Does a high PSA mean cancer?
Usually not cancer. Around 72 to 80 in 100 men with a raised PSA don’t have it. But high depends on age: 4.0 is over NICE’s line at 45, and under it at 65.
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Is a high PSA level cancer?
Usually not. PSA is a protein made by your prostate.
Around 72 to 80 in 100 men with a raised PSA don’t have prostate cancer. The NHS says a high PSA does not mean you have cancer.
Think of PSA as a smoke alarm. Burnt toast sets it off as well as a fire. Most of the time it’s the toast, but you still go and check.
| Age | NICE line for men with symptoms: raised if PSA is |
|---|---|
| Under 40 | Your doctor decides. |
| 40 to 49 | More than 2.5 |
| 50 to 59 | More than 3.5 |
| 60 to 69 | More than 4.5 |
| 70 to 79 | More than 6.5 |
| 80 and over | Your doctor decides. |
Source: NICE NG12
That line is NICE’s age threshold. PSA rises naturally with age, so the line moves up.
Your sheet may say ng/ml or µg/L. The number is the same.
NICE uses these lines when men have possible symptoms, such as peeing more often or erection problems. Above the line, a GP may refer you, taking your wishes and other health problems into account.
Ask your GP which line they used for your result.
What causes high PSA besides cancer?
| Cause | What it is |
|---|---|
| Enlarged prostate | The prostate growing as you get older. Very common, and not cancer. |
| Prostatitis | A swollen, sore prostate. It can cause pain when you pee and a high temperature. |
| Urine infection | An infection in your pee tubes or bladder. It can raise PSA until it clears. |
| Ejaculating | Coming in the 48 hours before your test. |
| Hard exercise or cycling | Activities that raise your heart rate may lift PSA for a few days. |
| Anal sex or prostate play | Receiving anal sex, or having your prostate stimulated, might raise it for a while. |
| Recent procedures | A biopsy, tests or surgery on your bladder or prostate, or a new catheter (a tube that drains pee). |
Sources: Prostate Cancer UK; NHS; NHS: prostatitis
An enlarged prostate does not raise your risk of prostate cancer. If you have trouble peeing, see enlarged prostate symptoms.
Cancer can raise PSA too, so one test can’t usually tell which cause is yours. Tell your GP about anything from the list that happened before your test.
How to prepare for a repeat PSA test
Sex, exercise and cycling can push PSA up. The NHS says that could make the test less accurate.
Before your repeat PSA blood test
- For 48 hours before, don’t ejaculate.
- For 48 hours before, skip anything that leaves you out of breath, and don’t ride a bike.
- For a week before, avoid receiving anal sex or having your prostate stimulated.
- Had a urine infection? Wait 4 to 6 weeks after it has cleared.
- Had a biopsy, a catheter (a tube that drains pee), or tests or surgery on your bladder or prostate? Ask if you need to wait up to 6 weeks.
- Tell your GP about every medicine you take, including ones you buy yourself.
Sources: NHS; Prostate Cancer UK
You can eat and drink as usual. Results usually take 1 to 2 weeks. For more on the test itself, see our PSA blood test guide.
Does finasteride lower PSA?
Yes. Finasteride and dutasteride, used for an enlarged prostate, can lower PSA and give a false result.
The small hair loss dose does it too. A trial gave 355 men aged 40 to 60 either 1 mg a day or a dummy pill for 48 weeks.
On 1 mg, PSA fell by about 40% for a typical man in his 40s (the median, or middle result). In men aged 50 to 60, it fell by 50%.
For men on the 5 mg dose, doctors are advised to double the result. The trial authors say the same should apply at 1 mg. So on finasteride, a 2.0 may really mean nearer 4.0.
Tell your GP if you take it, even for hair loss. Never stop or change a prescribed medicine without your prescriber.
What happens after a raised PSA?
What usually happens after a raised PSA
- 1
Repeat test
You may be offered another PSA test to check it’s still high.
- 2
GP review
Your PSA, any prostate exam, symptoms, risk and other health problems.
- 3
MRI scan
If you’re referred to a specialist, you’ll have an MRI scan, which takes detailed pictures of your prostate.
- 4
Biopsy if needed
A biopsy takes tiny samples of the prostate to test. Most men only have one if the scan finds anything unusual.
Sources: NHS; NHS: diagnosis; Prostate Cancer UK
If your GP thinks something else raised it, they may suggest another test later to see if it changes. You can also ask to be referred.
Your PSA rising over several tests? Regular tests every few years might help spot changes that suggest cancer. Prostate Cancer UK says more research is needed on how often to test.
If yours keeps rising, ask your GP what it means.
About 1 in 8 men in the UK are diagnosed with prostate cancer in their lifetime, and about 1 in 4 Black men. If you’re Black or it runs in your family, your risk is higher from 45. Tell your GP.
Over 50? See blood tests for men over 50.
When to speak to a GP
- You have pain in your penis, scrotum, testicles or bottom, pain when you ejaculate, or a high temperature. These can be prostatitis, which needs urgent medical help.
- You can’t pee at all, it hurts to pee, or your pee looks pink, red or brown. Or you’ve taken antibiotics for prostatitis for 48 hours and you’re no better or worse. Ask for an urgent GP appointment or call NHS 111.
- You have trouble peeing, erection problems, blood in your semen, or lower back pain and weight loss you can’t explain. These are possible signs of prostate cancer. Also see a GP if you’re over 40 and genetic tests showed a faulty BRCA2 gene, which raises your risk.
- You had a PSA test and heard nothing after a few weeks. Contact the surgery or hospital that did it.
- You had a PSA test at a community event. Tell your GP so they can add it to your records.
Call 999 or go to A&E if you suddenly feel confused, your speech is slurred or you’re not making sense. The same goes for blue, grey, pale or blotchy skin, lips or tongue, a rash that doesn’t fade under a glass, or severe trouble breathing. These may mean a serious infection or sepsis, a dangerous reaction to an infection.