Can prostate cancer be asymptomatic with a PSA of 27?

Question

Hello doctor,

My prostate level has been 27 for the past seven years. I have no symptoms except for urine dribbling. I am 65 years old and on medication for an enlarged prostate. Could prostate cancer be present without symptoms?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understood your concern.

You are absolutely right to be cautious. Here is a simple and clear explanation of what a PSA (prostate-specific antigen) level of 27 might mean, especially since you have had no major symptoms except urine dribbling, and you are already on medication for an enlarged prostate (likely BPH – benign prostatic hyperplasia).

What does a PSA of 27 mean?

Normal PSA: Below 4 ng/mL.
Mildly raised: 4 to 10 ng/mL (can be BPH, infection, or cancer).
Above 10 ng/mL: Needs close evaluation, and 27 is high.

However, PSA alone does not confirm cancer. It can also be high due to:

Enlarged prostate (BPH).
Prostate infection (prostatitis).
Recent ejaculation, catheter, or rectal examination.

Could cancer be hiding?

It is possible, but not certain. Red flags for prostate cancer usually include:
Persistently high PSA that keeps rising.
Hard, irregular prostate on rectal exam
Weight loss, back pain, or blood in urine or semen.
Family history of prostate cancer.

In your case only symptom is dribbling (common in BPH). PSA has been high for the last seven years, so not rapidly rising; this actually favors BPH over aggressive cancer. Still, cancer cannot be ruled out.

I hope this helps.

Kindly follow up if you have more doubts.

Thank you.