Medically Reviewed by Andrew Katims, MD, MPH
Most men have heard of the PSA test, but many don’t know what it measures or why it matters. About 1 in 8 men will be diagnosed with prostate cancer in his lifetime, and this simple blood test is our best tool for finding it early. Understanding what it can and cannot tell you is what allows you and your provider to make informed decisions about your health.
What is the PSA test?
PSA stands for prostate-specific antigen. It is a protein made by the prostate, a small gland below the bladder. A small amount of PSA leaks into the bloodstream normally. The test is a simple blood draw that measures how much is there.
When something irritates or enlarges the prostate, more PSA gets into the blood. A higher PSA number is a signal to look closer. There is no special preparation and no fasting necessary.
Why does screening matter so much?
Many men assume that if something were seriously wrong, they would feel it, but early prostate cancer causes no symptoms. By the time prostate cancer causes bone pain or trouble with urinating, it has usually already spread.
When prostate cancer is found early, it is one of the most curable cancers. Once it spreads to distant parts of the body, it can be controlled for years, but not cured.
What else can raise your PSA level?
A high PSA does not mean you have cancer. Several ordinary things can raise the number, including:
- An enlarged prostate, known as benign prostatic hyperplasia (BPH)
- A prostate infection or inflammation
- Getting older, since the prostate grows with age
- Recent ejaculation
- A long bicycle ride
- A recent procedure involving the prostate or bladder
If your PSA level is higher than expected, your provider may repeat the test or recommend more testing before deciding what to do next.
Can you have prostate cancer with a normal PSA?
Yes, though it is uncommon. A normal PSA is usually good news, but it does not rule prostate cancer out entirely.
It’s a good idea to get a PSA baseline in your 40s or 50s, even if the result is normal. It gives your provider something to compare against for the rest of your life. Your age, family history and any symptoms all factor in alongside the number.
Who should be screened, and when?
Not every man should start screening at the same age. The 2026 guideline from the American Urological Association recommends:
- Screening between ages 40-45 for men at higher risk, including Black men, men whose father or brother had prostate cancer, men with an inherited gene change such as BRCA1, BRCA2, ATM or CHEK2 or men with a strong family history of breast cancer, pancreatic cancer or ovarian cancer
- Men ages 45-50 at average risk, talk with your provider about getting a baseline PSA test
- Men ages 50-69 should get testing every two to four years
- After age 70, you and your provider should decide on testing based on your overall health and life expectancy
What happens if your PSA is high?
A high PSA does not diagnose cancer, and it may not even require a prostate biopsy. Each step is its own decision.
- First, the blood test is typically repeated
- If it stays elevated, a prostate MRI can show whether there is a suspicious area worth sampling
- Newer blood and urine tests can further refine your risk
- Your provider may perform a digital rectal exam
- A biopsy is taken only if it is warranted
If cancer is found, treatment is not one-size-fits-all. Many men with low-risk prostate cancer go on active surveillance, meaning that the cancer will be closely watched with regular blood tests, imaging and occasional biopsies, and treated only if it begins to behave differently.
The bottom line
The PSA test is a helpful screening tool, but it is only one part of the picture. It works best when combined with your age, health history, family history and other tests if needed.
If you have questions about prostate cancer screening, talk with your primary care provider or a WMCHealth urologist. Together, you can decide if PSA testing is right for you.