PSA testing in patients with symptoms

Using the PSA testing to investigate prostate cancer symptoms

A PSA test is usually the first test for men and other people with a prostate who have symptoms that could be caused by prostate cancer. Guidelines recommend considering a PSA test and a digital rectal examination (DRE) for patients with¹²³⁴:

• Any lower urinary tract symptoms, such as frequency, urgency, nocturia, hesitancy or a weak urinary stream

• Erectile dysfunction

• Visible haematuria

• Haematospermia

Considerations before testing

Before testing, consider whether there are any other factors could raise PSA levels. Consider postponing the PSA test for:

• An active UTI or prostatitis (wait ≥6 weeks after resolution)

• A recent biopsy or urological procedure (wait ≥6 weeks after procedure)

• Recent ejaculation or vigorous exercise (wait 48 hours)

The potential harms and benefits of PSA testing should be shared with patients before testing to support informed choice.

For guidance and advice about PSA testing in the absence of symptoms, read PSA testing in patients without symptoms.

Suspected prostate cancer referral guidelines

The resources below explain how to assess possible prostate cancer and when to refer based on PSA levels.

England and Wales

• NICE NG12 (2021) and clinical knowledge summary(2026)

• England and Wales GP guide to managing suspected prostate cancer(PDF, 348 KB) (November 2025)

Scotland

• Scottish Referral Guidelines (SRG) (2025)

• Scotland GP guide to managing suspected prostate cancer(PDF, 385 KB) (November 2025)

Northern Ireland

• Northern Ireland Referral Guidance for Suspected Cancer(NICaN) (2022)

• Northern Ireland GP guide to managing suspected prostate cancer(PDF, 358 KB) (November 2025)

Interpreting PSA results and assessing prostate cancer risk

• PSA thresholds for referral vary across UK guidelines. Check the relevant national guidelines and your local pathway when making referral decisions.

• Consider PSA results alongside symptoms, DRE findings, individual risk factors and clinical judgement. A normal PSA does not rule out prostate cancer, and a raised PSA does not necessarily mean cancer is present.

• Some groups of people are more likely to develop prostate cancer, including:

  • older men⁵

  • black men⁶,

  • men with a family history of prostate cancer⁷

  • men with inherited cancer predisposition syndromes such as BRCA1 and Lynch syndrome⁸⁹

• Although the incidence of prostate cancer is higher in these groups of people, there’s unclear evidence of whether they’re at increased risk of aggressive disease. This is an important consideration given issues with overdiagnosis.

• Men with a BRCA2 pathogenic variant and a family history of prostate, ovarian, breast or pancreatic cancer are at increased risk of aggressive prostate cancer. As a result, the UK National Screening Committee has recommended targeted prostate cancer screening for this group¹⁰.

• Although pre-biopsy MRI has improved the diagnostic pathway, overdiagnosis remains a challenge. Researchers are working to develop more accurate tests that better identify clinically significant prostate cancer while reducing overdiagnosis and overtreatment. Read about developments in diagnosing prostate cancer to learn more.

• Assess patients with ongoing, worsening or unexplained symptoms, regardless of their PSA result.

Resources to support you and your patients

Resources for health professionals

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

• NICE Clinical Knowledge Summary (CKS) for Prostate Cancer

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

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

• Earlier detection and diagnosis of prostate cancer: A technical summary of the challenges and evidence(PDF, 578 KB) (May 2026)

• Prostate cancer statistics

• PSA testing in patients without symptoms

Resources for patients

• Prostate cancer and PSA testing patient leaflets

• Prostate cancer webpages

• What is the PSA test webpage

• NHS UK PSA testing webpage

• NHS UK prostate cancer webpage

Patients without symptoms

For guidance and advice about PSA testing in the absence of symptoms, visit our PSA testing in patients without symptoms webpage.