PSA Screening

What Is Prostate-Specific Antigen?

PSA is a protein made by prostate cells that keeps semen in liquid form so sperm can move. A simple blood test measures how much PSA is present in your bloodstream. When a man has prostate cancer, his PSA level often rises, which is why the test is useful for screening. PSA can also rise for reasons that have nothing to do with cancer, so an elevated result is best understood as a signal to follow up with your doctor, not a diagnosis.

The Controversy Around PSA Screening

Over the years, PSA screening has been debated. In 2012 the U.S. Preventive Services Task Force (USPSTF) gave the PSA test a “D” rating, concluding that the harms of testing, such as unnecessary biopsies and treatment side effects, outweighed the benefits of finding the disease early. That recommendation did not carve out exceptions for men at higher risk, including African American men, men with a family history, and men with BRCA gene mutations. The rating matters because it guides primary care and can affect insurance coverage.

In 2018 the USPSTF updated its guidance. In response to new research showing the benefits of screening, more men choosing active surveillance, and years of advocacy, the task force raised the PSA test to a “C” rating for men ages 55 to 69, while keeping a “D” rating for men 70 and older. In plain terms, the USPSTF now recognizes a real, if modest, benefit and recommends that men make an individual decision after discussing the risks and benefits with their doctor.

When Should I Get a PSA Test?

The guidelines below are adapted from the NCCN Clinical Practice Guidelines in Oncology for prostate cancer early detection. Use them to start a conversation with your doctor about your personal risk and a screening plan that fits you.

If You Are Between Ages 45 and 75

• Discuss the risks and benefits of screening with your doctor, get a baseline PSA, and consider a baseline digital rectal exam (DRE).
• If your PSA is below 1 ng/mL and your DRE is normal, repeat testing every 2 to 4 years.
• If your PSA is between 1 and 3 ng/mL and your DRE is normal, repeat testing every 1 to 2 years.
• If your PSA is greater than 3 ng/mL, or your DRE is suspicious, your doctor may suggest additional testing or a biopsy.

If You Are Over 75

• Decide together with your doctor whether continued PSA and DRE testing is right for you.
• If you keep testing and your PSA is below 3 ng/mL with a normal DRE, repeat testing every 1 to 4 years.
• If your PSA is greater than 3 ng/mL, or your DRE is suspicious, your doctor may suggest additional testing or a biopsy.

A PSA test is often paired with a digital rectal exam. If your results suggest a closer look is needed, the next steps can include biopsy and imaging or additional testing. Still deciding whether it is time? Read our guide on when you should get tested or review your personal risk factors.

Keep Learning

The PSA test is one part of how prostate cancer is diagnosed. Explore the next steps and learn when you should get tested.