Should I have a PSA test?

The PSA test is a blood test which can detect the early signs of prostate cancer.

The test, which can be done at a GP surgery, measures the level of PSA (prostate-specific antigen) in your blood.

PSA is made by the prostate gland. Some of it will leak into your blood, and the amount depends on your age and the health of your prostate.

Raised PSA levels

The amount of PSA in your blood is measured in nanograms of PSA per millilitre of blood (ng/ml). PSA levels can range from 1ng/ml to hundreds of ng/ml.

  • If you're aged 50–59, your PSA level is considered raised if it's 3ng/ml or higher.
  • If you're aged 60–69, your PSA level is considered raised if it's 4ng/ml or higher.
  • If you're aged 70 or over, your PSA level is considered raised if it's 5ng/ml or higher.

A raised PSA level in your blood may show that you have a problem with your prostate. However, this may not be prostate cancer.

Key statistics

  • About 15% of all men with a 'normal' PSA level (under 4ng/ml) may have prostate cancer. 
  • Two out of three men with a raised PSA level don't have prostate cancer. 
  • One out of three men with a raised PSA level will have cancer.
  • Two out of three men who have a biopsy don’t have cancer.
  • Biopsies in one in five men fail to spot prostate cancer.

Other conditions, such as an enlarged prostate, prostatitis or a urinary infection, can also cause a raised PSA level.

All men over 50 are entitled to a PSA test free on the NHS, as long as they have made an informed choice based on the benefits, limitations and risks of having the test. 

Your GP can discuss this choice with you, and can help you make a decision. 

Men with a higher risk of prostate cancer, such as black men or men with a family history of the condition, may be encouraged to have a PSA test by their GP. Watch a video on black men and prostate cancer.

Before having the test

If you're having a PSA test, you should not have:

Each of these may give an inaccurate PSA reading.

What happens after the test?

There are usually three main options after a PSA test.

A normal PSA level
If your PSA level is not raised, you are unlikely to have cancer. No immediate action is needed, although you may have further PSA tests in the future. However, the PSA test doesn’t always pick up prostate cancer.

A slightly raised PSA level
Two out of three men with a raised PSA level will not have prostate cancer. If your PSA level is slightly higher than normal, you probably don’t have cancer but you might need further tests, including more PSA tests.

A raised PSA level
One out of three men with a raised PSA level will have cancer. The higher the level of PSA, the more likely it is to be a sign of cancer. If your PSA level is definitely raised, your GP will arrange for you to see a specialist for further tests to find out if you have prostate cancer.

A PSA test alone cannot tell you whether you have prostate cancer. If the test shows your PSA levels are raised, your doctor may suggest you have a digital rectal examination (DRE). This is an examination of the prostate gland, during which a doctor will insert a gloved finger into your rectum.

No screening

There is currently no prostate cancer screening programme on the NHS. However, the government is committed to introducing one if and when an accurate diagnosis test becomes available and there is a clear treatment process.

 

The DRE checks for signs of prostate cancer, such as the prostate gland feeling hard. However, a gland that feels normal does not necessarily mean you don't have cancer.

Many early cancers may not be detected by a DRE. Therefore, a DRE is not recommended as a substitute for the PSA test.

Your doctor will also consider your age, any family history of prostate cancer, your ethnic background and any previous PSA test results.

In some cases, extra PSA tests may help make the situation clearer or show any changes.

Pros and cons of the PSA test

Pros

  • It may reassure you if the test result is normal.
  • It may give you an indication of cancer before symptoms develop.
  • It may find cancer at an early stage, when treatment could prevent the cancer from becoming more advanced. 
  • If treatment is successful, you will avoid the risks of advanced cancer.
  • In cases of advanced cancer, treatment will usually extend life.

Cons

  • It can miss cancer and provide false reassurance.
  • It may lead to unnecessary worry and medical tests when there is no cancer.
  • It cannot tell the difference between slow-growing and fast-growing cancer.
  • It may make you worry by finding slow-growing cancer that may never cause any symptoms or shorten your life.
  • To save one life from prostate cancer, 48 men would have to be treated.

Further tests 

If your PSA level is raised, a biopsy, which involves taking tissue samples from the prostate gland, may be needed to check if you have cancer.

About two out of three men who have a biopsy of the prostate don’t have cancer.

However, biopsies can miss some cancers. Biopsies in one in five men will fail to pick up prostate cancer. You may not know for sure that you don’t have cancer after a clear result.

Biopsies can sometimes cause complications. About one in three men experience blood in the urine and blood in the sperm after a biopsy.

If the PSA test and biopsy show the early signs of cancer, talk to your consultant about the benefits and risks of any treatment before you begin.

Read more about prostate cancer treatment, including the side effects of different treatments.

Page last reviewed: 15/01/2013

Next review due: 15/01/2015

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Comments

The 15 comments posted are personal views. Any information they give has not been checked and may not be accurate.

CapeWerde said on 10 September 2014

I was never told this test was available on the NHS and that I was eligible. Why does the NHS not inform patients? It is too late as I have now been diagnosed with advanced prostate cancer which cannot be cured.

If I had known about the test I would have taken it and I may well have been diagnosed at an earlier stage which would allow be to have been cured. Now I have a treatable but ultimately terminal cancer diagnosis.

The NHS should write to all men to tell them this test is available.

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charles46 said on 04 February 2014

I found the after treatment I had lot of problem with my bowl
this will get better over time my psa was 35 that was over 3 years ago it is under 2PSA to day not bad

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Steuart2305 said on 20 November 2013

With around 40,000 men diagnosed with prostate cancer and more than 10,000 9Daily Mail 19.11.13) dying each year with no screening programme and no sign there will ever be one, we have a crisis. The very different ways approaches have been dealt with illustrates the priority the NHS places on this issue. All your helpful comments on pages such as this make no difference at all.

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Sutol said on 27 June 2013

My GP had my PSA test done when I went in for what I thought was a routine cholesterol test. Thank heavens he did as my PSA was found to be slightly elevated which led to cancer being diagnosed.

I had a transrectal biopsy performed which was negative but as my PSA was still rising my consultant decided to perform a template biopsy which turned out to be positive.

It is important to get retested regularly. I think for a man over 50 they should be getting tested once a year if normal. If your first PSA is slightly elevated then have another in 3-6 months and then decide on the frequency thereon. The rate of change of PSA is a good indicator if there is anything sinister going on.

At present the PSA test is the best we’ve got. How you interpret the results is up to you but don’t stick your head in the sand and think it can’t happen to you. Frankly I owe my life to the GP who asked for a PSA test to be done. I did not have any symptoms and my Gleeson score turned out to be 7 so quite aggressive, I was 54 at the time.

Just my sixpeneth :)

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BBumpsB said on 13 April 2013

I had a real struggle to convince my doctor to do my first PSA test. She told me, "don't go looking for trouble half way". What a great attitude! I told her about my two friends who were dying of cancer, which started in their prostate. This finally convinced her and I was glad I persisted. Since then I try to have a test every year and more often if advised to do so.

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Anarnatula said on 24 March 2013

This article is confusing. It lists levels at which PSA is considered raised. It then describes the impact of both a "raised" and a "slightly raised" PSA. At what point or level does PSA move from slightly raised to raised? My GP has advised me my level is raised for my age group and confirmed the raised level as being above that stated in this article. However I now want to know if the level is only "slightly raised" or if it is actually "raised".

It is important as according to this article the risk of me having cancer has doubled from a 33% chance to a 66% chance as my GP defined my PSA as raised. However, they never define the result as slightly raised. Can anybody direct me to a more informed site for information on PSA results ?

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El Presidente said on 18 March 2012

This page contains the same information as that provided to GPs by NHS's Prostate Cancer Risk Management Programme, This is the same information that my GP provided to me.

it is therefore wrong to say that my GP will have information to help me make the decision. In fact, my GP will simply have exactly the same information that appears on this page.

I asked for information from my GP and they gave me no more help that theg general narrative here. They did kindly make sure my smoking status and BMI were updated on their records though. .

My GP could tell me no facts about wrong diagnosis, missed cancer etc. .

Why are the facts and percentages of pros and cons not available here? Why does NHS choices insist people run along to their busy GP to simple get hold a facts?

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Cajetan said on 11 March 2012

I think before I subject myself to a screening test which leads me to undergo further invasive tests I would want a clearer insight to the risks than simply 1 in 3 risk for "slightly raised". Who decided 1 in 3 was the right - the NHS team behind the Prostate Cancer Risk Management Programme - manage their own budget and also are not independent in assessing mens health needs. In fact, having looked at their website for more information I see that they do not provide any. They simply direct the reader to either Cancer Research UK and The Prostate Cancer Charity. I have no faith in them as the information is provided in such a simple format. I want evidence based science when I have medical treatment not some dumbed down version of risk which are provided so that busy GPs and all patients can understand simple messages. I want detailed advice.

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Steven Shukor said on 08 March 2012

The information in this article is based on the NHS's Prostate Cancer Risk Management Programme, which aims to supply primary care teams with an easy reference to assist them in providing men (without cancer symptoms) with information on the benefits, limitations and implications for having a PSA test for prostate cancer.

Basically, this is the information a GP is likely to be referring to when discussing with you the pros and cons of having a PSA test.

Steven, Editor, Live Well

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toedhall said on 30 November 2011

I am trying to evaluate whether to have a PSA test or not.

There is no real information on this website. The pros and cons are too general. There is no statistics, ratios, or facts.

Why not make the information that my GP has to help me make a decision available on this website? This would save both me and my GP time.

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Balham High said on 07 November 2011

The NHS denies men the choice of a PSA test by not informing them of their entitlement.

There are no screening letters issued to men. Men are denied routine information about prostate cancer, the benefits and disadvantages of a PSA test.

Female health screening receives most funding and all women are invited to consider screening for both breast and cervical cancer. Men have to find the screening information themselves and often present later for diagnosis.

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Dismayed said on 20 October 2011

Kickoff's experience is oh so typical of what we have come to expect from our GPs today. I have sought advise on occasion from my GP but never get to see the same one twice, and never get a straight answer or advise. Unless they can refer you to someone else, they are of little help.

Being in my 50s, this is the sought of thing I should feel comfortable discussing with my GP but unfortunately, in my experience, the marketing of GPs does not match the reality of them .

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Kickoff said on 05 October 2011

My GP had very little information about a PSA test when I asked about a check - there is a family history of prostate cancer in my family. She suggested I may like to do a little research and suggested NHS choices website.

This website redirects me back to my GP. "Your GP can discuss this choice with you, and will have information to help you make the decision. " SIgh.

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Auld Guy said on 04 October 2011

Can I have a PSA test and get the result before deciding whether to have a DRE? The article says if the level if raised In addition to the PSA test, your doctor will give you a DRE. However, what is considered raised ? Surely there is a result on the borderline between raised and normal. I have heard of men who have had a DRE at the same time as a PSA test - before the result was even known.

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Bullit 3 said on 03 October 2011

There are no statistics on this page. I want to see the chances of each event. I want to see the average result, the variations. I want to know the chances of false positive results and false negatives. How can a patient make an informed choice with such little information ?

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