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>> if it's anything other than zero I know I have a problem

Is that actually factually always true?

At least two of the men I know have had prostate removed and show occasional PSA spikes, that have stumped their doctor for a decade but has never led to any specific issues concerns problems or actions (other than, yes, anxiety...)

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That is concerning. I've heard that PSA can be produced in other parts of your body but at very low level, not enough to pass the threshold of concern. If the spikes are high and the test is reliable then there could be something lurking in the body somewhere. The other answer also suggests it's difficult to diagnose where the cancer (or tumor, etc.) is located.

Here's an authoritative source on Protein Specific Antigen ( aka KLK3, Kallikrein related peptidase 3 ): https://www.proteinatlas.org/ENSG00000142515-KLK3/tissue

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