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PSA, Total (Prostate-Specific Antigen)

A protein made by the prostate gland. Blood levels rise with age, prostate enlargement, inflammation and sometimes prostate cancer.

AI-drafted. Awaiting verificationAlso called PSA, tPSALOINC 2857-1

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What it is

PSA stands for prostate-specific antigen. It is a protein made by cells in the prostate, and it helps thin (liquefy) semen. A small amount leaks into the blood, and this test measures it. PSA tends to creep up with age as the prostate grows. It can also rise for reasons that have nothing to do with cancer, such as an enlarged prostate or an infection. This page covers total PSA, which counts all the PSA in the blood.

Why it matters

Total PSA is the most common blood test used to look at prostate health. Clinicians use it in two main ways. One is as part of deciding whether to look further for prostate cancer. The other is to follow people who have been treated for it. It is not a perfect test. A result in the usual range does not rule out prostate cancer, and a high result is often caused by something else. Because of this, major guidelines say the choice to be tested should be shared between you and your clinician. Your clinician will look at the number together with your age, family history, exam and past results.

If it’s high

A PSA above your lab's range does not mean you have cancer. Many things raise it, and most of them are not cancer. Higher values are more common in people with prostate cancer, so your clinician may suggest more steps if the result stays high. A common first step is to repeat the test. The AUA guideline notes that 25% to 40% of newly raised results return to the usual range when retested.

Common causes

  • An enlarged prostate (benign prostatic hyperplasia), which becomes more common with age
  • Natural rise with age as the prostate grows
  • Prostate inflammation or infection (prostatitis), or a urinary tract infection
  • A recent catheter, cystoscopy, prostate biopsy or other prostate procedure (effects can last weeks)
  • Ejaculation or hard cycling shortly before the blood draw (a small effect at most, and studies disagree)
  • Testosterone therapy, which can raise PSA modestly
  • Prostate cancer

What can help

  • Ask your clinician whether to repeat the test in a few weeks to a few months before deciding on anything else, since many raised results settle
  • Tell your clinician about recent infections, urinary symptoms, catheters, procedures, and any medicines or supplements you take, since these can change PSA
  • Ask whether other tools, such as a free PSA, a blood or urine risk test, an MRI or an online risk calculator, would help in your case
  • Use the same lab for repeat tests when you can, since methods differ between labs

Usual ranges

What labs print as the reference range, by who was tested. Ranges differ a little between labs, so the range on your own report is the one your result is judged against.

The usual range depends on sex and age. Choose women or men to see the one that applies.

Children and teens 1 ranges

See PSA by age and sex, with the U.S. survey numbers where they exist.

Wellness targets

Narrower ranges some clinicians aim for. Being outside one doesn’t mean something is wrong.

0–1 ng/mL (Men, 45–70). Evidence: Moderate. The AUA/SUO guideline cites long-term cohort studies in people without a strong family history or known inherited gene change. Among those aged 40 to 59 with PSA below the age-specific median (about 0.7 to 1.0 ng/mL), the long-term risk of metastatic or fatal prostate cancer was very low. At age 60 with PSA under 1.0, the 25-year risk was 0.5% for metastases and 0.2% for death from prostate cancer. NCCN and the AUA suggest longer retest intervals below 1.0. These are observational findings used to set testing intervals, not a level to treat toward: medicines that lower PSA do not change what it means. Being above 1.0 does not mean something is wrong.

NCCN early-detection follow-up categories (average risk, ages 45–75)

  • Less than 1 (repeat testing every 2–4 years)below 1 ng/mL
  • 1 to 3 (repeat testing every 1–2 years)1 to under 3.01 ng/mL
  • More than 3 (talk with a clinician about further testing)3.01 and above ng/mL

If this applies to you

PSA means a little more for some people. Open the one that fits you.

On gender-affirming hormones

If you have a prostate and take estrogen, PSA is expected to run lower, and there isn't enough data for a separate cutoff. One review suggests reading PSA against the male range, since it depends on prostate size.

Blood tests on gender-affirming hormones

On testosterone therapy

For men 55 to 69, or 40 to 69 with a higher chance of prostate cancer (such as African American men, or men whose father, brother or son had it), the Endocrine Society suggests talking through PSA monitoring. For those who choose it, PSA is checked before starting and at 3 to 12 months, then on the usual screening schedule.

Blood tests on testosterone therapy

What can affect your result

  • Age: PSA rises gradually as the prostate grows, which is why some labs use age-based ranges
  • Prostate size, enlargement (BPH), inflammation and infection
  • Recent catheter, cystoscopy, prostate biopsy or surgery, which can raise PSA for weeks
  • 5-alpha-reductase inhibitors (finasteride, dutasteride), which lower PSA by about half after 6 months or more
  • Testosterone therapy, which can raise PSA modestly
  • Ejaculation or cycling: small or no effect, and studies disagree
  • Assay method and calibration: results from different methods are not interchangeable (in one study, two calibrations of the same assay differed by about a quarter)
  • Biotin supplements, which can interfere with some immunoassays
  • Prostate removal or treatment: after surgery PSA is expected to fall to undetectable levels
  • Digital rectal exam: little or no effect on PSA
  • A urinary tract or prostate infection, a recent catheter, cystoscopy, prostate biopsy or other prostate procedure can raise PSA for weeks (the National Cancer Institute says a month or two after a prostate infection or biopsy). Tell your clinician if any of these apply.
  • Finasteride and dutasteride (5-alpha-reductase inhibitors) lower PSA by about half after roughly 6 months or more. The size of the drop varies from person to person.
  • Testosterone therapy can raise PSA modestly.
  • Ejaculation or hard cycling shortly before the draw may raise PSA slightly in some men. Evidence is mixed: the AUA guideline describes the effect of ejaculation as small (about 10%) and says a digital rectal exam and cycling do not appreciably change PSA.
  • Biotin supplements can interfere with some immunoassays (FDA). Some PSA methods, such as the Roche assay used at Mayo Clinic Laboratories, are reported to tolerate very high biotin levels, so ask your lab if you take biotin.
  • Rare antibodies in the blood (heterophile or anti-mouse antibodies, or antibodies to streptavidin or ruthenium) can cause false results on some immunoassays.
  • Results from different assays and calibrations are not interchangeable. In one study, the same assay calibrated to the WHO standard read about 25% lower than with its traditional Hybritech calibration on the same samples.
  • Grossly hemolyzed specimens are rejected by Mayo Clinic Laboratories and ARUP.

PSA has a half-life of about 2–3 days, so a temporary rise from a procedure or infection fades over weeks. The drop after starting a 5-alpha-reductase inhibitor takes about 6 months to show fully.

When to talk to a clinician

Talk with your clinician soon if your PSA is above your lab's range, keeps rising on repeat tests, or comes with blood in your urine or semen, trouble passing urine, or new pain in your hips, back or pelvis. If you have had your prostate removed, talk with your care team if your PSA becomes detectable again: a result of 0.2 ng/mL or higher, confirmed by a second test, is the AUA's usual definition of PSA recurrence. If you take testosterone therapy, the Endocrine Society suggests a urology consultation if, in the first year, PSA rises by more than 1.4 ng/mL above your starting level on a confirmed repeat test, or is confirmed above 4.0 ng/mL. Get urgent care if you cannot pass urine, or if you have fever and chills with painful urination.

Questions you could ask

  • Is PSA testing a good fit for me, given my age, family history and preferences?
  • How often should I be tested, and should I use the same lab each time?
  • Do any of my medicines or supplements affect this test?
  • Should we repeat the PSA before deciding on next steps, and when?
  • Could a recent infection, procedure or medicine explain this result?
  • Would other tests, such as a free PSA, a risk calculator or an MRI, be useful in my situation?

Questions people ask

Does a PSA in the usual range mean I don't have prostate cancer?

No. No PSA level rules cancer out. In a large US prevention trial, men aged 62 to 91 whose PSA had stayed at 4.0 ng/mL or lower had a prostate biopsy. Prostate cancer was found in about 7 in 100 men with PSA 0.5 or lower and about 27 in 100 men with PSA 3.1 to 4.0. About 15% of the cancers found were higher-grade (Gleason 7 or above). A lower PSA goes with a lower chance of cancer, but never zero. Your clinician can explain how your number fits with your age and risk.

Why do labs use different ranges for PSA?

There is no single agreed cutoff. Many labs print 0 to 4.0 ng/mL for all men, a number that comes from early studies. Some labs use age-based limits instead, because PSA naturally rises as the prostate grows. Common limits are 2.5 for the 40s, 3.5 for the 50s, 4.5 for the 60s and 6.5 for the 70s. The AUA guideline says there is no universally accepted definition of an elevated PSA and that clinicians may tailor it to your situation. Use the range printed on your own report, and ask your clinician how it applies to you.

Can something I did before the blood test change my result?

Sometimes, but usually only a little. A urinary tract or prostate infection, a catheter, a cystoscopy or a prostate biopsy can raise PSA for weeks, so tell your clinician if you had any. Ejaculation or hard cycling just before the test may raise it slightly in some men, though studies disagree. Ask your clinician whether to avoid either before a repeat test. Finasteride and dutasteride lower PSA by about half, testosterone therapy can raise it, and high-dose biotin supplements can disrupt some lab methods. Tell your clinician and the lab about all of these.

Can I compare PSA results from different labs?

Not reliably. Labs use different methods and calibration. In one study of the same blood samples, one common assay read about 25% lower when calibrated to the WHO standard than with its older Hybritech calibration. ARUP warns that results from different methods cannot be used interchangeably, and Mayo notes that values may vary by method. For tracking over time, use the same lab and method when you can, and check the method named on your report.

How often should I have a PSA test?

It depends on your age, risk and preferences, and expert groups differ. The AUA/SUO guideline suggests offering testing every 2 to 4 years for ages 50 to 69. It says a first (baseline) test at 45 to 50 is an option, and that testing can start at 40 to 45 for people at higher risk, such as Black men or those with a strong family history or inherited gene changes. The American Cancer Society says every 2 years may be enough if PSA is under 2.5, and yearly testing if it is 2.5 or higher. The US Preventive Services Task Force (2018) says ages 55 to 69 should decide individually with their clinician, and it recommends against routine testing from age 70. Talk with your clinician about what fits you.

Show the science and sources

Units

  • 1 ng/mL = 1 ng/mL
  • 1 ng/mL = 1 µg/L

Is a change real?

PSA naturally varies about 6.8% from test to test in the same healthy person. Between two results from the same lab, a rise of 23% or more, or a fall of 19% or more, is unlikely to be day-to-day noise or lab variation (95% reference change value). Source: Critical review and meta-analysis of biological variation estimates for tumor markers (Marques-Garcia F et al., EFLM WG-BV).

For clinicians and researchers

PSA (KLK3, kallikrein-related peptidase 3) is a serine protease secreted by prostatic epithelium that liquefies the seminal coagulum. In serum it is mostly bound to protease inhibitors such as alpha-1-antichymotrypsin, with a smaller free fraction, and total PSA assays are designed to measure both. The serum half-life is about 2–3 days (AUA), so transient rises after instrumentation or infection take weeks to clear. The traditional 4.0 ng/mL cutoff came from early studies of men thought to be free of cancer; the age-specific limits (2.5, 3.5, 4.5 and 6.5 ng/mL for the 40s through 70s) came from Olmsted County, Minnesota men without cancer, measured on the Hybritech Tandem-R assay (Oesterling 1993). Calibration matters: when the Beckman Coulter Access assay was aligned to WHO 96/670, it read about 25% lower (Passing-Bablok slope 0.747) than its traditional Hybritech calibration on the same 641 sera, and the authors suggested a 3 µg/L cutoff for the WHO-aligned assay (Stephan 2008). ARUP states that results from different methods cannot be used interchangeably, and Mayo notes that values may vary by method. No threshold has zero risk: in the Prostate Cancer Prevention Trial, biopsy-found cancer ranged from 6.6% at PSA 0.5 or lower to 26.9% at 3.1–4.0 ng/mL, including high-grade disease (Thompson 2004). Guidelines therefore favor shared decision-making and risk-based follow-up over a single cutoff: repeat a newly raised PSA, then consider MRI, risk calculators or secondary markers (percent free PSA, PHI, 4Kscore). The AUA advises against using PSA velocity as the sole trigger. AUA/SUO, NCCN and EAU/EANM/ESTRO all revised their early-detection guidance in 2026, and the USPSTF 2018 statement is being updated. 5-alpha-reductase inhibitors lower PSA by about 50% by roughly 6 months (finasteride labeling, Labcorp), though the AUA notes wide individual variation. The Endocrine Society (2018) suggests urologic consultation during the first year of testosterone therapy for a confirmed PSA rise of more than 1.4 ng/mL above baseline or a confirmed PSA above 4.0 ng/mL. Biotin–streptavidin immunoassays can be disturbed by biotin (FDA); Mayo reports no interference up to 1200 ng/mL biotin on its Roche method, and rare heterophile, anti-streptavidin or anti-ruthenium antibodies can cause errors. After radical prostatectomy PSA should become undetectable. The AUA defines biochemical recurrence as a PSA of 0.2 ng/mL or higher confirmed by a second value of 0.2 or higher, and labs publish ultrasensitive assays for this setting. The adult reference intervals above are not intended for post-treatment monitoring. Mayo lists no reference interval for females.

LOINC 2857-1 (primary), 83112-3, 35741-8. Specimen: serum-or-plasma.

Sources

  1. Prostate-Specific Antigen (PSA) (test 010322), Labcorp
  2. Prostate-Specific Antigen (PSA), Ultrasensitive (test 140731), Labcorp
  3. Prostate Specific Antigen, Total (test 0070121), ARUP Laboratories
  4. PSA - Overview: Prostate-Specific Antigen (PSA) Diagnostic, Serum, Mayo Clinic Laboratories
  5. Prostate-Specific Antigen (PSA), Total, University of Iowa Hospitals and Clinics Pathology Handbook
  6. Serum prostate-specific antigen in a community-based population of healthy men. Establishment of age-specific reference ranges, JAMA (1993)
  7. Early Detection of Prostate Cancer: AUA/SUO Guideline (2023, amended 2026), American Urological Association (2026)
  8. Prostate Cancer Early Detection: Age Recommendations and PSA Levels Chart (based on NCCN Guidelines for Prostate Cancer Early Detection, 2025), ZERO Prostate Cancer (2025)
  9. Early Detection of Prostate Cancer Guideline Side-by-Side (AUA/SUO, NCCN, EAU/EANM/ESTRO), Guideline Central (2026)
  10. Screening for Prostate Cancer: US Preventive Services Task Force Recommendation Statement, JAMA / US Preventive Services Task Force (2018)
  11. American Cancer Society Recommendations for Prostate Cancer Early Detection, American Cancer Society (2023)
  12. Prostate-Specific Antigen (PSA) Test, National Cancer Institute (2025)
  13. Prevalence of prostate cancer among men with a prostate-specific antigen level <=4.0 ng per milliliter, New England Journal of Medicine (2004)
  14. Toward metrological traceability in the determination of prostate-specific antigen (PSA): calibrating Beckman Coulter Hybritech Access PSA assays to WHO standards compared with the traditional Hybritech standards, Clinical Chemistry and Laboratory Medicine (2008)
  15. Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline, Journal of Clinical Endocrinology & Metabolism (2018)
  16. Proscar 5 mg film-coated tablets: Summary of Product Characteristics, electronic medicines compendium (emc)
  17. Biotin Interference with Troponin Lab Tests - Assays Subject to Biotin Interference, US Food and Drug Administration

AI-drafted. Awaiting verification. Last reviewed 2026-10-03. How we build and check these pages.

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