What are normal Prostate-Specific Antigen (PSA) values for men of different ages?

Normal PSA Values by Age

Age-specific PSA reference ranges vary by ethnicity, with median values of 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

Age-Specific Reference Ranges by Ethnicity

The American Urological Association provides the following age-specific PSA reference ranges based on ethnic background 1:

Ages 40-49 years:

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

Ages 50-59 years:

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

Ages 60-69 years:

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

Ages 70-79 years:

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

Clinical Context and Interpretation

Cancer-free men in their 40s most likely have serum PSA values of 2.5 ng/mL or less. 1 These age-specific ranges account for the natural increase in PSA that occurs with aging due to benign prostatic hyperplasia and prostate gland enlargement 1.

Risk Stratification by PSA Level

Even within "normal" ranges, cancer risk exists on a continuum 1:

• PSA ≤0.5 ng/mL: 6.6% cancer risk 1
• PSA 0.6-1.0 ng/mL: 10.1% cancer risk 1
• PSA 1.1-2.0 ng/mL: 17.0% cancer risk 1
• PSA 2.1-3.0 ng/mL: 23.9% cancer risk 1
• PSA 3.1-4.0 ng/mL: 26.9% cancer risk 1

Important Clinical Caveats

Using higher "normal" levels for older men results in fewer biopsies but may miss high-grade cancers in older men, while potentially overdetecting smaller volume/lower grade tumors in younger men. 1 The National Comprehensive Cancer Network recommends that men aged 60 years with PSA <1.0 ng/mL have very low risk of metastases or death from prostate cancer 1.

PSA values above the median for age group indicate higher risk for prostate cancer and aggressive disease. 1 Men with baseline PSA above the age-specific median have a threefold higher risk for prostate cancer within 10-25 years 2.

Factors Affecting PSA Interpretation

Several conditions and medications alter PSA levels 1:

• Prostatitis, benign prostatic hyperplasia, and urethral/prostatic trauma can elevate PSA 1
• Finasteride and dutasteride lower PSA by approximately 50% regardless of dose 1
• Prostate biopsy causes substantial PSA elevation; testing should be postponed 3-6 weeks post-biopsy 1
• Laboratory variability ranges from 20-25% depending on standardization method; use the same assay for longitudinal monitoring 1