The PSA test, and deciding whether it is right for you

What the test is

Prostate specific antigen (PSA) is a protein made by the prostate gland and measured with a simple blood test. A level above the expected range can be a sign of prostate cancer, and it can also rise after a urine infection, recent ejaculation, a recent biopsy or a blocked bladder [1].

There is no single normal value. In men with possible symptoms, NICE uses thresholds that rise with age, from more than 2.5 micrograms per litre at 40 to 49 to more than 6.5 at 70 to 79 [2].

Why it is done and who it may suit

In the UK there is no screening programme for all men. In March 2026 the UK National Screening Committee recommended PSA testing every 2 years only for men aged 45 to 61 who carry a harmful BRCA2 gene variant and have a family history of related cancers [3]. It found that for the population as a whole, screening is more likely to cause harm than good, and for Black men the balance is still uncertain [3].

Outside a screening programme, a man can still choose to be tested after a conversation with a doctor. The European Association of Urology suggests offering this to well-informed men from 50, from 45 for men of African descent or with a family history of prostate cancer, and from 40 for BRCA2 carriers [1]. In the US, the Preventive Services Task Force calls testing an individual decision for men aged 55 to 69 [4].

Who it is not for

Men with a life expectancy below about 15 years are unlikely to benefit from early detection [1]. The US task force recommends against routine testing from age 70, because the harms are greater and trials show no clear benefit [4].

If you are passing urine more often or at night, have a weak flow, erectile problems or blood in your urine, you need an assessment rather than a screening decision, and a doctor may examine the prostate alongside the test [2]. If you cannot pass urine at all, or you are in severe pain, call 999 in the UK or the local emergency number elsewhere.

Benefits

Testing can find cancer before it spreads. The US task force estimated that screening men aged 55 to 69 may prevent about 1.3 deaths from prostate cancer and about 3 cases of cancer that has spread, for every 1,000 men screened over about 13 years [4]. A Cochrane review of 5 trials and 341,342 men found that screening led to more cancers being found early, with fewer advanced cancers at diagnosis [5].

Limitations, false positives and overdiagnosis

The same Cochrane review found no clear difference overall in deaths from prostate cancer between men offered screening and men who were not, though one large European trial did show a reduction [5]. The benefit, where it exists, is small and takes years to appear.

False positive results are common, and in one major trial more than 15% of men screened every 2 to 4 years had at least one false positive result over 10 years [4]. Some cancers found by testing would never have caused harm, and the task force estimates 20% to 50% of screen-detected cancers may be overdiagnosed [4]. In a UK trial of men with early cancer found by PSA, 2.7% died of prostate cancer after 15 years, with similar rates whether they were monitored or treated [6].

Risks

The blood draw itself is low risk. The risks come from what follows a raised result. About 1% of prostate biopsies lead to a complication needing a hospital stay [4]. Treatment can affect continence and erections, and about 1 in 5 men develop long-term urinary leakage after removal of the prostate [4]. A doctor explains each step before you decide on the next one.

How you prepare and what to expect

Avoid ejaculation and anything that presses on the prostate before the test, and wait until any urine infection has fully settled, because these can raise the level [1]. Tell the doctor if you take finasteride or dutasteride, which roughly halve PSA [1]. A clinician takes one blood sample from your arm in a few minutes.

Results and what happens next

A PSA level can vary by about 15% from one test to the next in the same man [1]. If the result is raised but below 10 ng/mL and the prostate feels normal, guidelines advise repeating it after about four weeks, in the same laboratory, before anything else [1].

If it stays raised, the next step is usually a specialist referral and an MRI scan before any biopsy [1]. A low result in middle age is reassuring for many years, and a man with a PSA below 1 ng/mL at 40 can usually wait several years before testing again [1].

• Given my age and family history, what could I gain from testing?
• What would we do if the result came back raised?
• Should we repeat a raised result before going further?
• If cancer were found, would monitoring be an option for me?

How The Wellness can help

A GP appointment gives you time to talk through your own risk and decide together, with no pressure either way. If you choose to test, the Advanced Health blood test includes PSA for men, with a priority call from a GP about your results. Every doctor is GMC registered, and samples go to accredited laboratories.

Our clinics are on Baker Street in Marylebone and Eccleston Street in Belgravia, and outside London appointments are arranged with partners in 12 city pages.