Accompaniment to PSA Reports

Published data from the Prostate Cancer Prevention Trial demonstrated that there is no PSA level below which the risk of having prostate cancer is zero. For an individual patient, the significance of a PSA level should be interpreted in a broad clinical context, including age, race, family history, digital rectal exam, prostate size, results of prior prostate biopsy, and use of 5α-reductase inhibitors.

Considering the high incidence of asymptomatic cancer in the general population that may not pose an ultimate risk to the patient, the decision to recommend urological evaluation or prostate biopsy should be individualized after considering all these factors.

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The risk that a patient will have prostate cancer detected if a biopsy is performed at various levels of PSA is listed in the table below:

PSA Relative risk for prostate cancer


Relative risk for prostate cancer

≤1.0 ng/mL


1.1-2.0 ng/mL


2.1-3.0 ng/mL


3.1-4.0 ng/mL


>4 ng/mL


*Thompson IM, Pauler DK, Goodman PJ, et al. Prevalence of prostate cancer among men with a prostate-specific antigen level <4.0 ng/mL. N Engl J Med. 2004; 350:2239-2246.

**Presti JC Jr, O’Dowd GJ, Miller MC, et al. Extended peripheral zone biopsy schemes increase cancer detection rates and minimize variance in prostate specific antigen and age related cancer rates: results of a community multi-practice study. J Urol. 2003;169:125-129.