PSA Test: What Every Man Over 40 Should Know

Quick answer

PSA is a blood test that screens for prostate cancer. Doctors suggest it for men over 50, or earlier with risk factors. The usual cutoff is 4 ng/mL, but your age and how the number changes over time matter too. A high PSA does not always mean cancer. Many things can raise it, like an enlarged prostate, an infection, or recent sex. Talk with your doctor before you test.

What PSA measures

PSA is a protein made by your prostate. Both normal and cancerous prostate tissue make it. A higher PSA means more prostate activity. This can come from cancer, but it often comes from something harmless instead.

Healthy ranges

Your age changes what counts as normal too:

These numbers are guides, not strict rules. Many men with a borderline PSA do not have cancer. Some men with cancer have a normal PSA.

When to test PSA

The usual advice

• Ages 50 to 70, after talking through the pros and cons with your doctor.
• Earlier, ages 40 to 45, if your father or brother had prostate cancer before age 65.
• Earlier too, if you carry a known BRCA gene change.
• Past 70, this becomes a personal choice based on your health and life expectancy.

PSA is not the only screening test worth timing well. Colorectal cancer screening starts around the same age, and it is worth planning both at once.

What else can raise PSA

A high PSA does not always mean cancer. Common non-cancer causes include:

• An enlarged prostate, very common as men age.
• Prostatitis, an infection or swelling of the prostate.
• Recent ejaculation, within the last 48 hours.
• A recent urinary procedure, like a catheter or an exam.
• Hard bike riding.
• A urinary tract infection.

This is why one high PSA never equals cancer on its own. Context always matters.

How to make sense of your result

Step 1: Retest to confirm

If your PSA comes back high, wait 4 to 6 weeks and test again. Avoid ejaculation for 48 hours first, and skip recent urinary procedures. About 1 in 4 high results turns out normal on a retest.

Step 2: Watch the trend

How fast your PSA rises matters. A jump of more than 0.75 ng/mL in a year is more concerning than a small, steady rise.

Step 3: Consider your prostate size

Doctors can compare your PSA to your prostate size, measured by ultrasound. This helps tell an enlarged prostate apart from cancer.

Step 4: Check free PSA percentage

This measures the share of PSA that floats freely in your blood, versus the share bound to other proteins.

Step 5: See a urologist

For a PSA that stays high, or rises fast, your doctor will likely refer you to a specialist. This may include a physical exam, an MRI, and sometimes a biopsy.

The risk of finding too much

PSA screening sometimes finds slow-growing cancers that would never have caused harm. Treating these brings its own risks, like urinary, sexual, or bowel side effects.

This is why a real conversation with your doctor matters:

• Some men want to know and treat right away.
• Some men prefer to avoid the risks of treating a slow cancer.
• Many doctors now use "active surveillance." This means watching a low-risk cancer closely, instead of treating it right away.

Most doctors now agree that PSA screening should come with an informed conversation, not just an automatic test.

Want PSA included as part of a full health check? Book your &you Labs panel and talk through your results with a doctor.

How &you Labs handles PSA

A &you Labs panel offers PSA as a standard add-on for men 40 and up, or earlier with risk factors. Your report shows your number, your age-based range, how it has changed over past panels, and your free PSA share when your result sits in the borderline zone.

How to prepare for the test

• Avoid ejaculation for 48 hours before the test.
• Avoid recent urinary procedures for 1 to 2 weeks.
• Avoid hard cycling for a few days before.
• Treat any active urinary infection first, then retest later.

What to do with a high result

Moderately high, 4 to 10 ng/mL

1. Confirm with a retest in 4 to 6 weeks, done the right way.
2. Check your free PSA share.
3. Consider an MRI before deciding on a biopsy.
4. Talk with a urologist about next steps.

Very high, above 10 ng/mL

1. See a urologist right away.
2. Expect an MRI, with a biopsy likely to follow.

A stable, mildly high result

1. This often points to an enlarged prostate or mild prostatitis.
2. Your doctor will likely recheck it every 6 to 12 months.
3. Treating any symptoms can help too.

Frequently asked questions

Should every man over 40 test PSA?

Not every man, but a conversation about screening makes sense from age 50. Start earlier, around 40 to 45, if you have a strong family history.

Will a high PSA mean an instant biopsy?

Usually not anymore. Doctors now often use an MRI first, to find suspicious spots and avoid an unneeded biopsy.

Can lifestyle changes lower PSA?

Some evidence links a Mediterranean-style diet, exercise, healthy weight, and not smoking to lower prostate cancer risk. The effect on your PSA number is usually small.

How often should I retest if my PSA is normal?

Every 1 to 2 years fits most men doing regular screening. Every 6 to 12 months fits men with a rising or borderline result.

Does PSA catch the dangerous, fast-growing cancers?

PSA catches many prostate cancers, but it misses some of the fast-growing ones that matter most. This is one reason PSA alone is not a perfect test.

Key takeaways

• PSA screens for prostate cancer, best used from age 50 to 70 with a real conversation, earlier for men at higher risk.
• The usual cutoff is 4 ng/mL, but your age, PSA trend, and free PSA share all add useful context.
• Many things besides cancer can raise PSA, so always confirm a high result the right way.
• An MRI now often comes before a biopsy when PSA is high.
• Active surveillance is common for low-risk prostate cancer, to avoid unneeded treatment.