Understand PSA testing and how to support your patients to make an informed choice

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

• PSA testing can help detect prostate cancer at an earlier stage, before there are symptoms. Treatment is more likely to be effective at earlier stages and may be associated with less severe side effects.

Potential harms

• PSA testing can give false positive results. Around 72-80% of people with a raised PSA do not have prostate cancer¹²³. This may lead to unnecessary and potentially invasive investigations, usually an MRI* or prostate biopsy, which carry their own risks.

• PSA testing can give false negative results. Around 7-15% of people with a normal PSA may have prostate cancer¹²³, which means it can miss aggressive and fast-growing cancers that need treatment.

• PSA testing can lead to identification of slow-growing tumours that may not cause any 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. This unnecessary treatment can have life-changing physical effects. For example, studies have shown that:

  • For men who have surgery, almost 50% experience erectile problems, and almost 20% experience leaking urine after 5 years⁴⁵.

  • For men who have radiotherapy, almost 40% experience erectile problems and around 5% experience bowel problems⁴⁵.

There are also psychological harms associated with treatment and an overall impact on quality of life⁶.

*Multiparametric MRI (mpMRI) is used in most areas across the UK to assess the need for prostate biopsy. It may improve detection of clinically significant prostate cancers that require treatment⁷. However, further research is needed to determine whether MRI reduces the risk of overdiagnosis and overtreatment that is associated with PSA testing. Research is ongoing to optimise the diagnostic pathway.

Using the PSA test in symptomatic cases and referral guidance

England and Wales

NICE Guidelines (NG12 as of 2021)⁸: Consider a PSA test and digital rectal examination (DRE) to assess for prostate cancer in men who have any of the following symptoms:

• Lower urinary tract symptoms

• Erectile dysfunction

• 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)

Scotland

Scottish Referral Guidelines (SRG as of 2025)⁹: 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

• 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:

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. Read 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

Northern Ireland Referral Guidance for Suspected Cancer (NICaN, as of 2022)¹⁰: Consider a PSA test for men presenting with any of the following:

• Lower urinary tract symptoms

• Erectile dysfunction

• 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)

Targeted prostate cancer screening

In May 2026, the UK National Screening Committee (UK NSC) published a recommendation to introduce targeted prostate cancer screening for men aged 45-61 with both a BRCA2 pathogenic variant and a family history of pancreatic, prostate, breast or ovarian cancer¹¹. They recommend that men in this cohort be screened using the PSA test every 2 years. This recommendation reflects the higher risk of aggressive prostate cancer in this group and as a result, the potential benefits of screening in this group outweigh the potential risks.

The UK NSC also confirmed that there is currently insufficient evidence to support:

• population-wide prostate cancer screening

• targeted screening for Black men

• targeted screening for men with a relevant family history of cancer without BRCA2 pathogenic variants

• targeted screening for men with BRCA1 pathogenic variants

Although some of these groups have a higher incidence of prostate cancer, it is not yet clear whether they are at greater risk of aggressive disease. The committee concluded that, in these groups, the potential harms of PSA-based screening (including overdiagnosis) are likely to outweigh the benefits.

For further commentary on this recommendation read our lates cancer news article: UK NSC recommends targeted prostate cancer screening (May 2026)

How this recommendation impacts primary care is still under consideration. For now, GPs should continue to follow existing guidance for men with confirmed or suspected BRCA2 pathogenic variants and relevant family history. If the UK Government and devolved administrations accepts the UK NSC’s recommendation, implementation will be planned and further guidance for healthcare professionals will follow. We will also be working closely with health systems in all four UK nations to develop resources to support any changes in practice.

Guidance for managing men with confirmed or suspected BRCA2 pathogenic variants

Whilst a targeted screening approach is still to be confirmed, GPs can follow existing guidance. The UK Cancer Genetics Group recommends that men with a confirmed BRCA2 pathogenic variant are offered annual PSA tests from age 40 and referred onwards if PSA >3ng/mL. For men who are concerned that they may be carriers of BRCA2 pathogenic variants, refer to existing guidance to assess who’s eligible for referral onto specialist clinical genomics services:

England and Wales

• NG241 and CG164 outline referral criteria based on family history of breast or ovarian cancer. The NHS England National Genomics Education Programme also provides example clinical scenario for managing patients with a family history of prostate cancer.

Scotland

• regional genetics services have similar guidance

Northern Ireland

• guidance is available via the Belfast Health and Social Care Trust. If a family member (parent, sibling or child) has already been tested in the NHS and is known to be a BRCA2 pathogenic variant carrier, referral can be made regardless of family history.

The above criteria can be applied to any man concerned about their family history of cancer, to determine if they meet criteria for onward referral. Once someone is referred, specialist genomics services will assess detailed family history alongside clinical factors to guide testing and/or management. If unsure, consider seeking advice from a specialist through Advice and Guidance (A&G) services. Further national guidance is expected following progress on targeted screening.

Supporting discussions with asymptomatic men requesting a PSA test

Even though population-wide screening for prostate cancer using the PSA test is not recommended, men without symptoms may still want a PSA test.

In these cases, it is important to support informed decision-making by discussing the potential benefits and harms of PSA testing, including overdiagnosis.

You can signpost patients to our prostate cancer screening webpages for clear, patient-friendly information.

Developments in diagnosing prostate cancer

Research and innovation are ongoing to develop more accurate approaches to diagnosing prostate cancer. Emerging areas include new blood, urine and genetic tests aimed at improving early detection.

Current research is exploring:

• 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 and emerging evidence for prostate cancer and across the pathway, read our cancer news article: “Detecting prostate cancer: why we need more research (April 2025)” or download our Technical summary of earlier detection and diagnosis of prostate cancer(PDF, 578 KB).

Resources to support you and your patients

Resources for health professionals:

• England and Wales GP guide to managing suspected prostate cancer(PDF, 348 KB)

• Scotland GP guide to managing suspected prostate cancer(PDF, 385 KB)

• Northern Ireland GP guide to managing suspected prostate cancer(PDF, 358 KB)

• UK NSC recommends targeted prostate cancer screening (May 2026)

• Earlier detection and diagnosis of prostate cancer: A technical summary of the challenges and evidence(PDF, 535 KB) (November 2025)

• Prostate cancer statistics

• GatewayC ‘The role of genomics in primary care’ course (England and Wales only) (February 2025)

Resources for patients:

• Prostate cancer screening webpage

• Prostate cance webpages

• What is the PSA test webpage

• Prostate cancer awareness leaflet