A PSA of 49? Why Men Can’t Afford to Skip Their Prostate Checks

By Dr. David Samadi

Recently, I saw a 63-year-old man who came to me for the first time. He had never had a PSA test before—ever. His prostate-specific antigen (PSA) level came back at 491. That number stopped me in my tracks—and I’ve seen a lot in my career.

To put this into perspective, a PSA that high is far beyond the normal range and almost certainly a red flag for advanced prostate cancer. It’s a stark reminder of why regular screening—starting at age 40—is so critical for men.

What Is PSA and What’s Considered Normal?

PSA is a protein made by both normal and cancerous cells in the prostate gland. A PSA test is a simple blood test that measures the level of this protein in the bloodstream. It’s one of the best tools we have for detecting prostate cancer early—before symptoms appear and when it’s still highly treatable.

So, what’s considered normal?

• For most men, a PSA level under 4.0 ng/mL is considered within the normal range.
• A PSA between 4 and 10 ng/mL is considered borderline or suspicious.
• A PSA over 10 ng/mL significantly increases the likelihood of prostate cancer.
• A PSA in the hundreds, like the patient I saw with a level of 491, strongly suggests advanced disease.

But here’s the thing—PSA levels aren’t black and white. They’re influenced by age, race, family history, and even prostate size. For example, a slightly elevated PSA in a younger man may be more concerning than the same number in an older man.

Does a High PSA Always Mean Cancer?

Not always. While a very high PSA level is a major warning sign, there are other conditions that can cause elevated PSA levels:

• Benign prostatic hyperplasia (BPH) – A non-cancerous enlargement of the prostate.
• Prostatitis – Inflammation or infection of the prostate.
• Recent ejaculation or a digital rectal exam (DRE) – These can cause a temporary bump in PSA.
• Urinary tract infections – May falsely elevate PSA until the infection resolves.

That said, when we’re talking about PSA levels that are extremely elevated—well into the triple digits—it becomes much less likely that the cause is something benign. At those levels, prostate cancer should be the top concern, and time is of the essence.

The Dangers of Skipping PSA Screenings

This patient’s case underscores a tough truth: when prostate cancer is caught late, it’s often more aggressive and harder to treat. With a PSA of 491, we’re likely looking at cancer that has extended beyond the prostate—possibly into lymph nodes, bones, or other tissues. This changes the treatment approach and may limit curative options.

But here’s the good news: prostate cancer is highly treatable when caught early. Men who are diagnosed in the early stages have a nearly 100% five-year survival rate. That’s why annual PSA testing, especially starting at age 40 for men at higher risk, is so vital.

When Should Men Get Screened?

• Age 40: Both average-risk men and especially men at higher risk (African American men, those with a family history of prostate cancer) should begin annual PSA screenings.
• Any age: If you have urinary symptoms like frequent urination, weak stream, blood in the urine, or pelvic discomfort, talk to your doctor right away—even if you’re under 40.

Bottom Line

A PSA of 491 is a tragic example of what can happen when prostate cancer goes undetected for too long. But it doesn’t have to be this way.

PSA testing is fast, easy, and could save your life. Don’t wait for symptoms. Be proactive, not reactive.

If you’re a man over 40—or if you care about one—make sure PSA testing is on your yearly to-do list. Let’s take the guesswork out of prostate health and focus on prevention, early detection, and smart treatment decisions.

Dr. David Samadi is the Director of Men’s Health and Urologic Oncology at St. Francis Hospital in Long Island. He’s a renowned and highly successful board certified Urologic Oncologist Expert and Robotic Surgeon in New York City, regarded as one of the leading prostate surgeons in the U.S., with a vast expertise in prostate cancer treatment and Robotic-Assisted Laparoscopic Prostatectomy.  Dr. Samadi is a medical contributor to NewsMax TV and is also the author of two books, Prostate Cancer, Now What? A Practical Guide to Diagnosis, Treatment, and Recovery and The Ultimate MANual, Dr. Samadi’s Guide to Men’s Health and Wellness, available online both on Amazon and Barnes & Noble. Visit Dr. Samadi’s websites at robotic oncology and prostate cancer 911.