Single marker guide · Prostate-specific antigen (PSA, free PSA, ratio)
One in eight men will get prostate cancer, one in four if you are Black, and the UK has no screening programme for it. A PSA test is the only blood marker that changes those odds, and it works best as a baseline in your forties and a trend from there, not as a one-off panic test at 60. Here is what it measures, what your number means at your age, the things other than cancer that raise it, and why the free-to-total ratio matters more than the headline figure.
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The short answer
Prostate-specific antigen is a protein made by the prostate and released into the blood in small amounts. Anything that makes the gland larger, inflamed or disturbed raises it: cancer, yes, but also the benign enlargement that affects most men over 50, prostatitis, a urinary infection, and even sex or a bike ride in the two days before the draw. That is why a single raised PSA causes so much anxiety and so many unnecessary biopsies, and why the NHS declined to build a screening programme around it.
Used well, it is a different tool. A baseline in your forties, when the prostate is small and PSA should be low, tells you your starting point: men with a PSA under 1 at 45 have a very low lifetime risk, and men above the median for their age are the ones who benefit from watching it. From then on it is the direction and speed of change that matters, and a free-to-total PSA ratio that separates benign enlargement from something to investigate. Modern NHS pathways now use MRI before biopsy, so a raised result leads to a scan, not straight to a needle. Men's health blood test guide.
Reference ranges
| Age | Typical PSA (ng/mL) | NICE referral threshold | What it means |
|---|---|---|---|
| 40 to 49 | Median about 0.7 | Above 2.5 | The baseline decade. Below 1.0 is reassuring for years. Above the median is a reason to retest every one to two years rather than five. |
| 50 to 59 | Median about 0.9 | Above 3.0 to 3.5 | The age the NHS will test on request. Benign enlargement begins to lift PSA slowly in many men, which is why the ratio and the trend matter. |
| 60 to 69 | Median about 1.2 | Above 4.5 | Peak diagnosis decade. A rise of more than 0.75 a year, or a free ratio below 15%, warrants a GP conversation whatever the absolute level. |
| 70 to 79 | Median about 1.7 | Above 6.5 | Enlargement is near-universal and thresholds rise with it. Testing is a personal decision weighed against overall health and life expectancy. |
| Any age | Free-to-total ratio | Above 25% reassuring | Cancer tends to produce PSA that is bound to other proteins, so a low proportion of free PSA (under 10 to 15%) raises concern, and a high proportion points to benign enlargement. Most useful when total PSA is between 4 and 10. |
Thresholds follow NICE guidance on suspected cancer and vary slightly by area; some NHS regions now use 3.0 for all men aged 50 to 69. If you take finasteride or dutasteride, your PSA reads roughly half its true value and should be doubled before comparing. TrueVitals reports adjust for medication you declare.
What else raises it
Most raised PSA results are not cancer. Around three in four men with a PSA between 4 and 10 who go on to biopsy do not have it. The reasons below account for most of the false alarms, and several are avoidable simply by preparing for the test properly.
The prostate grows with age in almost every man. A bigger gland makes more PSA, and a slow steady rise over years with a high free ratio is the signature. It causes the night-time trips to the toilet, not cancer.
A urinary infection or inflamed prostate can send PSA into the tens for weeks. If there is any burning, urgency or pain, wait six weeks after treatment before testing. Urinalysis and hs-CRP in the same panel flag this.
Raises PSA measurably for up to two days. The single most common reason for a mildly high result in a healthy man, and the easiest to avoid.
Pressure on the perineum from a bike saddle, and vigorous exercise generally, lift PSA for a day or two. No cycling for 48 hours before the draw. Blood tests for gym-goers.
A rectal examination, catheter or cystoscopy in the previous few weeks disturbs the gland. Test before an examination, not after.
The opposite trap. Finasteride and dutasteride, used for enlargement and hair loss, halve PSA within months. A "normal" 2.0 on finasteride is really a 4.0. Declare it and the report corrects for it. Hair loss blood test guide.
Who should test
Prostate Cancer UK and most urologists now support a baseline PSA in the mid-forties for every man, because that single number stratifies lifetime risk better than anything else available. From there, low-risk men can test every few years and higher-risk men every year or two. The men who should start at 40 rather than 45: Black men, whose risk is double and whose cancers present younger; anyone with a father or brother diagnosed, particularly before 60; anyone with a BRCA2 mutation in the family; and men on testosterone replacement, where PSA monitoring is a condition of safe treatment. Health check at 40 for men.TRT monitoring guide.
Symptoms are a separate matter. Difficulty starting, a weak stream, getting up at night, blood in urine or semen, or bone pain need a GP appointment, not a private test. A PSA is a screening tool for men who feel fine.
Read it in context
Total PSA on its own is the number that causes the worry. The markers beside it are what decide whether the worry is warranted.
The single most useful addition. A total of 5 with a free ratio of 30% is almost certainly enlargement; the same 5 with a ratio of 8% needs a scan. Standard PSA tests report total only. TrueVitals Ultimate reports total, free and the ratio together.
Leucocytes or nitrites in urine, or a raised CRP, point to infection as the reason PSA is up. That changes the next step from urology referral to antibiotics and a retest in six weeks. Both in Ultimate.
Testosterone drives the prostate. Men considering or on TRT need PSA and testosterone read together, and a rising PSA on treatment is one of the few reasons to stop. Testosterone guide.
An enlarged prostate that obstructs the bladder can back up into the kidneys. A raised PSA with a falling eGFR is a pattern that needs the obstruction treated, whatever the cause. Kidney function guide.
Blood in the urine that is not visible still costs iron. A low ferritin or anaemia alongside a raised PSA supports a urinary source and adds urgency.
Prostate cancer risk rises with obesity, insulin resistance and inflammation, and falls with the same changes that protect the heart. ApoB, HOMA-IR and hs-CRP in the same draw tell a man in his fifties what to do about all of it at once.
Which test
Advanced
74 biomarkers · £269
Testosterone, SHBG, cortisol, DHEA-S, full thyroid, ApoB, hs-CRP, liver, kidney, iron and vitamins. A strong men's baseline, but PSA is not included at this tier.
View AdvancedIncludes PSA + ratio
Ultimate
114 biomarkers · £349
Total PSA, free PSA and the free-to-total ratio, with urinalysis, hs-CRP, testosterone, complete hormones, cystatin C kidney function, Lp(a), fasting insulin and HOMA-IR. Everything needed to read a PSA properly, in one draw.
View UltimateSignature
230 biomarkers · £799
Processed by Randox. PSA with extended tumour markers, cardiovascular, metabolic and autoimmune screening, plus physical measurements. The deepest men's health picture available privately in the UK.
View SignatureClinic draw £19 at 103 UK clinics. At-home phlebotomist £39 across 200+ areas. No ejaculation, cycling or hard exercise for 48 hours before. Fast from 10pm the night before.
Honest comparison
If you are over 50 and simply want a PSA, your GP will do it free under the Prostate Cancer Risk Management Programme, and if you have symptoms that is the route regardless. A standalone PSA test from Medichecks costs around £39, and some providers offer free PSA for a little more. For tracking a known, stable PSA year on year, any of these is fine.
A panel is the better choice for a baseline under 50, which the NHS generally will not do, and for any first test, because a PSA without the ratio, urinalysis and CRP beside it is the version that generates false alarms. It is also the sensible route for men on TRT, who need PSA, testosterone and haematocrit monitored together. See how every UK provider compares.
After the result
Low risk. Under 45 with a PSA below 1, retest in five years. Otherwise every two to three years, sooner with family history. Your report records the baseline so future results are compared against it automatically.
Check the ratio, the urinalysis and the CRP in your report, and check you prepared properly. If the ratio is high and there is no sign of infection, this is most likely enlargement: retest in 12 months and watch the trend. If the ratio is low, or the rise from your last test is more than 0.75 a year, take the report to your GP now.
See your GP with your report. The NHS pathway is a repeat PSA and an MRI before any biopsy, and most men at this stage do not have cancer. Do not retest privately first; the referral clock starts with the GP.
This page is general information, not medical advice. Blood in urine or semen, difficulty passing urine, or bone pain need a GP appointment regardless of any PSA result.
FAQs
It depends on age. Medians run from about 0.7 ng/mL in the forties to 1.7 in the seventies, and NICE referral thresholds rise from 2.5 to 6.5 across the same span. The trend over time and the free-to-total ratio matter more than any single value. A PSA below 1.0 at 45 indicates very low lifetime risk.
Yes if you are 50 or over and ask, under the Prostate Cancer Risk Management Programme. Under 50 without symptoms or a strong family history, most GPs will decline, which is why men wanting a baseline in their forties test privately. There is no invitation-based screening programme. What to ask your GP for.
PSA circulates either free or bound to other proteins. Cancer tends to produce the bound form, so a low percentage of free PSA (under 10 to 15%) raises concern and a high percentage (over 25%) points to benign enlargement. The ratio is most useful when total PSA is in the 4 to 10 grey zone, and it is included in the TrueVitals Ultimate panel.
No ejaculation, cycling or vigorous exercise for 48 hours. Do not test within six weeks of a urinary infection, prostatitis or a rectal examination. Declare finasteride or dutasteride, which halve the result. Fasting is not needed for PSA itself, but TrueVitals panels ask you to fast from 10pm for the other markers.
Usually not. Around three in four men with a PSA between 4 and 10 who are biopsied do not have cancer; enlargement, infection and recent activity account for most raised results. What a high PSA means is that the next steps, a repeat test, the ratio, and if needed an MRI, are worth doing.
A baseline at 45 for most men, and at 40 for Black men, anyone with a father or brother diagnosed, or a family BRCA2 mutation. The baseline value sets how often you test afterwards.
TRT can raise PSA modestly in the first year, and PSA monitoring is a standard safety requirement of treatment. Any rise of more than 1.4 ng/mL in a year, or above 4.0, needs urology review. Testing PSA and testosterone together is the correct approach.
Ultimate (114 markers, £349) includes total PSA, free PSA and the ratio for men, and Signature (230 markers, £799) includes PSA with extended tumour markers. Advanced does not include PSA.
114 or 230 biomarkers. Venous draw at 103 UK clinics or at home. A report that tells you what your results mean and what to do next.
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