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Men's Health
PSA Testing
Understanding your PSA level — what it means, when to test, and what happens next.
Clinically reviewed by
Mr Paul Cathcart
Consultant Urological Surgeon & Robotic Prostate Cancer Specialist · Reviewed June 2026 · Review due June 2027
What is PSA?
PSA (prostate-specific antigen) is a protein produced naturally by both normal and cancerous cells in the prostate gland. A small amount of PSA normally leaks into the bloodstream, where it can be measured with a simple blood test.
The PSA test is the most widely used blood test in prostate health. It plays an important role in the early detection of prostate cancer, but it is not a cancer-specific test. Many non-cancerous conditions can cause the PSA level to rise, including benign prostate enlargement (BPH), infection, and even recent physical activity.
This means that a raised PSA does not automatically mean you have prostate cancer, and equally, a normal PSA level does not guarantee that cancer is absent. The PSA result must always be interpreted in the context of your age, prostate size, any symptoms you may have, family history of prostate cancer, and any other relevant factors.
A raised PSA does not mean you have cancer
Most men with a raised PSA level do not have prostate cancer. There are many benign causes of an elevated PSA, and modern investigation pathways — particularly MRI — can provide clarity quickly and without the need for immediate biopsy.
Who Should Consider PSA Testing?
There is currently no national screening programme for prostate cancer in the UK. However, under the NHS Prostate Cancer Risk Management Programme, any man aged 50 or over can request a PSA test from their GP after an informed discussion about its benefits and limitations.
Certain groups of men are at higher risk of prostate cancer and may benefit from earlier or more regular PSA testing:
Black Heritage
Men of Black African or Black Caribbean descent have approximately double the risk of prostate cancer and as such may consider undergoing a PSA test from age 45.
Family History
If your father or brother has been diagnosed with prostate cancer, your own risk is significantly increased and as such men with a family history of prostate cancer may consider a PSA test from the age of 45.
BRCA2 Carriers
Men who carry a BRCA2 gene mutation have a significantly higher lifetime risk of prostate cancer (1 in 4 men with the BRCA gene mutation will get prostate cancer in their lifetime). In addition, prostate cancers in BRCA mutation carriers often present with a more aggressive form of prostate cancer at a significantly lower age than the general population. As such men are strongly recommended to consider annual PSA testing from age 40, a recommendation that has been suggested by the national screening committee.
If you are unsure whether you should have a PSA test, we are happy to discuss your individual risk factors and help you make an informed decision.
What Can Cause a Raised PSA?
PSA is produced by all prostate cells, not just cancerous ones. Many common conditions and activities can cause the PSA level to rise temporarily or persistently:
Benign Prostate Enlargement (BPH)
The most common cause of a raised PSA. A larger prostate produces more PSA — this is entirely benign.
Prostatitis or Urinary Infection
Infection or inflammation of the prostate can cause a significant temporary rise in PSA, sometimes to very high levels.
Recent Ejaculation or Vigorous Exercise
Ejaculation within 48 hours of the test, vigorous exercise, or prolonged cycling can temporarily raise PSA levels.
Prostate Cancer
Cancer cells produce more PSA per cell than normal tissue, but a raised PSA alone does not confirm cancer — further investigation is needed.
Recent Urological Procedures
Catheterisation, cystoscopy, prostate biopsy, or a digital rectal examination can all temporarily raise PSA.
Age
PSA levels rise naturally as men get older, even without any underlying disease. This is why age-specific reference ranges are used.
Understanding Your PSA Result
PSA is measured in nanograms per millilitre (ng/mL). There is no single "normal" PSA level — instead, your result is interpreted using age-specific reference ranges, which account for the natural increase in PSA with age.
Age-Specific PSA Reference Ranges
| Age Range | Expected PSA (ng/mL) |
|---|---|
| 40 – 49 years | 0 – 2.5 |
| 50 – 59 years | 0 – 3.5 |
| 60 – 69 years | 0 – 4.5 |
| 70+ years | 0 – 6.5 |
Note: These ranges are guides, not absolute cutoffs. A PSA within the expected range does not completely exclude prostate cancer, and a PSA above the range does not confirm it. Clinical context is essential.
Beyond the raw PSA number, your specialist may consider several additional measures to improve the accuracy of the test:
PSA Density
The PSA density can be useful in the detection of early prostate cancer. PSA density is derived by dividing the PSA by the prostate volume (measured on ultrasound or MRI). A high PSA density (above 0.15) can be more concerning, as it suggests the PSA elevation may not be explained by prostate size alone. Most men however will not have had their prostate volume measured in the community and so PSA density is rarely a test done in primary care.
PSA Velocity
The rate at which PSA changes over time. A rapidly rising PSA — even within the normal range — may warrant further investigation, as this pattern can sometimes indicate underlying cancer.
Free-to-Total PSA Ratio
PSA circulates in both "free" and "bound" forms. A lower free-to-total ratio (below 10–15%) may suggest a higher probability of prostate cancer, while a higher ratio is more reassuring.
What Happens if Your PSA is Raised?
If your PSA level is above the expected range for your age, the next step is not an immediate biopsy. Modern investigation follows an MRI-first pathway, as recommended by NICE (NG131). This approach reduces the need for unnecessary biopsies while improving the detection of clinically significant cancers.
Repeat PSA
Your specialist will first confirm the raised PSA with a repeat blood test, ideally after ruling out temporary causes such as urinary infection, recent ejaculation, or vigorous exercise. A urine test to exclude infection is often performed at the same time.
Multiparametric MRI (mpMRI)
If the PSA remains raised, the first-line investigation is now an MRI scan of the prostate — specifically a multiparametric MRI (mpMRI). This is a non-invasive scan that provides detailed images of the prostate and can identify suspicious areas with high accuracy. The MRI is scored using the PI-RADS system, a 1 to 5 scale that correlates with the likelihood of prostate cancer and helps determine which men need a biopsy.
MRI Normal (PI-RADS 1–2)
PI-RADS score 1 and 2 essentially define a normal prostate on MRI, i.e. there are no suspicious areas. This is very reassuring. In most cases, no biopsy is needed and you will be placed on PSA monitoring — typically with a repeat PSA test in 3–6 months.
MRI Suspicious (PI-RADS 3–5)
If the MRI identifies a suspicious area — defined as a PI-RADS score of 3, 4 or 5 — the next step is an MRI-targeted transperineal prostate biopsy. At London Urology Specialists this is performed under a short general anaesthetic. The biopsy identifies first whether prostate cancer is present and, if so, how aggressive the cancer is.
MDT Discussion
A multidisciplinary team (MDT) meeting involving urologists, oncologists, radiologists and pathologists will review the biopsy and imaging of all men undergoing prostate biopsy. This ensures that every patient receives a carefully considered, expert-reviewed management plan.
PSA After Treatment
PSA monitoring is a cornerstone of follow-up after prostate cancer treatment. The expected pattern depends on the type of treatment you have received:
After Radical Prostatectomy
With the entire prostate removed, PSA should fall to undetectable levels (less than 0.1 ng/mL). Any subsequent rise may indicate recurrence and warrants prompt review.
After Radiotherapy
PSA falls gradually over months to a low point (nadir). A subsequent rise of 2.0 ng/mL or more above the nadir is considered a biochemical recurrence and requires further assessment.
After Focal Therapy
Because only part of the prostate is treated, the PSA does not fall to zero. Monitoring combines regular PSA testing with serial MRI scans to assess the treated area. A rising PSA or new MRI findings may prompt repeat biopsy to check for residual or recurrent disease.
Active Surveillance
For men with low-risk prostate cancer on active surveillance, PSA is monitored regularly (typically every 3–6 months) alongside repeat MRI and clinical assessment to detect any change that might require treatment.
For more detail on treatment and monitoring, please visit our prostate cancer page.
Meet your Specialists
Assessment and treatment of raised PSA is led by our experienced consultant urologists. Your care will be personally overseen by one of our senior specialists.
Key Takeaways
PSA is a valuable tool but must be interpreted in context. A raised PSA does not always mean cancer, and further investigation — starting with MRI — can provide clarity without the need for immediate biopsy. If you are concerned about your PSA result, specialist review can help put your mind at ease.
Further Reading — BAUS Patient Information
Frequently Asked Questions About PSA Testing
PSA (prostate-specific antigen) is a protein produced by both normal and cancerous cells in the prostate gland. A small amount leaks into the bloodstream and can be measured with a simple blood test. Because non-cancerous conditions can also raise PSA, the test is a useful screening tool but not a cancer-specific test — a raised result always needs to be interpreted in the context of your age, prostate size, symptoms and family history.
There is no single “normal” PSA level — the expected range rises with age. As a general guide, the expected range is 0–2.5 ng/mL for men aged 40–49, 0–3.5 for 50–59, 0–4.5 for 60–69 and 0–6.5 for those aged 70 and above. These are guides, not absolute cutoffs. A PSA within the expected range does not completely exclude prostate cancer, and a PSA above the range does not confirm it — clinical context is essential.
No — most men with a raised PSA do not have prostate cancer. Common benign causes include benign prostate enlargement (BPH), prostatitis or urinary infection, recent ejaculation or vigorous exercise, and recent urological procedures (including catheterisation, cystoscopy, biopsy or a digital rectal examination). A raised PSA is a signal that further assessment is needed, not a diagnosis.
PSA testing is a personal decision made after an informed discussion of the benefits and limitations. There is no UK national screening programme, but any man aged 50 or over can request a PSA test through their GP. Men at higher risk — those of Black African or Black Caribbean heritage, those with a father or brother who has had prostate cancer, and BRCA2 gene carriers — may benefit from earlier or more frequent testing (from age 45 for the first two groups; age 40 for BRCA2 carriers).
Several things can raise PSA temporarily. To avoid a misleading result, we recommend no ejaculation for at least 48 hours before the test, and avoiding vigorous exercise or prolonged cycling in the days beforehand. Testing should also be delayed after a recent urinary infection, catheterisation, cystoscopy, biopsy or digital rectal examination. If any of these apply, it is usually best to reschedule so the result is a true reflection of your baseline.
Not automatically. Modern practice — following NICE guidance (NG131) — is an MRI-first pathway. A multiparametric MRI (mpMRI) of the prostate is performed before any decision on biopsy. If the MRI is reassuring, biopsy can often be avoided altogether. If the MRI shows a suspicious area (PI-RADS 3–5), a targeted biopsy is arranged under short general anaesthetic. This approach reduces unnecessary biopsies while improving the detection of clinically significant cancers.
The interval depends on your baseline PSA, your age and your risk factors. For men with a normal PSA and average risk, an annual test is a reasonable rhythm. Higher-risk men (those of Black heritage, with a family history, or BRCA2 carriers) may benefit from annual testing from a younger age. Your specialist will recommend an interval tailored to your individual result and risk profile.
Yes — in fact, most PSA testing is done in men without symptoms, as a way of detecting early, curable prostate cancer before it produces symptoms. Prostate cancer in its early stages usually causes no symptoms at all, which is why proactive testing in men at higher risk, or those who simply wish to be informed about their prostate health, is worthwhile.
Concerned About Your PSA?
Whether you have been told your PSA is raised, or you would like to arrange a PSA test and specialist review, our team is here to help.