Navigation

PSA testing for prostate cancer


Expert reviewer, Professor Raj Persad, Consultant Urological Surgeon
Next review due July 2022

The PSA test is a blood test that measures the amount of a protein called prostate specific antigen (PSA). This protein is produced by both normal and cancerous prostate cells. A raised level of PSA may be a sign of cancer.

 Older man using smartphone

A PSA test can help spot early signs of prostate cancer. However, it’s not always reliable: the test may sometimes suggest you have cancer when you don’t or it may miss some cases of cancer. Furthermore, a raised PSA level can be caused by conditions other than cancer affecting your prostate.

It’s important to think about the risks, as well as the benefits, before you decide whether or not to have this test.

What is PSA?

PSA is a protein that’s produced by your prostate gland. All men have a prostate gland and it’s normal to have a small amount of PSA in your blood. Your PSA level rises as you get older and your prostate gets bigger.

If you have prostate cancer, this can raise the level of PSA in your blood. A PSA test can detect this. However, it’s important to bear in mind that a raised PSA level can be caused by something other than cancer. There are a number of much less serious causes of raised PSA. These include:

  • having an enlarged prostate (benign prostatic hyperplasia) – a very common condition in older men
  • urinary infections
  • inflammation or infection of the prostate gland
  • having a urinary catheter
  • vigorous exercise
  • ejaculation

Prostate cancer doesn’t always raise PSA. This is particularly true for early-stage cancers. It’s possible to have prostate cancer with a normal PSA level. There’s no way of knowing which early cancers will be ones that eventually grow and cause problems.

Prostate cancer doesn’t always cause symptoms and it becomes more common in men as they get older. Although prostate cancer causes problems for some men, others live with it for many years – even the rest of their lives – without any major problems.

.

Who can have a PSA test?

Your GP will usually offer you a PSA test if you have symptoms that could be caused by an enlarged prostate or prostate cancer. These symptoms can include having a weaker flow of pee (urine), a more urgent need to pee or feeling that you haven’t emptied your bladder fully. These symptoms could also be caused by other problems but your GP will want to check for prostate cancer.

Any man over the age of 50 can request a PSA test at their GP surgery even if they don’t have symptoms. However, it’s important to think about the benefits and risks of having the test, and its limitations. Your GP or practice nurse should give you detailed information about the pros and cons of the test to help you think this through. They’ll also discuss other tests you may be advised to have following a raised PSA result. If you’re diagnosed with prostate cancer, your GP or practice nurse will be able to discuss what treatments you may need. Talking to your doctor or nurse will help you make an informed decision about whether or not to have the test.

 Worried about prostate cancer?

Get a picture of your current health and potential future health risks with one of our health assessments. Find out more today. Find out more about health assessments >

 Worried about prostate cancer?

What are the benefits and risks of a PSA test?

Before offering you a PSA test, your GP will want to talk to you about the benefits and risks of having the test. We summarise some the main points here.

Benefits

  • If you have a normal result, it may help to reassure you.
  • If you have a prostate cancer that could go on to cause problems, the PSA test can help to diagnose it at an early stage, before you get symptoms.
  • Being diagnosed early means you can get treatment at an earlier stage when it will be most beneficial.

Risks

  • You may get a normal PSA result even if you do have cancer (a false negative) – this can provide false reassurance. Up to about 15 in 100 men who have a negative PSA test do actually have prostate cancer. However, these are often very early cancers and may not all be ones that go on to cause problems.
  • You may have a higher than normal PSA result even if you don’t have prostate cancer (a false positive). This can cause unnecessary anxiety and may mean you end up going for unnecessary invasive tests.
  • You may be diagnosed with a very slow-growing cancer, that would have never caused any symptoms or affect your lifespan. You may end up seeking treatment for your cancer, even if it’s not really necessary.

Every man will value these benefits and risks differently. Your own decision about whether to have the test will be based on your own personal feelings and preferences.

Having a PSA test

If you decide to go ahead with the test, your GP will ask you to book a blood test at a suitable time. You should be able to have a PSA test at your GP surgery.

You’ll be asked not to book the test if you have an active urine infection or you are still within at least:

  • 6 weeks of a having a prostate biopsy
  • 1 week of having a digital rectal examination (DRE)
  • 2 days after vigorous exercise
  • 2 days after ejaculation

All these things can raise your PSA level and so may give an inaccurate result.

When you have the test, your GP, phlebotomist (a health professional trained in taking blood) or a practice nurse will take a sample of blood. This will be sent to the laboratory for testing.

Your GP or nurse may also suggest having a DRE after your blood test. Your GP or nurse will gently feel inside your back passage (rectum) for any hard or irregular areas that could be a sign of prostate cancer. Having the DRE in combination with the PSA test will give your doctor a better idea of whether to offer you a referral for further tests. These further tests may include an MRI and then possibly a biopsy. But it’s important to note that like the PSA test, the DRE doesn’t always detect prostate cancer, especially in its early stages.

When will I get the results of my PSA test?

It can take around a week to get the results of your PSA test.

What is a high level of PSA?

PSA is measured in nanograms per millilitre of blood (ng/ml). The level that’s considered normal depends on your age and race. If you’re aged 50 to 69, your PSA level is considered to be raised if it’s 3.0 ng/ml or higher. However, this is just a guide. As you get older, your prostate gets bigger and your PSA level rises. It can also be affected by a urinary infection or vigorous exercise (for more information, see our section: Having a PSA test).

What happens if I have a high PSA level?

If you have a high PSA level, your GP may refer you to a urological cancer specialist. Remember, PSA level alone can’t conclusively show if you have prostate cancer. Your GP will look at several other factors, in addition to the results of your PSA test, to decide whether or not to refer you. These will include results of your digital rectal examination (DRE), if you’ve had one, and any symptoms and risk factors for prostate cancer. For more information about risk factors, see our FAQ: Am I at higher risk of prostate cancer?

If your PSA level is low or normal, you may sometimes still need to be referred to a specialist. This may be because you have an abnormal DRE, you have certain urinary symptoms or you’re considered to be at high risk of prostate cancer.

Your GP might ask you to repeat the test if your PSA level is borderline or just above normal. They may also want you to repeat the test if there’s something that could have affected the result – such as having a recent infection.

If you are referred to a urologist, they are likely to recommend that you have an MRI scan of your prostate. This may avoid the need for a biopsy or it may help indicate which areas to target with a biopsy.

You may then have a prostate biopsy to confirm or exclude a diagnosis. This is when small samples of tissue are taken from your prostate gland for analysis. The biopsy may be done using a needle inserted into your back passage, or into the area of skin between your testicles and back passage (the perineum).

Find out more about prostate cancer and how it’s treated in our information on prostate cancer.

Frequently asked questions

  • PSA testing isn’t part of a national screening programme for prostate cancer. This is because it’s not certain if the benefits of the test outweigh the risks. While there is evidence that the PSA test can reduce the risk of dying from prostate cancer, there are problems with over-diagnosis (diagnosing cancer that wouldn’t have caused any problems) and having unnecessary treatments.

    Instead, men can make an informed choice about whether or not to have their PSA level checked once they are 50. This is called prostate cancer risk management.

    If you have certain symptoms or you’re at higher risk of prostate cancer, your GP may suggest you have a PSA test as part of investigations to find out what’s causing your symptoms. But otherwise, if you’re healthy and not having any symptoms, then you won’t routinely be offered this test.

    Talk to your doctor about any questions you have about the PSA test so you can get all the information you need.

  • There are some risk factors that may put you at higher risk of prostate cancer. These include being older, family history and genes, and your ethnicity.

    Age

    Prostate cancer mainly affects men aged over 50. If you’re over 45 and have additional risk factor you may be at a higher risk too.

    Family history and genes

    If someone close to you in your family such as your dad or brother has had prostate cancer you may be at a higher risk. If your mum or sister has had breast cancer, this also increases your risk. This is because you may have inherited the same faulty genes that cause these cancers.

    Ethnicity

    Doctors don’t know why, but black men have a higher risk of prostate cancer.

    If these risk factors apply to you, it doesn’t mean you’ll get prostate cancer. But you may want to talk to your doctor about risk and your options, such as having a PSA test.


About our health information

At Bupa we produce a wealth of free health information for you and your family. This is because we believe that trustworthy information is essential in helping you make better decisions about your health and wellbeing.

Our information is guided by the principles of The Information Standard and complies with the HONcode standard for trustworthy health information. We are also a proud member of the Patient Information Forum.

PIF member logo  This website is certified by Health On the Net Foundation. Click to verify.

Learn more about our editorial team and principles >

Related information

    • Prostate cancer risk management programme (PCRMP): benefits and risks of PSA testing. Public Health England. www.gov.uk, published 29 March 2016
    • Prostate cancer. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised October 2017
    • Prostate specific antigen (PSA). PatientPlus. patient.info/patientplus, last edited 16 March 2019
    • LUTS in men. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised November 2018
    • Prostate symptoms: bladder outlet obstruction. British Association Urological Surgeons. www.baus.org.uk, accessed May 2019
    • PSA test. Prostate Cancer UK. prostatecanceruk.org, updated November 2016
    • Digital rectal examination (DRE). Prostate Cancer UK. prostatecanceruk.org, updated January 2019
    • Prostate cancer: diagnosis and management. National Institute for Health and Care Excellence (NICE), May 2019. www.nice.org.uk
    • Are you at risk? Prostate Cancer UK. prostatecanceruk.org, updated August 2017
  • Reviewed by Natalie Heaton, Specialist Health Editor, Bupa Health Content Team, July 2019
    Expert reviewer, Professor Raj Persad, Consultant Urological Surgeon
    Next review due July 2022



Has our health information helped you?

We’d love to know what you think about what you’ve just been reading and looking at – we’ll use it to improve our information. If you’d like to give us some feedback, our short survey will take just a few minutes to complete. And if there's a question you want to ask that hasn't been answered here, please submit it to us. Although we can't respond to specific questions directly, we’ll aim to include the answer to it when we next review this topic.

ajax-loader