What a raised PSA result actually means

A raised PSA result is unsettling, and the first thing worth knowing is this: most men with a raised PSA do not have prostate cancer.

PSA — prostate specific antigen — is a protein made by the prostate. Some leaks into the blood normally. Several things increase how much, and cancer is only one of them.

What raises PSA besides cancer

• Benign prostatic hyperplasia (BPH) — non-cancerous enlargement, extremely common with age and probably the most frequent cause of a raised reading
• Prostatitis — inflammation or infection of the prostate
• Urinary tract infection
• Recent vigorous exercise, particularly cycling in the 48 hours before testing
• Recent ejaculation, within about 48 hours
• Digital rectal examination shortly before the test
• Simply getting older — the normal range rises with age

What the numbers mean

The commonly used threshold is 4 ng/mL, which is what most rapid home tests are set to. Above that, further investigation is usually considered.

But the threshold is a convention, not a wall. Age-specific ranges are often used: a reading of 3.5 means something different at 45 than at 75. And roughly three in four men with a raised PSA turn out not to have cancer, while around one in seven men with a normal PSA do have it. PSA is a prompt to look further, not an answer.

What happens after a raised result

Your GP will typically repeat the test in a laboratory, since a rapid test indicates only whether you are above or below the threshold, not the actual number. They will ask about symptoms, examine the prostate, and consider your age and family history.

If further investigation is warranted, the current UK pathway usually involves an MRI scan before any biopsy. This is a significant improvement on older practice — it means many men avoid a biopsy entirely.

Before you test

To avoid a falsely raised reading, avoid vigorous exercise and cycling for 48 hours beforehand, avoid ejaculation for 48 hours, and do not test while you have a urinary infection.

If your result is normal

A normal PSA is reassuring but not conclusive. Some prostate cancers do not raise PSA at all. Report any urinary symptoms — difficulty starting, weak flow, getting up at night, blood in urine — to a GP regardless of a test result.

Who should consider testing

In the UK there is no routine PSA screening programme, because the evidence on whether population screening does more good than harm is genuinely mixed. Men over 50 can request a PSA test from their GP. Testing earlier, from around 45, is often suggested for men with a family history of prostate cancer, and for Black men, who have roughly double the lifetime risk.

This is a decision worth discussing with a GP rather than making on a test result alone.