• Finasteride and dutasteride (decrease PSA by approximately 50%)
• Recent prostate biopsy (increase PSA)

PSA Velocity Thresholds

PSA velocity becomes concerning when it rises ≥0.75 ng/mL per year in men with PSA ≤4.0 ng/mL. 2 Age-adjusted thresholds are more specific: 2

• Ages 40-59: ≥0.25 ng/mL/year
• Ages 60-69: ≥0.5 ng/mL/year
• Ages 70+: ≥0.75 ng/mL/year

To accurately measure PSA velocity, obtain at least three PSA values over a minimum of 18 months. 1

Screening Intervals Based on Baseline PSA

For men with PSA <2.0 ng/mL, annual testing is unnecessary—screening intervals can be extended to 2-4 years. 4, 5 Only 1.4-2.2% of men with initial PSA <2.0 ng/mL will have PSA rise to ≥3.1 ng/mL within 5 years. 4

For men with PSA 2.1-3.0 ng/mL, maintain annual or biennial screening. 4 This group shows 18-35% progression to PSA ≥3.1 ng/mL within 5 years. 4