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PSA Testing

What is the PSA test?

The most common screening tool for prostate cancer is the prostate-specific antigen (PSA) test. This is a simple blood test that measures the presence of PSA circulating in your bloodstream. This test is usually the first step in any prostate cancer diagnosis. However, the PSA blood test by itself cannot tell you if cancer is present.

The PSA test is also used to track the effects of prostate cancer treatment such as surgery, radiation, hormone therapy, and chemotherapy. When a man has treatment for prostate cancer, his PSA level will drop significantly. A regular PSA test is one of the tools the doctor will use to measure if the cancer may have returned.

What is Prostate-Specific Antigen?

PSA is a protein produced by prostate cells that keeps semen in liquid form so that sperm can swim. A simple blood test can measure how much PSA is present in a man’s bloodstream. In almost all cases of prostate cancer the PSA level increases, which is why the PSA test is used as a screening tool.

When should I get a PSA test? How do I know if my PSA levels are normal or not?

The age recommendations and guidance in the below PSA levels chart are adapted from the National Comprehensive Cancer Network Clinical Practice Guidelines In Oncology (NCCN Guidelines®) for Prostate Cancer Early Detection. Please use these guidelines to have a discussion with your doctor about your personal risk and make a plan for screening. The below table also provides guidance on what is considered a normal PSA range, and what may be considered a dangerous PSA level.

  • If you are between ages 40 and 75, and 
    • Black/African American, and/or
    • Have a family history of cancer and/or a known genetic mutation that increases the risk for prostate cancer 
      • Discuss the risk and benefits of prostate cancer screening with your doctor
      • Have a baseline PSA and strongly consider a baseline digital rectal exam (DRE)
      • If PSA less than 1 ng/mL and DRE normal (if done), repeat testing every 2 – 4 years
      • If PSA 1 – 3 ng/mL and DRE normal (if done), repeat testing every 1 – 2 years
  • If you are between ages 45 and 75, and
    • At average-risk
      • Discuss the risk and benefits of prostate cancer screening with your doctor
      • Have a baseline PSA and strongly consider a baseline DRE
      • If PSA less than 1 ng/mL and DRE normal (if done), repeat testing every 2 – 4 years
      • If PSA 1 – 3 ng/mL and DRE normal (if done), repeat testing every 1 – 2 years
  • If you are over age 75
      • Talk with your doctor about if prostate cancer screening should continue
      • If PSA less than 4 ng/mL and DRE normal (if done), repeat testing in select patients every 1 – 4 years
      • If PSA greater than 4 ng/mL or a very suspicious DRE, talk with your doctor about further testing and follow-up 

What is the latest information on PSA screening recommendations?

The latest NCCN recommendations are covered above in the Prostate Cancer Early Detection: Age Recommendations and PSA Levels Chart.

In 2012, the U.S. Preventive Services Task Force (USPSTF) assigned the PSA test a “D” rating. This meant that the USPSTF concluded the harms that resulted from PSA testing, such as unnecessary biopsies and negative treatment side effects, outweighed the benefits of finding and managing the disease early. This recommendation did not include exceptions for men at increased risk of developing the disease, such as Black or African American men, those with a family history of the disease, and those with BRCA gene mutations. The USPSTF recommendation is important as it guides primary care physicians in preventive care and can impact insurance coverage and reimbursement for screening. Prior to its “D” rating, the PSA test had an “I” rating, meaning the USPSTF concluded there was insufficient evidence to assess the pros and cons of testing.
History of PSA Testing Guidelines

In 2018, the USPSTF updated their recommendation on PSA screening, assigning the PSA test a “C” rating for men ages 55 to 69 (the test still has a “D” rating for men ages 70+). This was in response to research demonstrating the benefits of PSA screening (such as the European Randomized Study of Screening for Prostate Cancer), an increase in the number of men choosing active surveillance, and advocacy efforts.

This means that the USPSTF recognizes a small potential benefit of PSA testing and recommends that men make individual decisions about whether or not to get tested after discussing the risks and benefits with their doctors. Like the 2012 recommendation, this update does not include specific language for men at increased risk.

The National Comprehensive Cancer Network® (NCCN) and ZERO strongly recommend that men should be fully educated about prostate cancer, should know their options for early detection, and should have access to the tests we have available now. Researchers, with support from organizations like ZERO, are working every day to improve prostate cancer screening, but for now, we must use the tools we have. A PSA test score is an important part of making a decision on how best to determine a prostate cancer diagnosis and/or treatment pathway. Visit our advocacy site to learn about ZERO’s advocacy efforts in early detection and access to PSA screening.

How can I get a PSA test?

Talk to your primary care doctor or urologist about receiving a PSA test in their office. If you do not have a doctor or insurance, or if your insurance does not cover PSA screening, consult our national free prostate cancer testing map to find sites where free testing may be available.

How do I understand my PSA test results?

See the above “Prostate Cancer Early Detection: Age Recommendations and PSA Levels Chart” for more information on understanding your PSA level. In general, a PSA level that is below 3.0 ng/mL is considered within the normal range. A PSA level that is above 3.0 ng/mL is considered suspicious. 

However, PSA levels can rise as you get older. For men over age 75, a PSA below 4.0 ng/mL is considered normal. You and your doctor should consult age-specific PSA ranges and recommendations.

What if my PSA level is high?

You and your doctor can explore several options if your PSA is high. One option is to have a second PSA screening; recent research has shown that a second screening can improve the accuracy of an abnormal result. A digital rectal exam (DRE) can also provide more information, and a biopsy can confirm the presence or absence of prostate cancer. However, there are several other reasons why a PSA result might be high, including advanced age, ejaculation within the past 24 hours, and recently riding a bicycle.

If you have an elevated PSA, talk with your doctor about your activities and your health. Additional tests may also be recommended.

What if I’ve had prostate cancer treatment, and my PSA levels are rising?

When PSA levels rise to a certain threshold after prostate cancer treatment, this is known as biochemical recurrence. This means that some cancer cells have survived and are producing PSA. If this happens, the doctor will order additional tests and make recommendations for additional treatment.

What if my PSA level is low?

In general, a low PSA is a good result. However, there are some reasons a PSA level may be artificially low, including taking statins to lower cholesterol, anti-inflammatory drugs, and obesity (body fat decreases the amount of PSA circulating in the bloodstream). Be sure to discuss these with your doctor.

What if my PSA is rising quickly?

The rate of yearly increase in the PSA level is known as the PSA velocity. This is one measure of prostate cancer risk that your doctor will use to consider next steps, since PSA levels can rise rapidly in men who have prostate cancer. This can be especially useful to find prostate cancer in early stages before the cancer has left the prostate.

What additional tests may be needed?

A biopsy will be needed to confirm whether prostate cancer is present or not. There are additional tests that can give your doctor more information on how to determine the probability of both finding cancer during a biopsy and determining how aggressive that cancer is likely to be.

While none of these tests are conclusive on their own, when performed in addition to a PSA test, DRE, and a biopsy, they can provide each patient with more information about their specific cancer and can aid in both the diagnosis and decision on treatment. Read more about additional testing.