Understand PSA testing and how to support men in making informed choices

The PSA test and how it’s used

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)¹. Prostate cancer could also be present without increased PSA levels².

Before offering a PSA test, the potential benefits and harms of the test should always be discussed with patients, as outlined below.

Benefits and harms of PSA testing

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.

Potential benefits

• A raised PSA level can help detect prostate cancer that is aggressive or likely to progress earlier so that there are better treatment options.

Potential harms

• 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 cancer¹. 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 cancer¹².

• 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

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*Although MRI may reduce patients receiving an unnecessary biopsy, there's still a risk of overdiagnosis.

Using the PSA test in symptomatic cases and referral guidance

England and Wales

NICE Guidelines (NG12 as of 2021)¹: 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:

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)

How close are we to a prostate cancer screening programme?

The PSA test is not currently used for screening for prostate cancer in men at a population level⁵. 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).

Resources to support you and your patients

*We acknowledge that this resource is not prostate-specific but potentially has useful contact information and referral information. We will aim to share more detail and supporting resources when they are published.