A raised PSA is common, and most raised results are not cancer. It rises with age, with infection, and even after cycling. The conversation before the test matters, because a result you were not expecting leads to further investigation you may not have wanted.
PSA is a protein made by the prostate, and the blood test measures how much is circulating. A raised level can indicate prostate cancer. It can equally indicate an enlarged prostate, which is extremely common with age, a urinary infection, recent vigorous exercise, or recent ejaculation.
We want to be straight with you about this test, because a lot of providers are not. There is no national prostate screening programme in the UK, and that is a considered decision. PSA misses some cancers and flags many men who do not have them. It also finds slow-growing cancers that would never have caused a problem, and investigating those means biopsies and sometimes treatment with genuine side effects. So a PSA test can save a life, and it can also start a chain of events that harms a man who was never going to be harmed by his prostate.
None of which means do not test. It means to test knowingly. For men with symptoms, a family history, or of Black African or Caribbean background, where risk is substantially higher, the argument is stronger. And note: if you are over 50 you can request a free PSA test from your NHS GP.
PSA is easily raised by things unrelated to cancer, and a falsely raised result causes real anxiety and unnecessary investigation. Before a PSA test, avoid:
Testing during or shortly after a urinary infection. Wait several weeks after an infection, since PSA can stay raised for some time.
Monday to Friday, 8am to 7pm, Saturday 9:00 am to 2:00pm
Step 1
What the test can and cannot tell you, what a raised result would lead to, and whether it is the right choice for you.
Step 2
No ejaculation or vigorous exercise for 48 hours, and no recent urinary infection.
Step 3
A quick sample, with results in 24 to 48 hours and a GP report.
Step 4
Your result is explained against your age, with a repeat test or urology referral arranged where appropriate.
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PSA is produced by prostate tissue, both healthy and cancerous. More prostate tissue, or irritated prostate tissue, means more PSA. That is why the test is imprecise: it measures prostate activity, not cancer.
The normal range rises with age, because the prostate enlarges with age. Broad reference points used in UK practice: under 3.0 for men in their fifties, under 4.0 in their sixties, and higher thresholds above that. Interpretation against your age matters, and a single number without that context is close to meaningless.
Causes of a raised PSA other than cancer: benign prostatic hyperplasia, which is the commonest by far; urinary infection or prostatitis; recent ejaculation; vigorous exercise, especially cycling; a recent catheter or prostate procedure; and simply having a large prostate.
What actually happens with a raised result. The usual next step is not a biopsy. It is repeating the test, because a substantial proportion of raised PSAs normalise on repeat, particularly where infection or exercise was a factor. Where it remains raised, current UK practice uses an MRI scan before biopsy, which has substantially reduced unnecessary biopsies and is a genuine improvement on how this used to be done.
The honest account of the trade offs, which is the part most pages omit:
On active surveillance. Worth knowing before you test: many low-risk prostate cancers are now monitored rather than treated, precisely because treatment can do more harm than the cancer would. A diagnosis does not automatically mean surgery or radiotherapy.
| Private | NHS | |
|---|---|---|
| Availability | Book directly, £95 | Free on request to men over 50 in England, after a discussion |
| Waiting time | Same Day | Practice appointment availability |
| Results | 24 to 48 hours | Several days to two weeks |
| Pre test discussion | Ask at your appointment | Required as part of the informed choice process |
| MRI before biopsy | Ask at your appointment | Standard within the NHS pathway |
| Urology referral | Arranged | Within the NHS pathway |
| Cost | £95 | Free |
If you are over 50 in England, you can ask your NHS GP for a free PSA test, and they will discuss the pros and cons with you as part of that. That is a genuinely good option and we would rather tell you than not. Private testing is worth paying for when you want a result this week, are under 50 and want to test on the basis of family history or background, or would rather discuss it privately.
Yes, men over 50 in England can request one from their GP after a discussion of the pros and cons.
No. Benign enlargement, infection, recent ejaculation and vigorous exercise all raise it, and benign enlargement is by far the commonest cause.
Ejaculation and vigorous exercise for 48 hours, and testing during or soon after a urinary infection.
It is a genuine choice with trade offs rather than an obvious yes. The case is stronger with symptoms, a family history, or Black African or Caribbean background. We will discuss it with you honestly.
No. Many low risk cancers are monitored rather than treated, because treatment can cause more harm than the cancer would.
If you choose to test, the trend over time is more informative than a single result. Annually or every two years is a common approach.
It depends on your age, since the range rises with age. Your result will be interpreted against that rather than a single threshold.
No. PSA misses a proportion of prostate cancers, so a normal result is reassuring rather than conclusive.
Usually the test is repeated first, since many raised results normalise. If it stays raised, an MRI scan before any biopsy is current practice.
It may be offered as part of assessment. Have it after the blood test rather than before, since it can raise PSA.
Risk is around double in Black African and Black Caribbean men and presents younger, so testing from 45 is often advised.
Book an appointment. We will go through what a PSA test can and cannot tell you before you decide, and if you do test, results come back in 24 to 48 hours.
