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) in the blood. 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.
Elevated levels of PSA could potentially indicate prostate cancer, which is why it’s used as one of the first-line investigations for men with symptoms. However, elevated PSA levels could also be due to several factors that do not indicate cancer such as age or a urinary tract infection (UTI)
. Prostate cancer could also be present without increased PSA levels.Before offering a PSA test, the potential benefits and harms of the test should always be discussed with patients, as outlined below.
Before offering a PSA test to patients, health professionals should make sure they are aware of the key considerations below so they can make an informed choice.
A raised PSA level can help detect prostate cancer that is aggressive or likely to progress earlier so that there are better treatment options.
PSA testing may suggest some men have prostate cancer when they don’t (a false positive result). As noted by NICE, around 75% of people with a raised PSA do not have prostate cancer
. This may lead to unnecessary and potentially invasive investigations, such as MRI or prostate biopsy, which carry their own risks.It can miss aggressive cancer (a false negative result). As noted by NICE, around 15% of people with a normal PSA may have prostate cancer
.It can lead to further investigations (usually an MRI* and biopsy) that could find slow-growing tumours that may not be the cause of the symptoms or shorten life. This can lead to unnecessary diagnosis (overdiagnosis) of prostate cancer, as well as associated anxiety and unnecessary treatments (overtreatment) with adverse effects
.
*Although MRI may reduce patients receiving an unnecessary biopsy, there's still a risk of overdiagnosis.
NICE Guidelines (NG12 as of 2021)
: Consider a PSA test for men presenting with lower urinary tract symptoms, erectile dysfunction, or visible haematuria.Make an urgent suspected cancer referral for prostate cancer if PSA levels exceed the following age-specific thresholds:
Age (years) | PSA level (micrograms/litre) |
Below 40 | Use clinical judgement |
40 to 49 | > 2.5 |
50 to 59 | > 3.5 |
60 to 69 | > 4.5 |
70 to 79 | > 6.5 |
Over 79 | Use clinical judgement |
Elevated PSA levels can be a result of other factors. Check if the patient has or has had an active or recent urinary infection (UTI) or had a urological intervention such as prostate biopsy in the past 6 weeks, and whether they’ve ejaculated or done vigorous exercise in the last 48 hours.
Download our GP guide to managing suspected prostate cancer for England and Wales(PDF, 348 KB)
Scottish Referral Guidelines (SRG as of 2025)
: Consider a PSA test for men aged 50 years and over with the following symptoms, or aged 45 years and over if they have one or more of the below risk factors* plus any of these symptoms: lower urinary tract symptoms, unexplained visible haematuria, haematospermia or erectile dysfunction.*Risk factors: The patient has a first-degree relative who has or has had prostate cancer, is of Black or mixed Black ethnicity or carries a BRCA gene variant.
An urgent suspected cancer referral for prostate cancer should be made if PSA levels exceed the following age-specific thresholds:
Age (years) | PSA level (micrograms/litre) |
Below 70 | ≥ 3 |
70 to 79 | ≥ 5 |
80 and over | ≥ 20 - see further guidance below |
SRG recommend that PSA testing should be reserved for men aged 80 years or over in the following scenarios:
Clinical features suggestive of metastatic prostate cancer (e.g. new significant bone pain, unexplained weight loss or unexplained anaemia)
The man wants a PSA test after shared decision-making. See the benefits and harms of PSA testing for points to discuss with patients.
SRG recommend that a PSA test is not performed until at least 6 weeks after treatment for men with symptoms or signs of a urinary tract infection, or who have been prescribed antibiotics for a confirmed or suspected urinary tract infection.
Download our GP guide to managing suspected prostate cancer for Scotland(PDF, 385 KB)
Northern Ireland Referral Guidance for Suspected Cancer (NICaN, as of 2022)
: Consider a PSA test for men presenting with lower urinary tract symptoms, erectile dysfunction, or visible haematuria.Make an urgent suspected referral cancer on the basis of a single PSA result if the level is >20 µg /L, or if PSA levels are above the age-based thresholds (same as NG12 above), at both initial testing and when repeated 2-4 weeks later.
Wait six weeks to do a PSA test if a patient has had an active urinary infection, prostate biopsy, transurethral resection of the prostate (TURP), or prostatitis.
Download our GP guide to managing suspected prostate cancer for Northern Ireland(PDF, 358 KB)
The PSA test is not currently used for screening for prostate cancer in men at a population level
. This is largely due to the limitations in the accuracy of the test and the associated harms, as outlined under the benefits and harms of PSA testing. At present, it’s unlikely that the benefits would outweigh the harms when screening all men using the PSA test, or other tests like MRI (alone or in combination with PSA testing).On Friday 28 November the UK National Screening Committee (UK NSC) released a consultation for a targeted screening programme for prostate cancer. This follows a robust, expert-led review of the evidence, including conducting modelling for different prostate cancer screening scenarios. The proposal, if implemented, will invite men aged 45-61 with a pathogenic variant in BRCA1 or BRCA2 genes for prostate cancer screening once every two years.
This is still a draft recommendation and is going through the UK NSC’s consultation process. Responses will be carefully reviewed to determine if the recommendation will go forward as is or needs to be amended before progressing. When the recommendation is finalised, this will be considered by Ministers for Health, alongside Chief Medical Officers of the four UK nations.
To read more about UK NSC’s recommendation, read our news article: First steps towards a targeted prostate cancer screening programme (November 2025).
Even though there’s not yet a population-wide screening programme for prostate cancer, men without symptoms may request a PSA test. The guidance on counselling asymptomatic men aged over 50 who request a test is set out in the Prostate Cancer Risk Management Programme (PCRMP). The most important thing to communicate is the benefits and harms of the PSA test with patients.
The diagnostic pathway for prostate cancer has changed in recent years. For example, multiparametric MRI (mpMRI) is used to assess the need for a biopsy in most areas across the UK.
There’s some evidence to suggest mpMRI can better detect prostate cancers that need treatment (eg clinically significant prostate cancers)
. This could help mitigate some of the risks associated with the PSA test. However, more research is needed to determine if the benefits of MRI sufficiently reduce the risk of harm associated with PSA testing. Research is ongoing to optimise the pathway.Researchers are exploring the following:
How to optimise the PSA test. For example, by combining it with other patient factors or test results (eg free PSA or PSA volume)
The role of risk prediction models, including genetic risk scores to inform how likely a person is to develop prostate cancer
the use of AI to support current diagnostics
Screening for prostate cancer using newer diagnostic technology (eg TRANSFORM trial)
The potential of urinary biomarkers
To read more about the latest evidence for prostate cancer and across the pathway, explore our Technical summary of earlier detection and diagnosis of prostate cancer. (PDF, 535 KB)
GP guide to managing suspected prostate cancer(PDF, 348 KB) (England and Wales)
GP guide to managing suspected prostate cancer(PDF, 385 KB) (Scotland)
GP guide to managing suspected prostate cancer(PDF, 358 KB) (Northern Ireland)
News article: First steps towards a targeted prostate cancer screening programme (November 2025).
Earlier detection and diagnosis of prostate cancer: A technical summary of the challenges and evidence(PDF, 535 KB) (November 2025)
GatewayC ‘The role of genomics in primary care’ course (England and Wales only)
Prostate cancer webpages
What is the PSA test webpage
NICE. How should I assess a person with suspected prostate cancer. Accessed January 2025.
Thompson IM, Pauler DK, Goodman PJ, et al. Prevalence of prostate cancer among men with a prostate-specific antigen level < or =4.0 ng per milliliter N Engl J Med. 2004.
Fanshawe JB, Wai-Shun Chan V, Asif A, et al. Decision Regret in Patients with Localised Prostate Cancer: A Systematic Review and Meta-analysis. Eur Urol Oncol. 2023.
NICE. Suspected cancer: recognition and referral NICE guideline NG12. Accessed January 2025.
NHS Scotland Scottish Referral Guidelines for Suspected Cancer, Urological cancer. Accessed August 2025.
NICaN Northern Ireland Referral Guidance for Suspected Cancer – Red Flag Criteria. Accessed January 2025.
UK NSC Rapid Review Screening Prostate Cancer Final February 2021. Accessed January 2025.
Ahmed HU, El-Shater Bosaily A, Brown LC, et al. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet. 2017.
