Key takeaways

  • Prostate cancer is the most common type of cancer. The Centers for Disease Control and Prevention (CDC) states that for every 100 Americans with penises, 13 will develop prostate cancer in their lifetime.
  • A prostate-specific antigen (PSA) test can show if you have elevated levels of the PSA protein, which can be a symptom of prostate cancer or other conditions affecting the prostate. Elevated levels are generally considered to be anything above 4.0 nanograms per milliliter (ng/mL), but this will not always indicate that cancer is present.
  • Top tests for you to consider come from Pinnacle Biolabs and Labcorp OnDemand.

Prostate cancer is the most common type of cancer. The Centers for Disease Control and Prevention (CDC) states that for every 100 Americans with penises, 13 will develop prostate cancer in their lifetime.

A first step in testing for prostate cancer is a PSA test. PSA is a protein made by the prostate, the small gland underneath the bladder.

In some cases, an elevated PSA level can be a sign of prostate cancer. However, not all elevated PSA levels are a sign of prostate cancer. PSA is also found in the enlargement of the prostate (benign prostatic hyperplasia), infections, and inflammation of the prostate (prostatitis).

A PSA test will not provide enough information for a diagnosis, but it may help you begin a conversation with a doctor about your prostate health. Based on your test results, a doctor can decide whether to organize more testing.

While you used to only be able to get PSA tests at a lab or doctor’s office, you can now do a PSA test yourself at home.

Read on to learn more about PSA tests and where to find them.

PSA occurs in two forms within the blood. The first form, complexed PSA, is attached to proteins. The other form, percent-free PSA, floats freely within the bloodstream.

A standard PSA test typically measures total PSA — a combination of attached and unattached PSA. If your PSA test result falls outside of standard ranges, some doctors might consider testing different types of PSA to decide if you need a biopsy.

Percent-free PSA test

If your total PSA falls in the borderline range (between 4 and 10 ng/mL), a doctor may take a percent-free PSA test. A lower percent-free PSA means that your chance of having prostate cancer is higher.

According to the American Cancer Society, doctors generally advise those with a percent-free PSA of 10 percent or less to get a biopsy.

Complexed PSA test

Unlike the roaming PSA in your blood, complexed PSA is directly attached to proteins. This test can be done in place of a total PSA test, but it isn’t often used.

Other types of tests

Science and testing methodologies are always evolving. Several newer tests combine different types of PSA levels to offer an overall score to predict if a person has cancer. These include:

  • Prostate Health Index (PHI): This combines total PSA, percent-free PSA, and proPSA (a premature form of PSA).
  • 4kscore Test: This combines total PSA, percent-free PSA, complexed PSA, human kallikrein 2 (hK2), and other factors.

Most people with penises will get a PSA test in their lifetime. Depending on your age and risk factors, your doctor may encourage one.

In 2018, organizations like the U.S. Preventive Services Task Force (USPSTF) laid out recommendations for those considering a screening.

The USPSTF recommends the following for those who have an average or increased risk of prostate cancer, do not have symptoms of prostate cancer, and have never been diagnosed:

  • If you’re 55 to 69 years old, you should make an individual decision whether you want to take a PSA test.
  • Before making a decision, you should talk with your doctor about the benefits and harms of screening for prostate cancer, including the benefits and harms of other tests and treatment.
  • If you’re age 70 or older, you should not be screened for prostate cancer when you don’t have symptoms or other factors that put you at risk of prostate cancer.

The CDC suggests you also consider the following when talking with your doctor prior to screening:

  • if you have a family history of prostate cancer
  • if you’re African American
  • if you have other medical conditions that may make it difficult to treat prostate cancer if it’s found
  • how you value the potential benefits and harms of screening, diagnosis, and treatment
Test
Testing location
Results time
Price
Pinnacle Biolabs
at home
5 days
$185.84
Labcorp OnDemand
• Labcorp testing centers
• at home
• 1 to 2 days
• up to 5 days
$69

We selected these PSA test kits based on criteria we think are good indicators of safety, quality, and transparency.

We only include tests that send samples to CLIA-approved labs, and we regularly reassess the products on our lists to ensure we are only including the best quality options for our readers.

As a part of our vetting process, we consider:

  • the company’s reputation and business practices
  • a product’s composition and overall quality
  • any third-party certifications
  • any lab test results
  • marketing claims

When trying to choose the best PSA test for your needs, you’ll want to consider:

  • whether the company uses CLIA-certified labs
  • results turnaround time
  • what is tested
  • how easy the test is to use
  • how easily you can send your sample to a lab to be tested
  • the price of the test
  • the follow up care the company provides

Your results will share the ng/mL of PSA in your blood. This biomarker has stirred controversy over the years because there is no number considered standard.

The National Cancer Institute states there is no specific threshold defining what is a standard and non-standard “normal” and “abnormal” PSA level. Typically, a PSA of 4 or higher would show an increased risk of prostate cancer, but it does not confirm that prostate cancer is causing the elevated PSA level. The American Cancer Society (ACS) states that about 15 percent of people with a PSA below 4 will have prostate cancer.

The National Cancer Institute also suggests that the cutoffs should be adjusted for age, as PSA can increase in older people. Certain medications, supplements, health conditions, and procedures can also affect PSA levels, including:

  • testosterone
  • finasteride
  • dutasteride
  • aspirin
  • statins
  • diuretics
  • tobacco

According to the organization Zero Cancer, general PSA guidelines are:

  • 0 to 2.5 ng/mL is considered typical.
  • 2.6 to 4 ng/mL is typical for most, but you should talk with a doctor about your risk factors for prostate conditions.
  • 4.0 to 10.0 ng/mL might suggest the possibility of prostate cancer. It’s associated with a 25 percent chance of having prostate cancer.
  • 10.0 ng/mL and above should be discussed with a doctor immediately. It’s associated with a 50 percent chance of having prostate cancer.

Some people with lower levels of PSA may have prostate cancer, and some people with higher levels of PSA might not have cancer. The PSA test is simply the first marker of prostate enlargement and cell activity.

If you have elevated PSA levels, it’s best to schedule an appointment with a doctor. High PSA levels alone aren’t enough to diagnose any one condition because they can be elevated in several prostate conditions.

Meeting with a doctor for further testing can help find the cause of the elevated levels and receive early treatment.

Genetics and age can play critical roles in determining the likelihood of prostate cancer. If you have relatives on your maternal or paternal side of your family with prostate cancer, you’re at an increased risk. According to the CDC, African American men are at an increased risk of developing prostate cancer.

Research has shown that this higher risk may be due to a variety of factors, including access to care, stage of diagnosis, genetic makeup of tumors, socioeconomic status, and location.

Prostate cancer typically has a relative 5-year survival rate of 97 percent, but it can still be life threatening, depending on the stage at which it’s detected. Prostate cancer can be aggressive, which is why early detection is so important.

At-home PSA tests are sent to CLIA-approved labs, which may be the same ones doctors and government agencies use. That being said, it’s important to know that the PSA test isn’t a perfect method of detecting prostate cancer, but it can be a helpful first step.

Having elevated PSA levels does not always mean cancer. Noncancerous conditions, like benign prostatic hyperplasia or an enlarged prostate, can also raise PSA levels.

After a PSA test, your doctor will usually recommend an ultrasound and a biopsy as your next step if your levels are elevated.

On the contrary, PSA tests can also provide a false sense of safety to some. According to the National Health Service (NHS), the PSA test does not detect all types of cancers. And according to the ACS, roughly 15 percent of people with a PSA below 4 will have prostate cancer.

PSA tests are a good starting point for those in higher-risk groups, but they are not a definitive answer. As with any at-home test kit, at-home PSA test results are not comparable to ones from a clinic, hospital, or in-person lab.

There are many factors that can elevate PSA levels prior to a test, including:

  • physical activity
  • testosterone
  • urinary retention
  • urological procedures
  • ejaculation
  • certain medical conditions, like prostatitis and an enlarged prostate
  • older age

Some factors that can lower PSA levels include supplements and medications like:

  • 5-alpha reductase inhibitors
  • herbal mixtures
  • thiazide diuretics
  • aspirin
  • cholesterol-lowering drugs

One benefit of PSA testing is the increased chance of finding prostate cancer before it spreads. At-home tests may also prompt people who may not have gone to a doctor for testing to start the process and discuss their results with a doctor.

However, PSA testing is no longer routinely recommended because even in the potential of detecting all prostate cancers, it would not always lead to improved survival rates.

Plus, the CDC states that a false positive can lead to unnecessary worry and tests, like a biopsy, causing potential harm.

There are also some cases where the amount of prostate cancer is so minimal that it would never be life threatening. Overdiagnosis of people who would not have had symptoms or died from their amount of prostate cancer may lead to more medical complications from the treatment, according to the CDC.

Some treatment side effects include:

  • urinary incontinence
  • erectile dysfunction
  • bowel problems

If you’re concerned about your treatment plan, it’s a good idea to get a second opinion and weigh the pros and cons of treatment.

While there is no specific PSA level that indicates prostate cancer, a PSA of 4.0 ng/mL or higher can show an increased risk of prostate cancer. However, it does not confirm prostate cancer. If you have elevated PSA levels, a doctor may order a second PSA test to confirm your results, carry out a digital rectal examination, or perform a biopsy.

Research suggests that upper PSA levels by age are:

  • 40 to 49: 2.5 ng/mL
  • 50 to 59: 3.5 ng/mL
  • 60 to 69: 4.5 ng/mL
  • 70 to 79: 6.5 ng/mL

However, these ranges typically apply to white people. Black people often have naturally higher PSA levels. These ranges also do not account for transgender, nonbinary, gender nonconforming, genderqueer, agender, or genderless people.

Your health history, risk factors, and symptoms will play a part in whether a doctor feels further investigation is necessary.

The National Cancer Institute states that a PSA level above 4.0 ng/mL is considered “abnormal.” However, PSA levels vary by age, and some doctors will raise the cutoff to 5 ng/mL for older people, and lower it for younger people to 2.5 ng/mL.

Certain medications, such as finasteride and dutasteride, can also affect PSA levels, so a lower cutoff may be necessary to indicate an “abnormal” result.

If you have a PSA level between 4 and 10, you’re considered to be in the “borderline range,” according to the ACS. You have a 1 in 4 chance of having prostate cancer.

If PSA levels rise above 10, there’s a 50 percent chance you have prostate cancer.

According to Prostate Cancer UK, it is best to avoid the following activities for 48 hours before a PSA test:

  • vigorous exercise, like cycling
  • sexual activity that leads to ejaculation

You should also avoid anal sex or prostate stimulation for a week before a PSA test. It is important to speak with a doctor about any medication you’re taking before arranging a test, as certain medications can lower or raise PSA levels and may affect your results.

PSA tests can be a valuable tool to help you get preliminary answers about your prostate health. While PSA tests can have flaws, the information can still be beneficial for doctors when combined with your medical history and other criteria.

A PSA test can provide comfort while also potentially removing the need for a more invasive biopsy. While the results can help you feel a sense of ease, it’s best to talk with a doctor throughout the process. False positives and negatives can occur, and PSA levels are sensitive to many health and lifestyle factors.