PSA testing in primary care: when and how to use it

Overview of the PSA test

The PSA test is a blood test that measures the amount of prostate-specific antigen (PSA), a protein made by cells in the prostate gland. It’s normal for all people with a prostate - including men, trans women and some non-binary people - to have some PSA in their blood.

A raised PSA may indicate prostate cancer, but can also be caused by other factors such as:

• Age

• Benign prostate enlargement

• Infection (UTI)

• Recent ejaculation or exercise

A normal PSA does not exclude cancer and prostate cancer could also be present without increased PSA levels¹²³.

Before offering a PSA test to patients, the potential benefits and harms should always be discussed so they can make an informed choice.

PSA testing in symptomatic patients

A PSA test is the first-line investigation for people with possible symptoms of prostate cancer. Guidelines suggest considering a PSA test and DRE in men and people with a prostate who have:

• Lower urinary tract symptoms

• Erectile dysfunction

• Visible haematuria

• Haematospermia

Consider delaying the PSA test for the following:

• Active UTI or prostatitis (wait ≥6 weeks)

• Recent biopsy or urological procedure (≥6 weeks)

• Ejaculation or vigorous exercise (last 48 hours)

Cancer referral thresholds

Below are the age-specific PSA thresholds for an urgent suspected cancer referral according to national guidelines.

PSA referral thresholds for England, Wales and Northern Ireland¹⁴⁵

NICaN recommends making an urgent suspected cancer referral if PSA levels are above the age-based thresholds at both initial testing and when repeated 2-4 weeks later, or based on a single result if the level is >20 µg /L.

For more detail, refer to the following:

England & Wales

• NICE NG12(2021_ and clinical knowledge summary (March 2026)

• England and Wales GP guide to managing suspected prostate cancer(PDF, 348 KB) (November 2025)

Northern Ireland

• Northern Ireland Referral Guidance for Suspected Cancer(NICaN) (2022)

• Northern Ireland GP guide to managing suspected prostate cancer(PDF, 358 KB) (November 2025)

PSA referral thresholds for Scotland⁶

SRG recommend PSA testing in men aged 80 or over only in the following scenarios:

• The patient has clinical features suggestive of metastatic prostate cancer (e.g. new significant bone pain, unexplained weight loss or unexplained anaemia)

• The patient wants a PSA test after shared decision-making. See the benefits and harms of PSA testing for points to discuss.

For more detail, refer to the following:

• Scottish Referral Guidelines (SRG) (2025)

• Scotland GP guide to managing suspected prostate cancer(PDF, 385 KB) (November 2025)

PSA testing in asymptomatic patients (screening)

Population-level PSA testing to screen for prostate cancer is not recommended in the UK, as harms are likely to outweigh benefits. However, in May 2026, the UK National Screening Committee (UK NSC) recommended PSA-based screening for men with a BRCA2 pathogenic variant and relevant family history⁷(see targeted prostate cancer screening).

Despite this, men may request a PSA test. In this scenario, it’s important to:

• Support informed decision-making by discussing the potential benefits and harms before testing

• Provide clear patient information on PSA testing – you can signpost our ‘screening for prostate cancer’ webpage

• Document the discussion

Benefits and harms of PSA testing

Potential benefits

• May detect prostate cancer at an earlier stage, when treatment can be more effective and associated with less severe side effects.

Potential harms

• False positive results. Around 72-80% of people with a raised PSA do not have prostate cancer. This may lead to unnecessary and potentially invasive investigations, usually an MRI* or prostate biopsy, which carry their own risks¹²³.

• False negative results. Around 7-15% of people with a normal PSA may have prostate cancer, which means it can miss aggressive and fast-growing cancers that need treatment¹²³.

• Overdiagnosis and overtreatment. PSA testing can lead to the detection of slow-growing tumours that may

  never cause harm, leading to unnecessary diagnosis (overdiagnosis), anxiety and treatment. Treatment can have significant long-term effects. For example:

• Overdiagnosis and overtreatment. PSA testing can lead to the detection of slow-growing tumours that may never cause harm, leading to unnecessary diagnosis (overdiagnosis), anxiety and treatment. Treatment can have significant long-term effects. For example:

  • For men who have surgery, almost 50% experience erectile problems, and almost 20% experience leaking

    urine after 5 years⁸⁹.

  • For men who have radiotherapy, almost 40% experience erectile problems and around 5% experience bowel problems⁸⁹.

  • There are also psychological harms associated with treatment and an overall impact on quality of life¹⁰.

*Multiparametric MRI (mpMRI) is used across most of the UK to help decide whether a prostate biopsy is needed. It may improve detection of clinically significant cancers¹¹, but its impact on reducing overdiagnosis and overtreatment is still uncertain. Research to optimise the diagnostic pathway is ongoing.

Higher risk groups and targeted screening

The UK NSC recommends targeted prostate cancer screening every 2 years for men aged 45-61 with a BRCA2 pathogenic variant and a family history of pancreatic, prostate, breast or ovarian cancer.

This recommendation reflects strong evidence that this group is at higher risk of aggressive prostate cancer, meaning the benefits of screening are more likely to outweigh the harms.

For further information and commentary, read our latest cancer news article: UK NSC recommends targeted prostate cancer screening (May 2026).

What does this mean for current practice?

This recommendation is yet to be implemented. GPs should continue to follow existing guidance for men with BRCA2 pathogenic variants as follows:

• The UK Cancer Genetics Group recommends that men with a confirmed BRCA2 pathogenic variant are offered annual PSA tests from age 40 and referred onwards if PSA >3ng/mL.

For men who are concerned that they may be carriers of BRCA2 pathogenic variants, refer to existing guidance to assess eligibility for referral onto specialist clinical genomics services:

England and Wales

• NG241 and CG164 cover referral criteria based on family history of breast or ovarian cancer.

• The NHS England National Genomics Education Programme provides example clinical scenarios for managing patients with a family history of prostate cancer.

Scotland

• Refer to regional genetics services guidance.

Northern Ireland

• Refer to Belfast Health and Social Care Trust guidance.

Once someone is referred, specialist clinical genomics services will assess detailed family history alongside clinical factors to guide testing and/or management.

If unsure, consider seeking specialist advice (e.g. Advice and Guidance services). Further national guidance is expected as progress is made on targeted screening.

What about other men at higher risk of prostate cancer?

The UK NSC’s review of the current evidence also confirmed that there is currently insufficient evidence to support prostate cancer screening for:

• black men

• men with a relevant family history of cancer without BRCA2 pathogenic variants

• men with pathogenic variants in BRCA1

Although these groups have a higher incidence of prostate cancer, evidence is not yet clear whether they are at greater risk of aggressive disease. The committee concluded that, based on the available evidence, the potential harms of PSA-based screening for these groups of men are likely to outweigh the benefits.

Developments in diagnosing prostate cancer

Research and innovation are ongoing to develop more accurate approaches to diagnosing prostate cancer. Emerging areas include new blood, urine and genetic tests aimed at improving early detection. Current research is exploring:

• Screening for prostate cancer using newer diagnostic technology (eg TRANSFORM trial)

• How to optimise the PSA test. For example, by combining it with other patient factors or test results like free PSA or PSA volume (eg PROSCREEN, GOTEBORG-2 and ReIMAGINE trials)

• The role of risk prediction models, including genetic risk scores to inform how likely a person is to develop prostate cancer (eg TRANSFORM, BARCODE-1 and Stockholm-3 trials)

• The use of AI to support current diagnostics

• The potential of urinary biomarkers (eg ExoDx and MyProstateScore trials)

To read more about the latest and emerging evidence for prostate cancer and across the pathway, read our cancer news article: “Detecting prostate cancer: why we need more research (April 2025)” or download our Technical summary of earlier detection and diagnosis of prostate cancer(PDF, 578 KB) (May 2026).

Resources to support you and your patients

Resources for health professionals:

• England and Wales GP guide to managing suspected prostate cancer(PDF, 348 KB)

• Scotland GP guide to managing suspected prostate cancer(PDF, 385 KB)

• Northern Ireland GP guide to managing suspected prostate cancer(PDF, 358 KB)

• UK NSC recommends targeted prostate cancer screening (May 2026)

• Earlier detection and diagnosis of prostate cancer: A technical summary of the challenges and evidence(PDF, 535 KB) (November 2025)

• Prostate cancer statistics

• GatewayC ‘The role of genomics in primary care’ course (England and Wales only) (February 2025)

Resources for patients:

• Prostate cancer screening webpage

• Prostate cance webpages

• What is the PSA test webpage

• Prostate cancer awareness leaflet