What are PSA tests and screenings?
A PSA test can help detect abnormalities with a man’s prostate gland. The PSA test measures blood levels of a protein called prostate-specific antigen (PSA). A healthy prostate gland produces a certain amount of PSA, but the level of prostate-specific antigen in the blood may rise if the gland contains malignant (cancer) cells. The PSA blood test alone is not used to diagnose prostate cancer. Your doctor may use the test in conjunction with other exams and tests to arrive at a diagnosis of cancer or another prostate condition, such as prostatitis (inflammation of the prostate gland) or enlarged prostate (benign prostatic hyperplasia, or BPH).
What does a PSA test for?
PSA screening used to be a routine part of the annual health exam for men older than 50. Most medical and preventive care organizations no longer recommend this practice because the benefits do not outweigh potential harms (see What are the risks and potential complications of PSA testing section). Instead, your doctor may suggest you have a PSA test only if you have other symptoms of a prostate condition, such as:
Blood in the urine
Burning or other pain with urination
Frequent urination or urge to urinate
Frequent nighttime urination
Incomplete emptying of the bladder
Pain in the low back or hips that doesn’t go away
Trouble starting the flow of urine or weak urine flow
Who performs PSA testing?
A PSA test requires a blood sample that is drawn in a lab. Your primary care provider or a urologist may order the test. You do not need to fast before the PSA blood draw, but you may want to abstain from having sex or ejaculating for a couple of days beforehand. Some studies have correlated ejaculation with a temporary rise in PSA levels.
How is a PSA test done?
As a simple lab procedure, the PSA test only requires you to provide a blood sample. Depending on your insurance coverage, you may be able to have your blood drawn at your provider’s office, or you may have to go to a lab covered by your plan. If you have questions, consult your insurer. The phlebotomist will take a small vial of blood from a vein in your arm and send it for lab analysis.
What are the risks and potential complications of PSA testing?
The health risks of PSA testing are minimal. The more important concerns with PSA testing lie in interpreting its results. The main concerns and limitations of PSA testing include:
False-positive results. Because there is no standardized range for normal PSA levels, a man’s test result could show elevated PSA levels even though he does not have prostate cancer. False-positive PSA results can cause concern and lead to unnecessary prostate biopsies.
False-negative results. Some men with prostate cancer exhibit normal levels of prostate-specific antigen in their blood. A normal PSA finding can leave those men with a false sense of security about their health status.
Test results that lead to overtreatment. A positive PSA result might indicate only that a man has a small malignant tumor within the prostate—tumors that tend to grow very slowly and are rarely fatal. Observation is often recommended in this situation. Overtreating smaller, nonaggressive tumors by subjecting men to invasive treatments, such as prostate surgery, with significant potential complications may not prolong their lives and could cause unnecessary harm.
PSA testing is a personal health decision. Talk with your doctor about your risk of prostate cancer and the use of PSA screening as part of your annual physical.
How do I prepare for PSA testing?
You need not do anything special before the PSA lab draw. You may eat and drink as normal. However, before undergoing a PSA test, you should understand the reasons your provider wants you to have the test performed, and what information he or she expects to glean from it.
Why are you recommending this test for me?
How will you use the test results in making a diagnosis?
Are there additional tests I should have to rule out other potential prostate diagnoses first?
How can we determine if my result is a false positive or negative?
If my PSA appears elevated, what will be the next steps?
What can I expect after PSA testing?
You can go about your normal routine after your blood draw. There is no recovery period.
When should I call my doctor?
Potential complications from a blood draw are minimal, but you should notify your doctor if you experience:
Bleeding from the needle puncture site that won’t stop (particularly for men who take blood thinners)
Excessive pain, swelling or redness at the puncture site
Fever over 101 degrees Fahrenheit
You should not experience any effects from the PSA blood draw, but receiving favorable test results might give you peace of mind concerning your health status. Most blood testing labs return results quickly. Your provider or the provider’s office will call with the PSA test results within a few days. Be sure to follow up on the results with your provider, regardless of whether the test says you have normal or elevated PSA levels. Ask your doctor ahead of time how long it will take to get the results. Your healthcare provider can put the results in context and help you keep your prostate gland healthy over the rest of your life.