About the PSA Test

About the PSA Test

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The PSA test – what is it?

The PSA test is also called the prostate-specific antigen (PSA) test. It’s a simple and widely used blood test to see if you might have an increased risk of prostate cancer. It detects but doesn’t diagnose prostate cancer.

Follow the links to read more about:

What is PSA?
What is PSA Testing?
Should You Have a PSA Test?
When Should You Talk to Your Doctor About PSA Testing?

Should I have PSA testing?

PSA testing can help save lives, but it’s important to know the pros and cons and whether it’s right for you.

To find out more information to help you decide go to PSA Testing.

Man getting a PSA Test — a simple blood test for prostate cancer detection

The PSA test is a simple blood test that can be done during a routine visit to your doctor.

What does the PSA test check for?

Your prostate makes PSA all the time and some of it can be found in your bloodstream. PSA circulates in your blood in two forms – free PSA and bound PSA (PSA attached to blood proteins). Together, these forms of PSA in your blood are called total PSA.

From a blood sample, the PSA test can be used to measure the amount of total PSA circulating in your blood

2.2a free and bound PSA

The PSA test measures the total PSA – free and bound PSA.

How do you have your PSA levels measured?

You can have this simple blood test during a routine appointment with your doctor. It should be quick and relatively painless.

Your blood sample is then sent to a pathology laboratory where the total PSA levels will be measured. The pathologist will send a report to your doctor showing your PSA test results.

PSA test results - what do they mean?

When your doctor receives your pathology report, they will discuss it with you. The report will show your PSA levels measured as nanograms of PSA per millilitre (ng/mL) or micrograms per litre (µg/L) of blood. Your doctor will compare your PSA levels with the ‘normal’ range for your age.

It may be helpful to take your partner, a family member or a friend with you to the appointment when you receive your results and discuss what to do next with you doctor.

If the results show your level is above what they call the threshold of 3 ng/mL, it can mean something is going on in your prostate.

Your doctor may also recommend more tests if your PSA level is over 2.0 ng/ml and you:

  • Have a family history of prostate cancer
  • Are in your 40s
  • Have symptoms

But always remember that a high PSA level does not mean you have prostate cancer for certain. Other factors and diseases can raise your PSA levels, and further testing will be required to rule out or diagnose this cancer.

What else can raise your PSA levels, other than prostate cancer?

A very high PSA test result is closely linked with prostate cancer, but it does not mean that you have the disease, especially as other prostate diseases and activities can raise PSA levels and give false-positive results.

A ‘normal’ PSA level is different for everyone. Your PSA level can be raised due to:

  • Your age (the older you are, the higher your PSA level will be)
  • The size of your prostate (levels are higher with an enlarged prostate)
  • Your race or ethnicity
  • Medications you are taking
  • A urinary infection
  • Certain types of exercise, such as bicycle riding or vigorous exercise
  • How recently you had sex or ejaculated
  • Anal sex
  • Prostate irritation or trauma, for example after an infection or a biopsy
  • Digital rectal examination (DRE) – this is a physical examination where the doctor or urologist feels the size, firmness and texture of the prostate. They are sometimes done before or after getting your PSA result. It is best not to have a PSA test on the same day as a DRE.
  • Benign prostatic hyperplasia (BPH) – also called or enlarged prostate is a common condition that affects men as they get older. About half of all men over 50 and 80% of men over 80 will have some symptoms of BPH. Like prostate cancer, BPH can cause problems with urination.
  • Prostatitis – a condition where the prostate becomes inflamed, swollen and painful and can cause more frequent urination
  • Low-grade cancer

It’s a good idea to talk to your doctor if you are worried or have any changes or problems with urination. It may not be cancer but another condition that can be easily dealt with.

What happens after you have the results?

What happens next depends on many factors. Your doctor will look at your results and review your risk factors (age, family history) and any symptoms you may have.

If your results are in the normal range and you are over 50 years old, or 40–45 if you have a family history of prostate cancer, they may recommend regular PSA testing. Read the current testing guidelines to learn more.

Regular PSA testing can check for changes in PSA levels over time

If your levels are high, your doctor may request more PSA tests in the next 1 to 3 months, to check if the PSA levels go down, stay the same or go higher. This is because your PSA levels can go up and down and it helps to rule out other factors that can raise your PSA, such as urinary infections.

If regular testing shows your PSA is rising, your doctor can work out the PSA velocity (how quickly the PSA is rising) and doubling time (how long it takes for the PSA to double). This can help you know if the problem with your prostate is getting worse.

Your doctor may also recommend you have other PSA tests (free to total PSA testing or prostate health index). But this will depend on your results and individual circumstances. Either way, if your doctor still has any concerns, they will refer you to a urologist to rule out or diagnose prostate cancer.

Don’t forget to look after yourself as you are going through testing. It may be beneficial to try some relaxation techniques, look at the support services available, or reach out to a Prostate Cancer Specialist Nurse if you need more information or advice.

Key points

  • The PSA test is the most widely used test for detecting prostate cancer early.
  • It is a simple blood test that measures total PSA (free and bound PSA) levels.
  • The PSA level threshold is 3 ng/mL but may be lower if you are younger and have a family history of prostate cancer.
  • Many factors and diseases can raise PSA levels, other than prostate cancer.
  • Regular testing may be recommended to review the PSA levels over time.
  • Other PSA tests may be recommended (free to total PSA testing or prostate health index).
  • Ask your doctor whether the PSA test is right for you. This will be based on your symptoms, family history, age, medical history and other risk factors.
  • Your doctor will talk to you about what the PSA test result means for you. They will also discuss if further examinations or tests are recommended.
  • If your doctor has any concerns they will refer you to a urologist.
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