PSA levels by age: what your PSA test result means

What is PSA?

PSA stands for prostate-specific antigen, a protein made by the prostate that helps keep semen liquid. A small amount normally passes into the blood. The PSA test is a simple blood test that measures it, in nanograms per millilitre (ng/ml – the same as micrograms per litre).

PSA tends to rise when the prostate is enlarged, inflamed or affected by cancer. That makes it a useful clue, but not a diagnosis on its own. If you are new to the topic, our guide to what the prostate does explains the basics.

What is a normal PSA level by age?

There is no single “normal” PSA. Prostate Cancer UK says that for many men a normal level is below 3 ng/ml, but it varies from person to person and rises slightly as the prostate grows with age. For men with possible symptoms of prostate cancer, NICE guidance for GPs uses these age-specific thresholds when deciding on an urgent referral to a specialist:

A result below the threshold for your age is reassuring but not a guarantee. Prostate Cancer UK cites a major study showing that 1 in 7 men with a normal PSA may still have prostate cancer, and 1 in 50 may have a fast-growing cancer – so tell your GP if you have symptoms, whatever your PSA.

What can cause a raised PSA level besides cancer?

Many men with a raised PSA do not have prostate cancer. Common other reasons include:

• An enlarged prostate – a bigger gland makes more PSA. BAUS estimates PSA is raised in 50–60% of men with benign enlargement. See our guide to enlarged prostate symptoms.
• A urine infection or prostatitis – infection and inflammation can raise PSA, which is why the test is put off until an infection has cleared.
• Ejaculation in the previous 48 hours.
• Vigorous exercise, especially cycling, in the previous 48 hours.
• Receiving anal sex or prostate stimulation shortly before the test.
• Recent prostate or bladder procedures – a biopsy, a catheter, or tests or surgery on the bladder or prostate in the previous six weeks.

Some medicines work the other way. Finasteride and dutasteride, used for an enlarged prostate, lower PSA by at least half, so your doctor needs to interpret the result differently. Tell your GP about every medicine you take before the test.

How should I prepare for a PSA test?

• For 48 hours before, the NHS advises no ejaculation, no exercise that leaves you out of breath and no cycling.
• Avoid receiving anal sex for at least 48 hours before (NHS); Prostate Cancer UK suggests avoiding anal sex and prostate stimulation for a week.
• If you have a urine infection, wait 4 to 6 weeks after it has cleared.
• You can eat and drink as normal.

Results usually take one to two weeks. Contact your GP surgery if you haven’t heard anything after a few weeks.

What happens if my PSA is raised?

A single raised result is the start of a conversation, not a diagnosis. Depending on your level, age and symptoms, your GP may:

• Repeat the test a few weeks later, especially if an infection or recent activity could explain it.
• Examine your prostate with a quick rectal examination.
• Refer you to a hospital specialist – you would usually be seen within a few weeks.

At the hospital you may have an MRI scan of the prostate first. A biopsy – taking small samples of tissue – is often only done if the scan finds anything unusual.

Can PSA levels go down?

Yes. A PSA that was raised by an infection, prostatitis, ejaculation or cycling usually falls back once the cause has passed, which is why GPs often repeat the test. Treatment with finasteride or dutasteride lowers PSA, and PSA usually falls after treatment for prostate cancer. Don’t try to lower your PSA with diet or supplements: no food or supplement has been shown to protect the prostate, and Prostate Cancer UK warns that some herbal remedies may affect your PSA level and make the test unreliable. Tell your GP about any you take.

Should I have a PSA test if I have no symptoms?

It is your choice. Anyone with a prostate can ask a GP about PSA testing. In England, under the Prostate Cancer Risk Management Programme, men aged 50 or over without symptoms who decide to be tested after talking through the benefits and risks can have the test free on the NHS. Prostate Cancer UK strongly recommends that Black men and men with a family history of prostate cancer talk to their GP about testing from 45, as their risk is higher. The NHS also advises seeing a GP if you are over 40 and know you carry a faulty BRCA2 gene.

Is there a prostate cancer screening programme in the UK?

Not for most men. The NHS does not routinely offer PSA testing to men without symptoms, apart from men known to carry a faulty BRCA2 gene. The UK National Screening Committee has recommended screening for a small group – men aged 45 to 61 with a BRCA2 gene variant and a parent or sibling with breast, ovarian, pancreatic or prostate cancer – with a PSA test every two years. It has not recommended screening for all men, for men with a BRCA1 variant, or for Black men or men with a family history in general, and Prostate Cancer UK says it could take years before the programme is available to everyone eligible.