Prostate cancer becomes more common with age, and many men in their 80s will have a higher prostate-specific antigen (PSA) level simply because the prostate grows larger over time. This enlargement is normal and is known as benign prostate enlargement (BPE). PSA is a protein made by the prostate, and higher levels do not automatically mean cancer.
Because PSA naturally rises with age, deciding when to test it in men over 80 requires a different approach. Recent UK guidance offers clear advice on when PSA testing is genuinely helpful and when it is unlikely to make a difference to long-term health. The aim is to avoid unnecessary worry and tests while still identifying prostate cancer that may benefit from treatment.
This article explains how PSA behaves in older men, when a test is useful, what levels matter, and which symptoms should prompt further investigation.
Why Does PSA Change in Men Over 80?
As men age, several changes affect PSA:
- The prostate grows larger, and this alone can raise PSA.
- Inflammation or infection of the prostate (prostatitis) can temporarily increase PSA.
- Urine infections or recent catheter use can also raise the reading.
- Many prostate cancers found in this age group grow extremely slowly and are unlikely to cause harm.
By their 80s, up to 80% of men have benign enlargement of the prostate. Research shows PSA can rise by 3–4% per year after age 50 even without cancer. Because of this, a PSA that looks high in a younger man may be entirely normal for someone in their 80s.
Should Men Over 80 Have a PSA Test?
For most men over 80, a routine PSA test is not recommended. This is because:
- Many cancers found at this age do not grow fast enough to affect health.
- PSA often rises for non-cancer reasons.
- Extra tests—especially biopsy—carry risks such as infection or urinary retention.
- If life expectancy is less than 10 years, finding a slow-growing cancer rarely changes long-term outcomes.
However, PSA testing can be very useful if there are symptoms that raise concern for prostate cancer that has spread beyond the prostate.
PSA testing is recommended when symptoms suggest advanced cancer, such as:
- Bone pain in the hips, lower back, ribs, or pelvis
- Unexplained weight loss
- Feeling unusually tired or weak
- A noticeable and sudden change in health
- New episodes of urinary retention
These symptoms might point to prostate cancer that is growing more quickly. In this situation, diagnosis and treatment—usually hormone therapy—can improve symptoms and quality of life, even in very elderly men.
What PSA Level Is Concerning in an 80-Year-Old Man?
Because PSA rises naturally with age, the “normal” range for an 80-year-old is higher than for younger men. What matters most is whether the level suggests a cancer that needs treatment.
Current UK recommendations use the following thresholds:
An urgent referral is advised when:
- PSA is above 20 ng/mL, with or without symptoms
- PSA is above 7.5 ng/mL and symptoms are present, such as bone pain or weight loss
When PSA is between 7.5 and 20 ng/mL and there are no symptoms:
- A repeat PSA after 6 months is advised before considering referral
This approach reduces unnecessary investigations for slow-growing cancers while still detecting more aggressive disease.
Why these cut-offs?
- PSA values in this age range are often high for benign reasons.
- Only a minority of older men develop a fast-growing prostate cancer that would benefit from treatment.
- The thresholds aim to identify these cancers without over-testing.
Does a High PSA Always Mean Cancer?
No. In men over 80, a raised PSA is much more likely to be caused by:
- Benign prostate enlargement
- Prostatitis
- Recent procedures involving the bladder or prostate
- A urinary infection
Even a PSA as high as 7–10 ng/mL may be entirely normal for an enlarged prostate.
Cancer becomes more likely as the number rises, but PSA alone cannot diagnose cancer. It simply shows that the prostate is producing more of this protein and needs to be looked at in the right context.
When Should an 80-Year-Old Man Be Referred to a Specialist?
A referral to a urologist is usually recommended when:
- PSA is above 20 ng/mL
- PSA is above 7.5 ng/mL with symptoms
- PSA has doubled within 6 months and the man is otherwise well
If a man is frail or has several health issues, referral may not always be the best option. Instead, the focus may be on comfort and managing symptoms. When a man is fit and healthy, further testing can be very helpful.
Do Men Over 80 Need MRI Scans or Biopsies?
MRI scans and biopsies are used to confirm the presence of prostate cancer. In men over 80, these tests are considered only when:
- The PSA level is concerning
- Symptoms suggest cancer
- The man is well enough to benefit from treatment if cancer is found
When MRI is helpful:
MRI can show whether there is a suspicious area in the prostate. If the scan looks normal, a biopsy may not be needed.
When prostate biopsy is needed:
A biopsy may be offered if:
- The PSA is high
- MRI shows an area that looks like cancer
- The man is healthy enough for treatment if required
Biopsy is avoided when it is unlikely to change management.
Is Prostate Cancer Common in Men Over 80?
Yes. Many older men have prostate cancer cells that never cause symptoms. Post-mortem studies show that up to 70–80% of men in their 80s have some cancer in the prostate.
However:
- Only a small proportion have a cancer that is fast-growing
- The majority will never experience symptoms from it
- The focus is on identifying cancers that may spread or cause problems
This is why PSA testing is guided by symptoms and overall health rather than age alone.
Can an 80-Year-Old Man Still Have Treatment for Prostate Cancer?
Yes. Treatment choices depend on:
- General health
- Symptoms
- PSA level
- Whether the cancer has spread
Most men in their 80s with advanced prostate cancer respond well to hormone therapy, which can relieve symptoms quickly.
Fit older men may also be offered radiotherapy in some cases.
Surgery is rarely used at this age.
FAQs About PSA Testing After Age 80
Is a PSA of 6 or 7 normal for an 80-year-old?
Yes, this can be normal due to benign prostate enlargement.
Should an 80-year-old man have a PSA test if he feels well?
Usually no. Testing is most useful when symptoms are present.
Does a rising PSA always mean cancer?
No. Infection, inflammation, or even cycling can temporarily raise PSA.
What happens if PSA is very high?
Further tests may be advised, usually starting with a repeat PSA and possibly an MRI.
Can prostate cancer still be treated at this age?
Yes. Many men respond very well to hormone therapy, especially for advanced cancer.
Key Points on PSA Testing After Age 80
- PSA naturally rises with age, especially with benign prostate enlargement.
- Routine PSA testing is not recommended in well men over 80.
- Testing is helpful when symptoms such as bone pain or weight loss are present.
- PSA above 20 ng/mL, or above 7.5 ng/mL with symptoms, should be assessed further.
- MRI and biopsy are considered only when the man is fit enough to benefit from treatment.
- Treatment can still be very effective in older men when cancer is causing symptoms.
