Your PSA test results and what happens next

PSA levels vary from person to person and so a ‘normal’ PSA level does not exist. Instead, your doctor will assess what level is normal for you. Among other things, they will think about your age and size of the prostate. Your doctor may feel the prostate gland to check it’s normal.

What happens next will depend on your PSA result. If your result is considered normal, you’re unlikely to have cancer and you won’t need more tests. If you have a raised PSA level, you may need more tests. A high PSA level does not always mean you have prostate cancer. When deciding if you need further tests, your doctor will consider:

  • any other symptoms you may have
  • how your prostate feels
  • your personal risk of prostate cancer
  • how much your PSA level is raised.

Common prostate problems, such as, benign prostatic hyperplasia (BPH) and prostatitis can also cause a raised PSA level.

What is a normal PSA level?

Although the term ‘normal PSA level’ is often used, there isn’t a single number for a normal PSA level. There are a few reasons for this:

  • The older you are, the higher your PSA level is likely to be, whether or not you have prostate cancer.
  • PSA levels vary with the size of your prostate gland (this differs from man to man and the gland gets bigger with age).
  • Different laboratories use different methods to measure PSA levels.
  • Specialists have different opinions on what’s ‘normal’.

It’s best to check with your specialist what they think the normal level should be for you. The numbers given here are only a guide and are based on age:

  • For men in their 50s, a PSA level of up to 3 nanograms per millilitre of blood (3ng/ml) is considered normal.
  • For men in their 60s, a PSA level of up to 4ng/ml is considered normal.
  • For men aged 70 and over, a PSA level of up to 5ng/ml is considered normal.


Your PSA test result and what happens next

As a guide, here’s what may happen depending on your PSA test result.

A normal PSA level

You’re unlikely to have cancer. If your prostate feels normal during a digital rectal examination (see below), then no further action is needed.

A high PSA level

There are no rules about what to do if your PSA level is high - even healthcare professionals don’t always agree on the best course of action. If the test shows that the level of PSA in your blood is raised, what happens next depends on:

  • whether or not you have any symptoms
  • how your prostate gland feels during a digital rectal examination. A digital rectal examination is when a healthcare professional inserts a gloved finger into your rectum (back passage) to feel the prostate. It may be uncomfortable, but it’s quick and shouldn’t be painful.
  • your personal risk of prostate cancer.
  • whether your PSA is slightly higher than normal or significantly higher than normal (see below).

If your PSA level is slightly higher than normal

In this case you probably don’t have cancer. You might need to have another PSA test in a few weeks. Some men may have a series of PSA blood tests. This is to see whether the level is changing over time and if so, how quickly.

If the PSA level remains abnormal or increases, you may be advised to have a sample of tissue taken from your prostate (a biopsy).

Your doctor or nurse practitioner may also ask you if you were sexually active in the 48 hours before your PSA test, or if you’ve had a recent urine infection. This is because these can raise your PSA level.

If your PSA level is significantly higher than normal

If the levels are a lot higher than normal you probably need to have a prostate biopsy to find out if cancer cells are present.

If the biopsy shows that you have prostate cancer, there are a number of different options for managing it, depending on your particular situation. Your medical team will be able to give you more information about the best options for you.


A normal PSA result

You’re unlikely to have cancer and no further action is needed if your prostate feels normal.


A high PSA result

There are no rules about what to do if your PSA level is high – even healthcare professionals don’t always agree on the best course of action. If the test shows that the level of PSA in your blood is raised what happens next depends on:

  • whether or not you have any symptoms
  • how your prostate gland feels when examined using a digital rectal examination. A digital rectal examination is when a healthcare professional inserts a gloved finger into your rectum (back passage) to feel the prostate. It may be uncomfortable, but it’s quick and shouldn’t be painful. If you have a PSA test your healthcare professional may also carry out a digital rectal examination.
  • your personal risk of prostate cancer
  • whether your PSA is slightly higher than normal or significantly higher than normal (see below).

If your PSA level is slightly higher than normal you probably don’t have cancer. You might need to have another PSA test in a few weeks. Some men may have a series of PSA blood tests. This is to see whether the level is changing over time and if so, how quickly.

If the PSA level remains abnormal or increases you may be advised to have a biopsy.

Your doctor or nurse practitioner may also ask you if you were sexually active in the 48 hours before your PSA test or if you’ve had a recent urine infection. This is because these can raise your PSA level.

PSA significantly higher than normal You probably need to have a prostate biopsy to find out if cancer cells are present.

If the biopsy shows that you have prostate cancer, there are a number of different options for managing it, depending on your particular circumstances. Your specialist team will be able to give you more information about the best options for you.


Common prostate problems

You’re unlikely to be aware of your prostate unless it causes you trouble.

The two most common prostate problems are benign prostatic hyperplasia (also called benign prostatic hypertrophy) and prostatitis.

Benign prostatic hyperplasia (BPH)

This is when the prostate increases in size. It’s part of the normal ageing process and is common in men over the age of 50.

BPH can cause the following symptoms:

  • difficulty in starting to pass urine, or having a restricted flow of urine
  • passing urine more often than usual, especially at night
  • an urgent need to pass urine
  • blood in the urine or sperm, although this is rare.

BPH is not the same as prostate cancer.

Prostatitis

This is when the prostate gland is inflamed or has an infection. In some men, it may not cause any symptoms. When symptoms do occur, they can include:

  • repeated urine infections
  • pain at the end of the penis
  • a dull ache in your testicles, inner thighs, the area between your testicles and back passage (perineum) or your lower back
  • pain during ejaculation or blood in the ejaculated semen.

Prostatitis is not prostate cancer. It can be caused by an infection, which is treated with antibiotics. It can also be caused by physical injury to the prostate gland, or by some autoimmune diseases in which the body’s immune system damages the body’s own cells.

BPH and prostatitis can both cause the PSA test to show a raised level of PSA in the blood.


More information and support

We have a section on further tests for prostate cancer and more detailed information about prostate cancer and treatments.

If you’re finding it difficult to cope with the emotions caused by your test results, you can visit our online community. There, you can get support from people who’ve been through similar experiences to you.


Back to PSA test

The prostate gland

The prostate gland produces semen and a protein called prostate specific antigen (PSA), needed for ejaculation.

What is the PSA test?

The prostate specific antigen (PSA) test is a blood test that measures levels of PSA protein in the blood.