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Prostate-specific antigen (PSA) is a protein produced by the epithelial cells of the prostate gland. Its primary biological role is to liquefy semen, optimising sperm motility and morphology. While it is normal for small amounts of PSA to circulate in the blood, an elevation can be a signal of various conditions, ranging from benign enlargement and inflammation to prostate cancer. Prostate cancer tissue produces approximately 10 times more PSA than benign tissue.
The challenge in modern urology is the mildly raised PSA level between 4 and 10 ng/mL. In this range, the majority of men do not have clinically significant cancer. This creates a diagnostic dilemma in choosing those who require further investigation and/or biopsy. To move beyond a “one size fits all” interpretation, we must look at PSA derivatives, such as age-specific ranges, Free PSA and PSA Density, to understand the unique biology of the individual.
Relevant Fact:
Research published in 2025 indicates that the PSA Density (PSAD) and the PSA-Age Volume index (PSA-AV) significantly outperform standard PSA tests in terms of diagnostic accuracy. In patients with PSA levels below 10 ng/mL, PSAD has shown a specificity as high as 94.7 percent, helping to rule out cancer more effectively than traditional methods.
Symptoms
A high PSA result is often discovered during routine screening before any physical symptoms appear. However, you should consult a specialist even if you do not have any symptoms.
Mr Collins Approach
Mr Gerry Collins views a PSA result not as a definitive verdict; he incorporates your prostate volume, your age, and the “Free to Total” PSA ratio to build a risk-stratified map. By using advanced tools like the Stockholm3 biomarker test and MRI-guided interpretations, he filters out the benign causes of PSA elevation, such as inflammation or BPH, ensuring that only those who truly need an intervention proceed to biopsy.
FAQs
What is the “Free to Total” PSA ratio?
PSA circulates in the blood in two forms: bound to proteins or “free.” Men with prostate cancer tend to have more bound PSA and less free PSA. A ratio (Free/Total) of less than 10 to 20 percent may indicate a higher risk of malignancy.
Does a large prostate mean I have cancer?
Not necessarily. A large prostate (BPH) will produce more PSA. This is why we calculate PSA Density: dividing the PSA level by the volume of the prostate (measured by scan). If the density is low, the rise is likely due to size, not cancer.
What are the age-specific thresholds?
NHS guidelines generally suggest:
– 40 to 49 years: >2.5 ng/ml
– 50 to 69 years: >3.0 ng/ml
– Over 70 years: >5.0 ng/ml
However, these are starting points; the trend over time is often more important than a single reading.
Can medications affect my PSA?
Yes. Medications for an enlarged prostate, such as Finasteride or Dutasteride, can artificially lower your PSA by about 50 percent. It is vital to tell your consultant if you are taking these, as we must “double” the result to see the true clinical picture.
Based in Manchester and Cheshire, Mr Gerald Collins is currently accepting private consultations for the assessment of kidney masses, haematuria, and general urological concerns. With 29 years of experience, he provides the clarity and expertise needed to move from uncertainty to a confident treatment plan.
