Who should not use the Prostate Specific Antigen (PSA) Blood Test?

If you're under 40 years of age your risk of prostate cancer is extremely low and we don't have any research to suggest a benefit in terms of predicting your future risk of prostate cancer when testing at this age.

What should I do to prepare for my Prostate Specific Antigen (PSA) Blood Test?

In order to make your PSA blood test as accurate as possible, it’s important to prepare for it by: making sure you’ve not had a urinary tract or coronavirus infection (or vaccination) in the previous 6 weeks avoiding ejaculation for 2 two days beforehand avoiding vigorous exercise, particularly cycling, for the previous 2 days waiting at least 6 weeks after a prostate biopsy or cystoscopy before testing

How often should you have a PSA blood test?

How often you should take a PSA blood test depends on your last PSA level and if you're at higher risk of prostate cancer (black ethnicity or family history of prostate cancer for example). If your PSA level is 1-3 μg/L or you're at higher risk of prostate cancer, guidelines recommend checking your PSA every year. If your PSA level is less than 1 μg/L and you're not at higher risk of prostate cancer, then guidelines recommend checking your PSA level every 2 years.

What is free PSA and the Free to Total PSA ratio?

Total PSA actually includes two different forms of PSA. PSA can be bound to other proteins in the blood or it can be ‘free’, meaning that it’s not bound to other proteins. Free PSA levels are often higher with non-cancerous conditions of the prostate and lower in those with prostate cancer. We routinely measure free PSA and the ratio of free to total PSA in people who have a PSA of between 2.5 - 10μg/L because it provides more information on prostate cancer risk. If your PSA level is 2.5 - 4 μg/L then a normal Free:Total PSA ratio is >0.19. If your PSA level is 4 - 10 μg/L then a normal Free:Total PSA ratio is >0. If your Free:Total PSA ratio is above these cut-offs then it makes prostate cancer more likely compared to a ratio below the thresholds.

Are trans women at risk of prostate cancer?

People assigned male at birth will have a prostate and this is not removed during gender-affirming surgery. Therefore trans women are at risk of prostate cancer. However, testosterone lowering therapy can reduce the risk of prostate cancer but it can also falsely lower PSA levels, making them difficult to interpret. Prostate Cancer UK has useful information about the risk of prostate cancer as a trans woman.

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PSA Blood Test (Prostate Specific Antigen)

A PSA blood test measures the amount of prostate specific antigen in your blood as a way to test for prostate cancer risk.

Use our PSA test kit to collect your blood sample and send it to our NHS-testing lab. In under a day we'll check your PSA levels and send you an easy-to-understand doctor's report about your risk of prostate cancer.

Prostate specific antigen (PSA) Blood Test Box

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Testing for Prostate Specific Antigen

Your questions answered

What you need to know about our PSA Blood Test (Prostate Specific Antigen)

Prostate cancer often doesn't cause any symptoms and the commonest way to pick it up is actually following a PSA blood test.

Regular PSA testing has been shown to pick up more cases of prostate cancer, increases your chances of picking up prostate cancer before it has spread and reduces the chance of dying from prostate cancer by about 30%^ref.

Guidelines support PSA testing from age 45 to understand your baseline risk of prostate cancer and to guide how regularly you should consider testing. Men at higher risk - of black ethnic origin or with a family history of prostate cancer for example - should start testing earlier, from age 40.

PSA testing is the first, crucial step in the pathway of prostate cancer diagnosis and management and taking it puts you firmly in the driving seat.

: Your PSA level needs to be interpreted in the context of your age because PSA naturally goes up as you get older due to the prostate increasing in size. The National Institute of Clinical Excellence (NICE) have suggested PSA thresholds for specific ages to trigger further investigation of the prostate (e.g. with an MRI scan).

Age PSA Threshold (μg/L)
40 - 49 >2.5
50 - 69 >3
70 and over >5

However, other guidelines recommend that all men with a PSA above 3μg/L undergo further investigations. We suggest that anyone with a PSA level over 3μg/L discuss this with their doctor.

A high PSA level doesn't mean you have prostate cancer but it does make prostate cancer more likely and you'll generally be advised to have a scan of the prostate to investigate further.
: Remember that the PSA blood test is not meant to be a test to identify prostate cancer. It is a test to assess your risk of having prostate cancer. Your risk of prostate cancer will depend on how high your PSA level is.

If your PSA level is between 3 - 10 μg/L, your risk of prostate cancer is about 25%.

If your PSA level is over 10 μg/L, your risk of prostate cancer is over 50%.

However, it's important to bear in mind that about 1 in 7 men can have a normal PSA level and later be diagnosed with prostate cancer. This is why it's so important for men to monitor their PSA level regularly rather than just as a one-off.

5α-reductase inhibitors can falsely lower PSA levels so you need to adjust your result (doubling your PSA) if you take this medication.

Age	PSA Threshold (μg/L)
40 - 49	>2.5
50 - 69	>3
70 and over	>5

What's tested in the PSA Blood Test (Prostate Specific Antigen)?

Our PSA blood test checks for prostate specific antigen levels in your blood. High PSA levels can be a sign of prostate cancer and should be followed up with a prostate scan.

In addition to testing your PSA level, we'll also test your free PSA level and Free-to-Total PSA ratio if your PSA level is borderline high, at no extra cost. These markers give you more information on your prostate cancer risk.

Prostate specific antigen (PSA)

Your PSA level can help you understand your risk of prostate cancer and guide further testing.

Free PSA

If your PSA level is between 2.0 - 10μg/L we'll check your free PSA level to get more information on your prostate cancer risk

Free PSA to Total PSA ratio

If your PSA level is between 2.0 - 10μg/L we'll calculate your free to total PSA ratio to help guide further actions by your doctor.

How it works

Do your test

You'll get your kit next-working day.

Collect your sample at home and send it back to our UKAS-accredited lab for analysis.

Get rapid results

We'll let you know when the lab have received your sample for analysis.

You'll get your results and doctor's report in your online dashboard. You'll also be able to download your formal lab report to share with your GP if you wish.

Improve your health

Numbers are useful but it's what you do with them that counts.

We'll give you advice on how to improve your health based on your results. You can also book a consultation to discuss your results with one of doctors (costs extra).

PSA Blood Test FAQs

: If you're under 40 years of age your risk of prostate cancer is extremely low and we don't have any research to suggest a benefit in terms of predicting your future risk of prostate cancer when testing at this age.
: In order to make your PSA blood test as accurate as possible, it’s important to prepare for it by:

making sure you’ve not had a urinary tract or coronavirus infection (or vaccination) in the previous 6 weeks

avoiding ejaculation for 2 two days beforehand

avoiding vigorous exercise, particularly cycling, for the previous 2 days

waiting at least 6 weeks after a prostate biopsy or cystoscopy before testing
: How often you should take a PSA blood test depends on your last PSA level and if you're at higher risk of prostate cancer (black ethnicity or family history of prostate cancer for example).

If your PSA level is 1-3 μg/L or you're at higher risk of prostate cancer, guidelines recommend checking your PSA every year.

If your PSA level is less than 1 μg/L and you're not at higher risk of prostate cancer, then guidelines recommend checking your PSA level every 2 years.
: Total PSA actually includes two different forms of PSA. PSA can be bound to other proteins in the blood or it can be ‘free’, meaning that it’s not bound to other proteins.

Free PSA levels are often higher with non-cancerous conditions of the prostate and lower in those with prostate cancer.

We routinely measure free PSA and the ratio of free to total PSA in people who have a PSA of between 2.5 - 10μg/L because it provides more information on prostate cancer risk.

If your PSA level is 2.5 - 4 μg/L then a normal Free:Total PSA ratio is >0.19.

If your PSA level is 4 - 10 μg/L then a normal Free:Total PSA ratio is >0. If your Free:Total PSA ratio is above these cut-offs then it makes prostate cancer more likely compared to a ratio below the thresholds.
: People assigned male at birth will have a prostate and this is not removed during gender-affirming surgery. Therefore trans women are at risk of prostate cancer. However, testosterone lowering therapy can reduce the risk of prostate cancer but it can also falsely lower PSA levels, making them difficult to interpret. Prostate Cancer UK has useful information about the risk of prostate cancer as a trans woman.

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