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What is the PSA test?

#Dr Rakesh Kumar 22 Aug, 2024

What is the PSA test?

PSA is a protein produced by both normal and cancerous cells in the prostate gland. The PSA test determines how much PSA is present in a man's blood.

How a PSA test is done?

In PSA test requires the blood sample to be analysed in laboratory. Results are usually available within a few days. It can be of two kinds. Total PSA and Free PSA.

What are the normal PSA levels?

PSA levels are commonly expressed in nanograms per millilitre of blood (ng/mL).

Toal PSA of less than 4 ng/ml is regarded as normal.

Free PSA is done when the Total PSA is in the range of 4 to 10 ng/ml, to add to the available information for further evaluation.If your PSA level is elevated, you may require additional testings and imagings to rule out prostate cancer.

When to get a PSA test done?

A PSA test is usually offered as an “Opportunistic screening” for patients who present for a medical consultation for Lower urinary tract symptoms prior to starting treatment after informed decision making by the patient.

Who should get a PSA done and at what frequency?

AUA Panel strongly recommends shared decision-making for men age 55 to 69 years that are considering PSA screening, and proceeding based on a man's values and preferences. (Standard; Evidence Strength Grade B)

The greatest benefit of screening appears to be in men ages 55 to 69 years.

To reduce the harms of screening, a routine screening interval of two years or more may be preferred over annual screening in those men who have participated in shared decision-making and decided on screening.

As compared to annual screening, it is expected that screening intervals of two years preserve the majority of the benefits and reduce overdiagnosis and false positives. (Option; Evidence Strength Grade C)

Additionally, intervals for rescreening can be individualized by a baseline PSA level.

What are the other reasons that can affect your PSA levels?

Here are some factors that can affect your PSA levels:

  • Age: PSA values in older males are somewhat greater than those in younger men.
  • Urinary tract infection, prostatitis (inflammation of the Prostate)
  • Surgical intervention in the urinary tract
  • Prostate stimulation: Extra PSA might be released as a result of any prostatic stimulation. Ejaculation can boost PSA levels, but merely having a DRE can do so too.
  • Medications: Finasteride and Dutasteride, for example, can reduce PSA levels artificially.


    • What are the limitations of PSA test?

    There are certain limitations of PSA screening including but not limited to:

  • To diagnose cancer, additional tests, such as an MRI and biopsy, may be performed.
  • It's possible to have false-negative test results

    • What if My PSA is High?

    PSA screening is just the first step, alerting you and your doctor that more testing may be needed. If PSA is only slightly elevated, your doctor may recommend repeating the test a couple of weeks later. From there, other types of tests can help with the decision on whether you need a biopsy, including:

  • Digital rectal exam (DRE), if not already done
  • Free PSA test (measures PSA not bound to proteins in blood; <10% Free PSA indicates greater risk of having cancer; 10-20% is borderline)
  • PSA velocity, or the rate of rise over time (faster increase means more risk)
  • PSA density, or the PSA per volume of prostate (higher density means more risk)
  • PSA-based blood markers (e.g., Prostate Health Index, 4K score)
  • Urinary markers (e.g., EPI test score >15, urinary PCA3 or SelectMDx)
  • Magnetic resonance imaging (MRI) of the prostate

    • Patients seeking PSA test are advised to discuss the advantages and limitations of a PSA test with your doctor and make an informed choice accordingly

    What level of PSA indicate cancer ?

    There is no specific PSA level that indicates whether you have cancer or not.The only way is to get a prostate biopsy.

    A PSA level between 4 and 10 means you have over a 25% chance of having prostate cancer.

    If you have a PSA level greater than 10, you have over a 50% chance of having prostate cancer. It’s very important to talk to a healthcare provider about a prostate biopsy if your PSA is in these ranges.

    Normal range of PSA with age:

    All age- 4mg/dl

    40 - 49- < 2.5 ng/dl

    50 - 59- < 3.5 ng/dl

    60 - 69- < 4.5 ng/dl

    > 70 - < 6.5 ng/dl.