PSA (Prostate-Specific Antigen)
The main screening marker for prostate health. One number can't tell the whole story — here's how to read it properly.
PSA is a protein made by your prostate. Levels rise with prostate enlargement, infection, or cancer. It's the primary screening tool for prostate cancer in men over 50, but interpreting it requires context — not just a cutoff number.
What is this test?
PSA is a protein produced by both normal and cancerous prostate cells. A small amount leaks into your blood, and that's what the test measures. The key thing to understand: PSA is prostate-specific, not cancer-specific. Many things besides cancer raise it.
That's why a single PSA number doesn't tell you much on its own. What matters more is the trend over time (PSA velocity), your age, prostate size, and whether there are other symptoms.
What your number means
| PSA level | What it suggests |
|---|---|
| < 1.0 ng/mL | Low risk — can extend screening interval to every 2–3 years |
| 1.0–2.5 ng/mL | Normal for most men — annual monitoring |
| 2.5–4.0 ng/mL | Grey zone — consider free PSA ratio, age, and velocity |
| 4.0–10.0 ng/mL | Elevated — about 25% chance of cancer. Urologist referral |
| > 10.0 ng/mL | Significantly elevated — about 50% chance of cancer. Urgent workup |
Avoid ejaculation for 48 hours, vigorous cycling for 48 hours, and intense lower-body exercise for 24 hours before your blood draw. These can all falsely elevate PSA.
How to support prostate health
- Maintain a healthy weight — obesity is associated with more aggressive prostate cancer and can dilute PSA (larger blood volume), masking elevations
- Exercise regularly — consistent physical activity is associated with lower prostate cancer risk
- Eat more lycopene — tomatoes, watermelon, and pink guava are rich in lycopene, which has modest evidence for prostate protection
- Limit processed meat — high intake is associated with increased prostate cancer risk
- Consider saw palmetto — may help with BPH symptoms, though evidence for cancer prevention is limited
- Track your PSA over time — a baseline at 40, then annual from 50, gives you the trajectory that matters most
Track your PSA velocity over time
A single PSA is a data point. eterni shows you the trend — so you and your doctor can spot changes before they become problems.
Get early accessFrequently Asked Questions
At what age should I start PSA screening?
Most guidelines recommend discussing PSA screening starting at age 50 for average-risk men. If you have a first-degree relative with prostate cancer or are of African descent, consider starting at 45. Some longevity-focused physicians recommend a baseline PSA at 40 to establish your personal trend.
Does a high PSA always mean cancer?
No. Most men with elevated PSA do not have prostate cancer. Common non-cancer causes include benign prostatic hyperplasia (BPH), prostatitis (infection/inflammation), recent ejaculation, vigorous cycling, and urinary tract infections. Only about 25% of men who undergo biopsy for elevated PSA are found to have cancer.
Can exercise or sex affect PSA?
Yes. Ejaculation can raise PSA for 24–48 hours. Vigorous cycling can elevate it through direct prostate compression. Intense lower-body exercise may also cause a transient bump. Avoid ejaculation for 48 hours and vigorous exercise for 24 hours before your blood draw for the most accurate result.
What is PSA velocity?
PSA velocity is the rate of PSA change over time, measured in ng/mL per year. A rise of more than 0.75 ng/mL per year is concerning even if the absolute PSA is within the normal range. This is why tracking PSA over time is more valuable than a single reading — it reveals the trajectory.
Free PSA and PSA density
When your total PSA is in the grey zone (2.5–10 ng/mL), two additional calculations help distinguish cancer from benign causes:
- Free PSA ratio — PSA circulates in "free" and "bound" forms. Cancer tends to produce more bound PSA, so a low free PSA ratio (< 10%) is more suspicious for cancer, while a high ratio (> 25%) is more likely benign
- PSA density — PSA divided by prostate volume (from ultrasound). A density > 0.15 ng/mL/cc raises concern for cancer beyond what prostate size alone would explain
India-specific context
- Rising incidence — prostate cancer is now the second most common cancer in Indian men in urban areas, with incidence rising steadily
- Late detection — most Indian men are diagnosed at advanced stages due to lack of routine screening and cultural reluctance to discuss prostate symptoms
- BPH prevalence — benign prostatic hyperplasia affects over 50% of Indian men above 60, commonly causing elevated PSA without cancer
- 5-alpha reductase inhibitors — drugs like finasteride (used for hair loss and BPH) cut PSA roughly in half. If you take finasteride, multiply your PSA by 2 for the true value
Know what's working. Know what's not.
eterni connects your lab results, supplements, and retests — so you can see the trajectory, not just a snapshot.
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