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).

However, men who are concerned about prostate cancer should speak to their GP and may still request a PSA test. Previously, the Prostate Cancer Risk Management Programme (PCRMP) provided advice for GPs on counselling asymptomatic patients on PSA testing. This document has now been retired, and the public-facing guidance on NHS.net and the GP-facing guidance at NICE Clinical Knowledge Summary (CKS) have been updated to reflect the updated position.

If an asymptomatic patient asks for a PSA test, it’s important to:

• Assess patients’ relevant family history using current guidance – read ‘Guidance for managing people with genetic risk and family history'

• Support informed decision-making by providing clear information about the PSA test and discussing the potential harms and benefits before testing

• Document the discussion

Harms and Benefits of PSA testing

The potential harms and benefits of PSA testing are important to communicate whenever a PSA test is offered. This applies whether in symptomatic patients or those requesting testing without symptoms.

Potential harms

Potential benefits

Targeted prostate cancer 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).

Guidance for managing people with genetic risk and family history

People with a confirmed BRCA2 pathogenic variant

The UK NSC targeted screening recommendation is yet to be implemented. NHS England plans to establish a programme from 2027, whilst other UK nations are yet to announce implementation dates.

For now, GPs should continue to follow the UK Cancer Genetics Group recommendation. Men with a confirmed BRCA2 pathogenic variant should be offered annual PSA tests from age 40 and referred onwards if PSA >3ng/mL.

Peopled with a possible inherited risk of prostate cancer

Refer to the guidance for referrals to clinical genetics or familial cancer services (depending on local service arrangements) as follows:

England and Wales

• NICE referral guidance for people with a family history of breast cancer (CG164) and ovarian cancer (NG241) and people with an inherited high risk of pancreatic cancer (NG85).

• The NHS England National Genomics Education Programme provides example clinical scenarios for managing patients with a family history of cancer, and specifically prostate cancer, breast and/or ovarian cancer and bowel cancer

• The National Genomic Test Directory outlines eligibility criteria for genetic testing.

Wales

• The All Wales Medical Genomics Service has referral criteria for family history of breast, ovarian, and colorectal cancer.

• NICE referral guidance for people with a family history of breast cancer (CG164) and people with an inherited high risk of pancreatic cancer (NG85).

Scotland

• Refer to region-specific guidance for cancer genetic services. This outlines the referral guidance for people with a family history of breast, ovarian and colorectal cancers.

Northern Ireland

• Refer to Belfast Health and Social Care Trust. This outlines referral guidance for people with a family history of breast and ovarian cancer and Lynch syndrome.

Once someone is referred, specialist services can assess detailed family history alongside clinical factors to determine whether genetic testing or additional management is needed.

If unsure, consider seeking Advice & Guidance from specialist clinical genomics services or familial cancer services (depending on local service arrangements).

Developing clearer advice for assessing family history

We are supporting an expert advisory group, co-chaired by the UK Cancer Genetics Group and the Royal College of General Practice. The group are developing more practical advice for primary care on assessing prostate cancer risk in asymptomatic men with a family history of prostate cancer. This advice aims to provide more clarity on which patients can be managed and reassured in primary care, and which may need a referral and further assessment. Advice is expected to be published in autumn 2026.

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)

• NICE Clinical Knowledge Summary (CKS) for Prostate Cancer

• 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, 578 KB) (May 2026)

• Prostate cancer statistics

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

• GatewayC ‘When should primary care be concerned about a family history of prostate cancer’ article (June 2026)

Resources for patients:

• Prostate cancer screening webpage

• Prostate cance webpages

• What is the PSA test webpage

• Prostate cancer awareness leaflet

• NHS UK PSA testing webpage

• NHS UK prostate cancer webpage