PSA test
The PSA test is a blood test that measures the level of PSA protein in the blood. It can be used with other tests to help diagnose prostate cancer.
What is the PSA test?
PSA stands for prostate specific antigen. PSA is a protein made in the prostate gland. Some PSA leaks into the blood and can be measured in a blood test. If you have a prostate gland, a small amount of PSA in the blood is normal.
The PSA test is 1 of the tests that doctors use to diagnose prostate cancer.
A raised PSA level may be a sign of prostate cancer. But it can also be caused by other things, such as an enlarged prostate or an infection.
In this cancer information video, Urologist Shiv Bhanot describes the symptoms of prostate cancer and explains the PSA test. Patrick, who is living with prostate cancer, talks about going to his GP after having symptoms and how the condition affects Black males more than others.
Who can have the PSA test?
If you are over 50, you can ask your GP for a PSA test. GPs do not routinely offer PSA testing as part of a general health check, or if you do not have any symptoms.
There are benefits and disadvantages to having a PSA test. Your GP will talk to you about these before you have a test. They can also talk to you about your own personal risk.
Your GP will advise you to think carefully about the benefits and disadvantages, and your personal risk before having a test. Ask any questions you need to. Your GP can help you to make an informed decision about having a PSA test.
Related pages
If you have symptoms
You may want to have a PSA test if you have symptoms, such as:
- needing to pee more often than usual, especially at night
- trouble peeing (passing urine)
- an urgent need to pee
- erection problems.
These are often caused by other prostate problems and not prostate cancer.
Higher risk of getting prostate cancer
If you have a higher risk of developing prostate cancer, your GP may talk to you about having a PSA test. Your risk is higher if:
- you are Black
- other family members have had prostate cancer
- you have a change to the BRCA2 gene.
People with any of these risk factors may develop prostate cancer at a younger age.
You may be offered a PSA test from the age of:
- 45 if you are Black
- 45 if you have a family history of prostate, breast or ovarian cancer
- 40 if you have a change to the BRCA2 gene.
Prostate Cancer UK has a risk checker that you can use to learn more about your risk of developing prostate cancer.
You can talk to your GP about having a PSA test if they have not spoken to you about it.
Talk to your doctor
There is no right or wrong answer about whether to have a PSA test. Your doctor can explain the benefits and disadvantages of having the test to help you make your decision. It may be helpful to make a list of questions before your appointment.
If you are trans
People who have a prostate include men, trans (transgender) women and people assigned male at birth. If you are a trans woman and have had genital gender affirming surgery as part of your transition, you will still have a prostate. It is important to talk to your GP or nurse if you are worried about prostate cancer or have symptoms and want to have a PSA test.
If the thought of talking to your GP feels difficult, you could try showing them our information on transgender and cancer. There is further help available:
- Prostate cancer UK has detailed information about trans women and prostate cancer.
- The LGBT Foundation can give you confidential advice and support.
- You can talk to one of our cancer support specialists for free on the Macmillan Support Line on 0808 808 00 00.
Screening for prostate cancer
Screening uses tests to try to find cancer early in people who do not have any symptoms. In the UK, there are screening programmes for breast, bowel and cervical cancer.
There is currently no UK national screening programme for prostate cancer. One reason for this is that the PSA test on its own is not accurate enough. It may suggest that a person has prostate cancer when they do not.
It may also miss some cancers:
- 1 in 7 people with a normal PSA level may have prostate cancer.
- 1 in 50 people will have a normal PSA and have a fast growing prostate cancer.
For a screening programme to be effective, the benefits need to outweigh the disadvantages.
A prostate cancer screening trial called TRANSFORM will use different tests including MRI scans to provide evidence for the best way to screen for prostate cancer. Prostate Cancer UK has more information about the trial.
Things to think about
The PSA test may help to diagnose very early prostate cancer before any symptoms develop. There are benefits and disadvantages to having treatment for early prostate cancer.
Having a PSA test may lead to an earlier diagnosis of prostate cancer, when treatment to cure the cancer could be more effective.
A PSA test may find prostate cancers that are very slow growing and are unlikely to cause any problems. With early prostate cancer, you are not likely to die from it within the next 10 years. You may only need monitoring instead of treatment. But the thought of not having treatment might be difficult for some people.
Prostate cancer treatments can cause side effects that may have a big impact on your life. These include:
- urinary incontinence
- bowel problems
- difficulty getting an erection.
Having a normal PSA does not mean you will not get prostate cancer in the future. Also, some people might have a normal PSA but still have prostate cancer.
Benefits and disadvantages of having the PSA test
Making a decision about whether to have a PSA test can be difficult. It can help to think about the possible benefits and disadvantages before having a PSA test.
Thinking about what is important to you can help you make the best decision. You may also want to think about the following questions:
- What would you do if your PSA level is raised?
- What would you do if further tests find that you have early prostate cancer?
- What difference will it make for you to know about an early prostate cancer?
Possible benefits
Some possible benefits of a PSA test include the following:
- You may feel reassured if the PSA result is normal. You can have the PSA repeated. There is not enough evidence to say how often you should have a PSA test. You can talk with your doctor about what would be best for you.
- If your PSA level is raised, you can discuss with your doctor if you need further tests or how often you need it monitored.
- It can help diagnose a faster growing prostate cancer early when treatments may cure it or help you to live longer.
Possible disadvantages
Some possible disadvantages of a PSA test include the following:
- If your PSA level is raised, you may feel anxious.
- If your PSA level is raised you may need further tests, which may include a biopsy. This can have side effects.
- If you are diagnosed with prostate cancer, you need to make decisions about treatments.
- Treating early prostate cancer may not help you to live for longer and the side effects of treatment can affect your quality of life.
Having the PSA test
If you decide to have the PSA test, you will have a blood sample taken. This is sent to a laboratory to be tested. You can ask how long the result will take.
You may have seen PSA tests kits available to buy in shops or online. It is always best to talk to a doctor or other healthcare professional before having a PSA test.
If you are having the PSA test, your doctor may do a digital rectal examination as well. The doctor gently inserts a gloved finger, using lubricating gel, into your back passage (anus and rectum) to feel the prostate. It may be uncomfortable, but it is quick and should not be painful.
Preparing for a PSA test
Some things may affect the PSA level. These include:
- urine infections or an infection of the prostate (prostatitis)
- recent ejaculation (within the last 48 hours)
- having a tube in your bladder to drain pee (urinary catheter)
- a recent prostate biopsy
- prostate or bladder surgery
- exercising energetically 48 hours before the test – some doctors include cycling in this advice
- receiving anal sex or prostate stimulation during sex – it is best to avoid this for 1 week before a PSA test.
Your doctor may suggest you delay having the test if any of these apply to you.
Medicines that lower PSA
Some medicines can lower the PSA level in your blood. These include medicines that help with urinary symptoms caused by benign prostatic hyperplasia (BPH), such as:
- finasteride (Proscar®)
- dutasteride (Avodart®, Combodart®).
Always tell your GP or nurse about any medicines you are taking. This includes ones you buy over the counter, complementary therapies and drugs made from herb and plant extracts.
PSA test results
There is no ‘normal’ PSA level that works for everyone. This is because:
- the level of PSA naturally rises as you get older
- the PSA level varies depending on the size of the prostate – this is different for everyone
- other things can affect the PSA level – for example, non-cancerous prostate problems or a urine infection.
PSA is usually measured in nanograms per millilitre of blood (ng/ml). Your PSA level will depend on your age and situation.
This table gives an idea of a normal PSA depending on your age.
| Age (years) | Prostate-specific antigen |
|---|---|
| 40 to 49 | 0 to 2.5 ng/ml |
| 50 to 59 | 0 to 3.5 ng/ml |
| 60 to 69 | 0 to 4.5 ng/ml |
| 70 to 79 | 0 to 6.5 ng/ml |
Your GP will use their clinical experience and judgement when assessing the results of your PSA test.
If you are at higher risk of developing prostate cancer, your GP may refer you to a specialist doctor called a urologist, even with a lower PSA.
Having a raised PSA level does not mean you have prostate cancer. But the higher the PSA level, the greater the chance of prostate cancer. A continuous rise in PSA level over time may also be a sign of prostate cancer.
Prostate conditions that can affect PSA levels
There are non-cancerous conditions that can also cause a raised PSA level. This includes common prostate conditions, such as:
- benign prostatic hyperplasia or hypertrophy (BPH)
- inflammation of the prostate (prostatitis).
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Benign prostatic hyperplasia (BPH)
This is the medical term for a prostate that has got bigger. This happens as part of the normal ageing process and is common over the age of 50.
Symptoms of BPH can include:
- difficulty starting to pee (pass urine)
- having a weak flow of pee
- needing to pee more often than usual, especially at night
- feeling like you have not completely emptied your bladder
- an urgent need to pee.
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Prostatitis
This is when the prostate is inflamed, usually because of an infection. There are different types of prostatitis. It does not always cause any symptoms, but you should contact a GP if you have symptoms. These include:
- pain when peeing or difficulty peeing
- needing to pee more often than usual
- pain in or around the end of the penis, the testicles, the inner thighs, the lower back, or the area between the testicles and back passage (perineum)
- pain during ejaculation
- a high temperature.
Prostate Cancer UK has more information about prostatitis
What happens after the PSA test?
What happens next depends on the results of the PSA test and the digital rectal examination (DRE). If both the PSA level and the DRE are normal, you will not need any more tests.
If your PSA level is raised but your prostate feels normal, your GP usually checks your PSA level again.
Your GP will talk to you about meeting with a specialist doctor called a urologist if:
- your PSA level is raised
- your prostate feels abnormal.
Meeting with a urologist
You will usually meet with a urologist within 2 weeks of your GP making a referral. The urologist will talk to you about having a specialised scan called a multi-parametric MRI scan.
Depending on the results of your scan, your doctor may:
- explain that you do not need any further tests
- ask you to think about having a prostate biopsy.
Before a biopsy, the urologist will explain the risks and benefits to help you to decide. If you have prostate cancer, they will talk to you about your options.
About our information
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer.
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References
Below is a sample of the sources used in our prostate cancer information. If you would like more information about the sources we use, please contact us at informationproductionteam@macmillan.org.uk
National Institute for Health and Care Excellence (NICE). Prostate cancer: diagnosis and management. NICE Guideline [NG131]. Published: 09 May 2019. Last updated: 15 December 2021. Available from: www.nice.org.uk/guidance/ng131 [accessed March 2024].
Castro E, Fizazi K, Heidenreich A, Ost P, Parker C, Procopio G, et al. Prostate cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology. 2020; 31(9): 1119–1134. Available from: www.annalsofoncology.org/article/S0923-7534(20)39898-7/fulltext [accessed March 2024].
Reviewer
Consultant Medical Oncologist & Honorary Associate Professor
University College Hospitals, London
Date reviewed
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