PSA test explained

Prostate-specific antigen is an enzyme produced by the cells of the prostate gland — both healthy cells and altered ones. A small amount enters the blood, and when the prostate enlarges, becomes inflamed or develops a tumour, more of it is released. That makes PSA a sensitive but non-specific marker: a rise shows that something is going on in the prostate, but not what exactly. With age PSA naturally rises slightly, because the prostate grows larger. Alongside total PSA, laboratories can also measure free PSA — the ratio between the two helps the doctor decide whether further tests are needed.

• As screening — under the state prostate cancer early diagnosis programme; the decision to be screened is worth discussing with a doctor
• When a doctor finds a changed prostate during an examination
• For urinary problems — passing urine often, a weak stream, getting up at night
• To monitor prostate cancer that has already been treated — to assess how well treatment worked and to watch for recurrence
• Earlier — for men under 55 with prostate cancer in the family

A raised PSA can point to prostate cancer, but more often it is caused by non-malignant conditions: an enlarged prostate, prostatitis, a urinary tract infection, recent bladder or prostate examinations, a catheter, a colonoscopy, or sexual intercourse before the test. What happens next — repeating the test, measuring free PSA, referral to a urologist — is decided by the doctor, based on the value, your age and how it changes over time.

• An enlarged prostate (benign hyperplasia)
• Prostatitis — inflammation of the prostate
• A urinary tract infection
• Recent bladder or prostate examinations and procedures, insertion of a catheter
• A recent colonoscopy
• Sexual intercourse or ejaculation before the test
• Prostate cancer

Symptoms that may go with a raised PSA

• Often there are no symptoms at all — a raised PSA is found at screening
• Passing urine often or with difficulty, a weak stream, getting up at night to urinate
• Pain in the perineum or when passing urine — in prostatitis

• Whether there was an infection, a procedure or sexual intercourse before the test — the test is then repeated
• The ratio of free to total PSA
• A prostate examination and, if needed, a urologist consultation
• PSA dynamics — how quickly the value changes over time
• Family history

PSA bands and what they mean

PSA 4–10 ng/ml: This is above the general limit given by MedlinePlus (4.0 ng/ml), but non-malignant causes are common in this range too — an enlarged prostate, prostatitis. Before deciding about further tests, a doctor usually assesses the ratio of free to total PSA, the examination and how the value is changing over time.

PSA above 10 ng/ml: This is clearly raised. A value like this requires assessment by a urologist and usually additional tests; it still does not mean a diagnosis, but it should not be put off.

A low PSA is normal and is not in itself a reason for concern. Some prostate medicines lower PSA by roughly half, and the doctor assessing the result needs to know about that. So the step that matters is telling your doctor about any prostate medicines you take — he or she will take them into account when assessing the result.

Free PSA and total PSA

Part of the PSA in the blood circulates unbound — that is free PSA. Its ratio to total PSA helps a doctor tell benign causes from more suspicious ones when total PSA is 4–10 ng/ml. The test is ordered by a doctor when it is needed.

According to Valstybinė ligonių kasa (VLK, the National Health Insurance Fund), the prostate cancer early diagnosis programme running in Lithuania is for men aged 50 to 69 inclusive; under the programme the PSA test is ordered by a family doctor. Under the programme rules in force since 1 September 2026, the test is repeated every 2 years, or less often if PSA was below 1 ng/ml; a PSA above 3 ng/ml leads to a referral to a urologist, and the earlier exception for younger men whose father or brother had prostate cancer no longer applies — details on prostate cancer screening in Lithuania. The decision about screening is worth discussing: MedlinePlus notes that in men aged 55–69 screening can reduce the chance of dying from prostate cancer, but for some men screening and treatment can do more harm than good.

Paying privately, a PSA test at the Medicina practica laboratory costs from €15 (September 2026 pricing). Under the state programme a family doctor orders it free of charge. Related pages: creatinine, how to prepare for a blood test and how to read blood test results.