What is the PSA test?

The PSA test is a blood test that measures the amount of prostate specific antigen (PSA) in your blood. PSA is a protein produced by normal cells in the prostate and also by prostate cancer cells. It’s normal to have a small amount of PSA in your blood, and the amount rises slightly as you get older and your prostate gets bigger. A raised PSA level may suggest you have a problem with your prostate, but not necessarily cancer.

Who can have a PSA test?

You have the right to a PSA test if you’re over 50 and you’ve thought carefully about the advantages and disadvantages. If you’re black or you have a family history of prostate cancer, this can increase your own risk – so you may want to speak to your GP about having a PSA test from the age of 45.

You may also be offered a PSA test if you have symptoms of a possible prostate problem.

Some men are offered a PSA test as part of a general check-up. You should still think about the advantages and disadvantages and whether the test is right for you before agreeing to have one.

What could affect my PSA level?

Prostate specific antigen (PSA) is produced by healthy cells in the prostate, so it’s normal to have a small amount of PSA in your blood. The amount rises as you get older because your prostate gets bigger.

Prostate problems, such as an enlarged prostate, prostatitis or prostate cancer, can cause your PSA level to rise – but lots of other things can affect your PSA level too, including the following.

• A urine infection – You may have a test for a urine infection as this can raise your PSA level. If you have an infection, you’ll be given treatment for this. You’ll need to wait until the infection has gone – around six weeks – before you have a PSA test.
• Vigorous exercise – You might be asked not to do any vigorous exercise in the 48 hours before a PSA test.
• Ejaculation – You may be asked to avoid any sexual activity that leads to ejaculation in the 48 hours before a PSA test.
• Anal sex and prostate stimulation – Receiving anal sex, or having your prostate stimulated during sex, might raise your PSA level for a while. It might be worth avoiding this for a week before a PSA test.
• Prostate biopsy – If you’ve had a biopsy in the six weeks before a PSA test, this could raise your PSA level.
• Medicines – Let your GP or practice nurse know if you’re taking any prescription or over-the-counter medicines, as some might affect your PSA level. For example, some medicines used to treat an enlarged prostate, known as 5-alpha-reductase inhibitors such as finasteride (Proscar^®) or dutasteride (Avodart^®), can reduce your PSA level and give a false test result.
• Other tests or surgery – If you've had any tests or surgery on your bladder or prostate, you may need to wait up to six weeks before having a PSA test.
• Urinary catheters – If you have a catheter to drain urine from your bladder, you may need to wait up to six weeks after it has been put in before having a PSA test.

Having a PSA test

You can have a PSA test at your GP surgery. Your GP or practice nurse might talk to you about having a PSA test if you're worried about prostate problems, if you’re at increased risk of getting prostate cancer, or if you have symptoms such as problems urinating.

What will happen at the GP surgery?

If you don't have any symptoms, your GP or practice nurse should talk to you about the advantages and disadvantages of the PSA test before you decide whether to have one. You should tell them if anyone in your family has had prostate or breast cancer.

Your GP or practice nurse will also talk to you about your general health and any other health problems. If you have a serious health problem that means you wouldn't be fit enough for treatment for prostate cancer, or if treatment wouldn’t help you to live longer, your GP may not recommend having a PSA test unless you have symptoms of a possible prostate problem.

If you decide you want a PSA test, your GP may also suggest doing a digital rectal examination (DRE) – sometimes known as a physical prostate exam – and a urine test to rule out a urine infection.

What does the PSA test involve?

A sample of your blood is taken and sent to a laboratory to be tested. The amount of PSA in your blood is measured in nanograms (a billionth of a gram) per millilitre of blood (ng/ml). You can eat and drink as normal before having a PSA test.

It can take one to two weeks to get your test results.

PSA testing in the community

You may see PSA tests being offered in places such as community centres or football stadiums. If you’re thinking about having a PSA test at this type of event, make sure a doctor or nurse will be there to give you information and support.

If you can, it’s usually best to visit your GP if you’re thinking about having a PSA test. If you do have a PSA test in the community you should visit your GP to discuss the results, especially if you have a raised PSA level.

What will the test results tell me?

Lots of things can cause a raised PSA level, including the following prostate problems:

• an enlarged prostate
• prostatitis
• prostate cancer

So a PSA test alone can’t usually tell you whether you have prostate cancer. Many men with a raised PSA level don't have prostate cancer. And some men with a normal PSA level do have prostate cancer.

To decide whether you need to see a specialist at the hospital, your GP will look at:

• your PSA level
• the results of a DRE, if you've had one
• whether you have any risk factors for prostate cancer
• any other health problems or things that may have affected your PSA level
• whether you’ve had any tests for prostate cancer before.

What happens next?

If your GP thinks your PSA level is higher than it should be for your own situation, they may arrange for you to see a specialist at the hospital. For example, they might make an appointment for you to see a specialist if your PSA level is 3 ng/ml or higher. But this is just a guide and slightly higher levels may be normal in older men.

They might refer you to a specialist if your PSA level is lower than 3 ng/ml but you have an increased risk of prostate cancer for other reasons, such as your family history.

If your GP thinks you could have prostate cancer, you will usually see a specialist within two weeks. You may hear this called a 'two-week wait' or 'fast-track' referral.

If your GP thinks something else has caused your PSA level to be raised, they might suggest having another PSA test in the future to see if your PSA level changes, rather than seeing a specialist straight away.

Your GP should discuss all of this with you, to help you decide what to do next.

Advantages and disadvantages of the PSA test

It’s important to think through the advantages and disadvantages of the PSA test. Having a PSA test is a personal decision – what might be important to one man may be less important to another.

Advantages

• It can help pick up prostate cancer before you have any symptoms.
• It can help pick up a fast-growing cancer at an early stage, when treatment could stop it spreading and causing problems.
• A regular PSA test could be helpful, particularly if you have an increased risk of prostate cancer. This could detect any unusual increase in your PSA level that might be a sign of prostate cancer.

Disadvantages

• Your PSA level might be raised, even if you don’t have prostate cancer. Many men with a raised PSA level don’t have prostate cancer.
• The PSA test can miss prostate cancer. For example, one major study showed that 1 in 7 men (15 per cent) with a normal PSA level may have prostate cancer, and 1 in 50 men (two per cent) with a normal PSA level may have a fast-growing cancer.
• If your PSA level is raised you may need a biopsy. This can cause side effects, such as pain, infection and bleeding. But in most hospitals, men now have an MRI scan first, and only have a biopsy if the scan finds anything unusual.
• Being diagnosed with a slow-growing prostate cancer that is unlikely to cause any problems or shorten your life may still make you worry, and may lead you to have treatment that you don't need. But most men with low-risk, localised prostate cancer now have their cancer carefully monitored instead, and only have treatment if the cancer starts to grow. 

Should I have a PSA test?

Deciding whether or not to have a PSA test can be difficult. Before you decide, try asking yourself the following questions, or discuss them with your GP or practice nurse.

• Am I at increased risk of prostate cancer?
• If my PSA level was normal, would this reassure me?
• What would happen if my PSA level was higher than expected?
• Would my local hospital do an MRI scan before deciding whether to do a biopsy?
• If I was diagnosed with slow-growing prostate cancer that might never cause any problems, would I still want to have treatment, even though it could cause side effects? Or would I be comfortable having my cancer monitored instead?

It might help to talk this over with your partner, family or friends. If you want to discuss the test, call our Specialist Nurses. They can help you understand your own risk of prostate cancer and talk you through the advantages and disadvantages of the PSA test.

You may also find it helpful to fill out this information sheet. It has space to write down any risk factors or symptoms you have and lists questions you might want to ask your GP.

You could have the sheet in front of you when you talk to your GP, to help guide your conversation.

Worried about going to the GP?

What if my GP won't give me a PSA test?

You have the right to a PSA test if you’re over 50 and you’ve thought carefully about the pros and cons. If you then decide that you want a test, your GP should give you one.

A PSA test isn't suitable for everyone. For example, your GP may not recommend it if your general health means you wouldn't be fit enough for treatment for prostate cancer, or if treatment wouldn't help you to live longer.

If your GP doesn't agree to do a PSA test, ask them to explain why, as there may be a good reason.

Explain that you are entitled to a PSA test under the NHS Prostate Cancer Risk Management Programme. It might help to print this webpage and take it to the appointment with you. You could also print and show them our information for GPs.

• If they still say no, try speaking to another GP or practice nurse.
• If they also say no, speak to the practice manager at your GP surgery.
• Your GP surgery should have information about its complaints procedure. You can follow this procedure, or write to the GP or practice manager explaining your complaint.

If you still can't get a PSA test, you could follow the NHS complaints procedure.

• In England: you can complain to NHS England. The NHS website has more information.
• In Scotland: you can complain to your local health board. The Patient Advice and Support Service can provide information, advice and support. Get more information from NHS Inform.
• In Wales: you can complain to your local health board. Your local Community Health Council can help with this. Health in Wales has more information.
• In Northern Ireland: you can complain to the Health and Social Care board. The Patient and Client Council can provide advice and support. Get more information from nidirect.

Make sure you include the following information in your complaint:

• your name
• your contact details – such as your home address, telephone number or email address
• a clear description of your complaint – including what happened, where and when
• details of any relevant conversations, letters or emails you’ve had.

You can also get advice and support from Citizens Advice.

If you’re not sure whether to make a complaint, get in touch with our Specialist Nurses. They can help you understand your risk of prostate cancer so that you can decide what to do next.

What is a baseline PSA test?

A baseline prostate specific antigen (PSA) test involves having a PSA test while your risk of getting prostate cancer is still low – for example in your 40s.

The aim of a baseline PSA test is not to help diagnose prostate cancer. Instead, some research suggests that it could be used to predict how likely you are to get prostate cancer in the future. For example, if a man’s PSA level in his 40s is slightly higher than expected, he might have a higher risk of getting prostate cancer in the future.

If the test suggests you're at higher risk, you and your doctor may decide to do regular PSA tests to spot any changes that might suggest prostate cancer.

However, we don’t yet know exactly what PSA level in your 40s would suggest an increased risk of prostate cancer in the future, or how often you should have a PSA test after the baseline test. Because of this, baseline testing isn’t very common in the UK. For more information about baseline testing, speak to your GP.

Why isn't there a prostate cancer screening programme?

Screening programmes aim to find early signs of cancer in people who don’t yet have any symptoms. They invite all suitable people to have a test to find out if they are at risk. In the UK there are screening programmes for breast, cervical and bowel cancer. Finding cancer early means it could be treated in time to get rid of it before it causes any problems.

There is currently no screening programme for prostate cancer in the UK.

It’s important that the benefits of any screening programme outweigh the disadvantages. But it isn’t clear that screening all men with the PSA test would have more benefits than disadvantages.

Some studies have found that screening with the PSA test could mean fewer men die from prostate cancer. But it would also mean that:

• some men would have a biopsy, which could cause side effects
• a large number of men would be diagnosed with a slow-growing cancer that wouldn’t cause any symptoms or shorten their life
• some of these men would have treatment they didn’t need, which could cause side effects.

While the PSA test on its own isn't suitable as a screening test for prostate cancer, researchers are working to find a test, or combination of tests, that might be suitable in the future.

Until then, the Prostate Cancer Risk Management Programme gives men over 50 the right to have a PSA test on the NHS – as long as they’ve thought carefully about the advantages and disadvantages.

References and reviewers

Updated February 2021 | Due for Review: February 2024