PPSA Level Confusion

User

Posted 14 Jul 2026 at 17:02

Hello all. I'm new here with my first question.

A few of years ago I had a biopsy procedure after a PSA level of 5 (at age 65). Luckily for me this turn out to be benign. The high level being put down to an inflamed prostate possibly due to a lot of cycling.

I've just had another reading of 4.2 after it was less than 2 for a few years. This is without any cycling at all.

The results came back through the NHS app with a sub-note saying 'refer further if PSA level is above 10'. I questioned this with my doctor who then wrote to the consultant who did my original biopsy. The consult apparently said the threshold of 10 is based on the size and density of my particular prostate.

Is this a standard approach, is it acceptable? I'm a bit concerned that I am being categorised differently than the standard NHS guidelines for my age. I clearly don't want to miss scans or biopsies when I might need them.

Any thought, opinions or advice are most welcomed.

User

Posted 14 Jul 2026 at 19:29

Hi, Mark.

I'm sorry that you've got prostate concerns, but welcome to the forum.

I'm I right in saying that you are now 68 years old and that you had a prostate biopsy 3 years ago. During that time, your PSA was 5 dropped to 2 for a while and has recently risen to 4

You say that the biopsy showed benign. Do you mean there was a benign tumour or your prostate was found to be enlarged (Benign Prostatic Hyperplasia, or BPH)

BPH can increase your PSA. Say your prostate is 90 cc, 3 times larger than normal, it could result in your PSA being three times greater.

Without knowing the size of your prostate I can't really say what your normal PSA range would be.

For a 68 year old, with a normal sized prostate, your PSA 4 is still within the normal range. My guess is if the consultant has said in your case the normal range is extended to 10, it is likely that your prostate is about twice as large as normal.

Have you ever been given a PSA density which involves dividing the PSA level by the volume of your prostate?

Personally, I'd not be worried. I'd continue to be checked and keep an eye on whether the PSA rise increases or stabilises.

Good luck, mate. 👍

Edited by member 14 Jul 2026 at 20:07 | Reason: Typo

User

Posted 14 Jul 2026 at 19:34

Hi Mark Att,

I am sorry life has brought you to this site, but please be most welcome and stick with us for as long as you need.

Importantly, let me start by saying I am not medically trained and I am only talking from my own experience. I was diagnosed with prostate cancer in March 2024. My PSA was first measured in January 2024 and was 9.8, this led to a second test in late January 2024 and a PSA of 8, which I thought meant I was okay, but to my surprise I was sent for a MRI that found a suspicious lump in my prostate. This led to a biopsy that found the suspicious lump was bigger and was cancerous.

It might be worth asking to have a second PSA test to get more data points, although I think PSA tests have to be at least 4 weeks apart. My doctor did act based on the two results being near 10. I don't know the exact guidelines and I do know as we age the threshold for action does go up slightly, but 10 sounds high given that my 9.8 and 8 turned out to be cancerous and was eventually found to have broken out of the prostate. If you need peace of mind and you can afford it then maybe a private healthcare approach could help. A friend of mine went down that route when he found out he was going to wait over 6 months for a consultation for potential Parkinson's disease. Sadly, he found out the worst, but he is now being treated under the NHS.

I hope others add to this and correct me on anything I may have wrong. Either way, I wish you all the best and hope that your worries soon put to rest.

User

Posted 15 Jul 2026 at 17:15

One might be outside the normal range for age but that does not automatically mean that treatment is thought necessary immediately, unless the PSA is very high in which situation other indicators should be found Patients vary so much in how they present and clinicians have to use their judgement on a case by case basis using histology, PCa tools and their experience, so not necessarily using general figures. However, in the case of a friend of mine, his PSA fluctuated as PSA can and over many years reached 9.8 on one occasion. After many years without treatment, he died of something else at about 85 years of age. Regular monitoring should be done.

Barry

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