PSA TestThe PSA blood test for men is not that confusing. With a little background knowledge, you will be ready to talk to your doctor about the test and understand it.

PSA stands for Prostate-specific antigen, (at least in the field of urology). It is a small enzyme molecule that is produced by prostate cells that should remain within the prostate and the semen. The PSA molecule actually has a job. It breaks down other proteins and stays within the semen and helps the sperm survive and swim freely for several days after ejaculation. It is produced by prostate cells, and it SHOULD remain in the prostate and seminal fluid unless something is abnormal. If PSA does leak out from the prostate, it goes into the bloodstream and can easily be measured with a simple blood test.

There is NO TRUE CUTOFF VALUE for the PSA concentration in the bloodstream; however, the higher the PSA, the higher chance something bad could be brewing inside the prostate. Dr. Bevan-Thomas recommends a PSA cutoff of 2.5 for all of his patients. If the PSA is higher than 2.5, it’s time to pay attention to whether something could be abnormal in the prostate that would warrant further investigation.

The PSA is either complexed with other proteins (complex PSA) or unbound (free PSA). This differentiation continues to give us clues as to the risk of a man having prostate cancer. Dr. Bevan-Thomas uses this test often to identify those men at higher risk. The lower the free PSA, the higher the risk of prostate cancer. Men with a percent free PSA of greater than 30% have a lower risk of cancer, and men with a lower percent free of less than 15% have a higher risk of the disease. Basically, men with a high total PSA and a lower percent free PSA have a higher risk of cancer but only for men with a PSA up to 10. Once the PSA increases above 10, the percent free PSA is no longer valid.

The GOOD NEWS is that not all men with an elevated PSA have prostate cancer. There are numerous reasons why a PSA could be elevated including but not limited to: an enlarged prostate (BPH), a prostate infection, urinary retention, recent instrumentation (such as a cystoscopy or Foley catheter) or prostate inflammation (prostatitis). In addition to those reasons, almost all prostate cancers will show up with an elevated PSA test. The job of the urologist is to become a PSA detective.

MORE GOOD NEWS. Men with a PSA below 10 who are diagnosed with prostate cancer have a better chance for cure than men with higher levels of PSA. In addition, roughly 40% of men are diagnosed with lower-grade prostate cancer that can be followed closely (active surveillance) without any intervention.

CAUTION: Men should not ignore the PSA test. Certain men have a higher risk for developing prostate cancer, including men with a family history of prostate cancer and African American men. Dr. Bevan-Thomas always recommends having this discussion with your doctor. Remember that prostate cancer is a real cancer that can progress and grow into the bones and the rest of the body and cause pain in the latter stages of the disease. Because prostate cancer rarely presents with symptoms early, the PSA blood test is the best way to find out whether a man is at risk.


Always repeat the PSA test if it’s abnormal, as there can be up to a 20% variability of the test for various reasons.

Try to refrain from ejaculation for two to three days before taking the test. Stimulation can cause the PSA to be falsely elevated.

The digital rectal exam should not change the test results. Unless your doctor did a vigorous rectal exam, the PSA should stay the same, so it’s ok to get a PSA test on the same day as the exam.

Consider a free and total PSA and discuss the results with your doctor.

The PSA is only the first step in evaluating the problem. For further reading, To learn more, please see "My PSA is Elevated. Now What?"

Prostate Cancer is the second leading cause of cancer death in men, According to the American Cancer Society, roughly 33,300 men will die of prostate cancer in 2020.

If prostate cancer is found early, the cure rate is in the high 90th percentile. The PSA test is the best way to find cancer early before it spreads to other areas of the body.

Urologist Dr. Richard Bevan-Thomas of Urology Partners
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