Also known as: Prostate-specific antigen blood test
A PSA test is a simple blood test that measures prostate-specific antigen levels to help detect prostate cancer and identify other prostate conditions such as benign enlargement and inflammation.
What is Prostate Specific Antigen (PSA)?
Prostate-specific antigen (PSA) is a protein produced by the prostate gland, an important part of the male reproductive system. A PSA test is a simple blood test that measures the level of prostate-specific antigen in your bloodstream. Healthcare professionals use this test to help identify prostate cancer, as well as other prostate conditions such as benign prostatic hyperplasia (BPH), a non-cancerous enlarged prostate, and inflammation of the prostate.
Although a high PSA level can be a sign of prostate cancer, it can also rise due to other prostate-related conditions, including prostatitis (inflammation), urinary infections, or natural enlargement with age. Because PSA is not cancer-specific, an elevated reading does not automatically mean you have prostate cancer. If your PSA result is higher than expected, your urologist may recommend further investigations, such as a multiparametric MRI (mpMRI) or a prostate biopsy, to determine the underlying cause.
The PSA test is an important tool for assessing prostate health and detecting potential signs of prostate disease, but it forms only one part of a comprehensive diagnostic process. Your PSA result is interpreted alongside other factors, including symptoms, physical examination findings, medical history, and imaging results, to provide an accurate assessment of your risk and guide the need for any further testing or treatment.
What PSA changes can suggest a higher risk of prostate cancer?
Prostate cancer may not cause any symptoms in its early stages, which is why PSA testing can help identify men who may need further checks. Certain changes in PSA levels and prostate health can suggest a higher risk and prompt your doctor to investigate further, although they do not by themselves mean you have cancer.
- Elevated PSA Level: A higher-than-normal PSA level in your blood can be a sign of prostate cancer. However, it can also be caused by other prostate conditions, such as an enlarged prostate (called benign prostatic hyperplasia) or prostatitis.
- Rapid Increase in PSA Levels: Changes in PSA over time (PSA velocity) can sometimes help identify men who may be at higher risk, but this is usually interpreted together with other factors such as MRI findings, age, and prostate size.
- Abnormal PSA Density: PSA density, which considers the PSA level relative to the size of the prostate gland, can help distinguish between cancer and benign conditions. A higher PSA density may indicate a greater likelihood of prostate cancer.
- Persistent Elevated PSA Despite Treatment: If PSA levels remain high or continue to rise after treatment for other prostate conditions, this may suggest that prostate cancer is present or, in men previously treated for cancer, that it has returned.
- PSA Levels Elevated Alongside Urinary Symptoms: Symptoms such as difficulty urinating, frequent urination, or pain during urination combined with elevated PSA levels warrant further evaluation, as they may indicate prostate disease.
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Ways to payBefore the test
Before undergoing PSA testing, you will come in for an initial consultation with your urologist, where you will discuss your general health, family history, and any prostate symptoms you may be experiencing. It is important to inform your doctor if you have a family history of prostate cancer or other prostate problems, as this may increase your risk of prostate cancer and influence the decision to proceed with testing.
Before the test, you should avoid vigorous exercise, such as cycling, and refrain from sexual activity or prostate stimulation for at least 48 hours prior, as these activities can temporarily raise PSA levels and affect the accuracy of the results. Additionally, if you have a urine infection or have recently undergone procedures such as a prostate biopsy or other urinary tract procedures, your provider may recommend waiting until things have settled.
During the test
The PSA test involves a simple blood test in which a healthcare professional takes a blood sample from a vein in your arm using a small needle. The procedure typically takes only a few minutes and is usually performed at your GP surgery or clinic. You can eat and drink normally before the test, and there is minimal discomfort involved. The blood sample is then sent to a laboratory where the level of prostate-specific antigen in your blood is measured.
After the test
Once the laboratory processes your blood sample, your healthcare provider will receive your PSA test result, typically within 1 to 2 weeks. PSA levels are measured in nanograms per millilitre (ng/ml) of blood. It is important to understand that there is no single “normal” PSA level; levels can vary depending on age, prostate size, and other factors. An elevated PSA level does not necessarily mean you have prostate cancer, as benign prostatic hyperplasia, urinary infections, or inflammation of the prostate can also cause it. If your PSA test shows a raised PSA level, your urologist may recommend further tests, including a repeat PSA test, a digital rectal examination, MRI scans, or a prostate biopsy to obtain prostate tissue samples for analysis. These additional tests help improve diagnostic accuracy and determine whether prostate cancer or other prostate conditions are present.
Appointment and Treatment Plan
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Initial Consultation
Your urologist reviews your general health, family history, and any prostate symptoms to determine whether PSA testing is appropriate. Be sure to mention any family history of prostate cancer, as this may influence testing decisions.
Preparing for the Test
To ensure accurate results, you should avoid vigorous exercise (especially cycling), sexual activity, and any prostate stimulation for at least 48 hours beforehand. If you have a urine infection or recently had a prostate or urinary tract procedure, your clinician may advise delaying the test.
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The PSA Blood Test
A small blood sample is taken from a vein in your arm, usually in just a few minutes, with minimal discomfort. You can eat and drink normally. The sample is sent to a laboratory to measure your prostate-specific antigen level.
Receiving Your Results
Your results are typically available within 1-2 weeks. PSA levels vary with age and prostate size, and a raised level does not automatically indicate cancer. Depending on your result, your urologist may recommend further testing such as a repeat PSA, digital rectal examination, MRI, or prostate biopsy.
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Experts
We are proud to provide patients with access to a wide range of clinicians, chosen specifically for their knowledge and reputation in their area of expertise. Our experts align with our values: putting you at the centre of your care and educating you on your options at each step of the journey. We encourage you to learn more about our clinicians and how they can help you below. As always, please contact our patient services team if you require any additional information.
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FAQs
The PSA test is a blood test that measures the amount of prostate-specific antigen (PSA) protein produced by prostate cells and present in your blood. PSA is naturally produced by the prostate gland, which is part of the male reproductive system. While PSA helps to liquefy semen and supports sperm movement, elevated levels of PSA in your blood can indicate prostate cancer, as well as other prostate health problems, such as benign prostatic hyperplasia or prostate infections. The test involves drawing a blood sample, usually from a vein in your arm, which is then analysed in a laboratory to determine the PSA concentration, measured in nanograms per millilitre (ng/ml). It is important to note that PSA testing is not a definitive diagnosis of prostate cancer but rather a screening tool that helps guide further diagnostic steps, such as MRI scans, prostate biopsies, or other tests.
To ensure the accuracy of your PSA test results, there are several important precautions you should take before the test:
- Avoid prostate stimulation: Activities such as ejaculation, sexual intercourse, or prostate massage should be avoided for at least 48 hours before the test, as they can temporarily raise PSA levels.
- Refrain from vigorous exercise: Exercises like cycling or heavy physical activity involving the pelvic area should be avoided for 48 hours before testing to prevent elevated PSA levels.
- Delay testing after medical procedures: If you have recently had a prostate biopsy or other urinary tract procedures, your healthcare provider may advise waiting several weeks before having a PSA test, as these can temporarily raise PSA levels.
- Treat urinary infections first: If you have a urinary infection or prostatitis, your PSA levels may be elevated due to inflammation. Your doctor may recommend treating the infection before performing the PSA test.
- Inform your doctor about medications: Certain medications used for treating benign prostatic hyperplasia can lower PSA levels. Make sure your healthcare provider knows about any medicines you are taking.
Following these guidelines will help reduce the risk of false-positive or false-negative PSA test results and improve the reliability of your prostate cancer screening.
PSA testing can help detect prostate cancer at an early stage, when treatment is more likely to be effective, although it is not offered as part of a routine national screening programme.
Early detection through PSA blood tests can help reduce your risk of mortality from prostate cancer, as it enables timely medical intervention before the malignancy spreads to surrounding tissues. However, PSA testing is not without inherent risks that you should carefully consider. One of the primary concerns healthcare professionals encounter is the possibility of false positive test results, which can lead to unnecessary patient anxiety, additional diagnostic testing, and even treatment interventions that may not be clinically indicated for your specific condition. Additionally, it’s important to understand that not all prostate cancers exhibit aggressive characteristics; some are slow-growing malignancies that may never cause symptoms or health complications during your lifetime. PSA tests may also fail to detect some cancers, as not all men with prostate cancer will present with elevated PSA levels in their blood work.
National clinical guidelines from organisations such as the National Institute for Health and Care Excellence (NICE) provide evidence-based recommendations on when PSA testing should be used in clinical practice, helping healthcare professionals balance the benefits of early detection with the risks of overdiagnosis and overtreatment for patients. It’s essential to discuss the potential benefits and risks of PSA testing thoroughly with your healthcare provider to make a well-informed decision about your prostate cancer screening and ongoing care management.
While the PSA test remains the most commonly used blood test for assessing prostate cancer risk, several additional tests and approaches can help clarify your individual risk and guide decisions about further investigation.
A Digital Rectal Examination (DRE) enables your healthcare provider to examine your prostate gland for any abnormalities.
MRI scans offer detailed imaging of your prostate, which helps identify suspicious areas that may require further investigation and evaluation.
PSA velocity tests monitor changes in your PSA levels over time, which can prove helpful in identifying men who may be at higher risk of developing prostate cancer. Urine tests, such as the PCA3 test, measure prostate-related genetic markers that may help clarify cancer risk, while genetic testing can help identify inherited risk factors that may affect you. Discussing these various options with your healthcare provider will help you choose the most appropriate approach based on your individual risk factors, overall health status, and personal preferences.