PSA testing in primary care

This information is aimed at supporting health professionals, academics and researchers. If you are a patient or carer, you may want to visit our public-facing webpages to learn more about the PSA test.

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.

Using the PSA test in primary care

PSA testing in patients with symptoms

Using the PSA test to investigate possible prostate cancer symptoms and suspected prostate cancer referral guidelines.

PSA testing in patients without symptoms

Information on targeted prostate cancer screening, managing PSA test requests and assessing patients with a family history and inherited risk of prostate cancer.

Harms and Benefits of PSA testing

Before offering a PSA test, it’s important to discuss the potential benefits, risks and limitations with patients so they can make an informed choice.

PSA testing is not routinely recommended for people who do not have symptoms of prostate cancer. To support discussions with people who ask about testing, we've developed a patient guide explaining the benefits, risks and limitations of the test.

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.

^{*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 cancers4, but its impact on reducing overdiagnosis and overtreatment is still uncertain. Research to optimise the diagnostic pathway is ongoing.}

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 treatment

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 years⁵⁶.

• For men who have radiotherapy, almost 40% experience erectile problems and around 5% experience bowel problems⁵⁶.

There are also psychological harms associated with treatment and an overall impact on quality of life⁷.

Potential benefits

The test may lead to an earlier diagnosis when patients could have more effective treatment options.

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 read our Technical summary of earlier detection and diagnosis of prostate cancer(PDF, 578 KB) (May 2026).

Resources to support you and your patients

Prostate cancer and PSA testing patient leaflets

What is the PSA test webpage

Prostate cancer webpages

NHS UK PSA testing webpage

Prostate cancer statistics

Contact us

You can contact our Strategic Evidence team if you have any questions.