PSA

PSA (prostate-specific antigen) is a protein produced by prostate cells, a small proportion of which enters the blood. The test measures blood PSA levels and is used for urinary symptoms, early prostate cancer detection and monitoring men treated for prostate cancer. Elevated PSA is not a diagnosis, because it also rises with benign enlargement and prostate inflammation.

Who is this test for

• men with urinary symptoms when the doctor is investigating the cause;
• men from age 50 who choose early prostate cancer detection after discussing it with their doctor;
• men from age 45 whose father or brother had prostate cancer or who are of African descent;
• men carrying a BRCA2 gene mutation, from age 40;
• men treated for prostate cancer, because rising PSA may indicate recurrence.

What PSA shows

PSA is produced by both healthy and abnormal prostate cells. The test is therefore specific to the prostate, but not to cancer. PSA naturally rises with age and prostate size and may be increased by:

• benign prostate enlargement (benign prostatic hyperplasia);
• prostate inflammation (prostatitis) and urinary tract infection;
• pressure on the prostate, prostate biopsy or surgery;
• prostate cancer.

Alongside total PSA, it is possible to measure free PSA (fPSA). Their ratio helps the doctor assess whether moderately elevated PSA is more likely due to benign prostate enlargement or needs further investigation.

The most common cause of urinary symptoms is benign prostate enlargement, rather than cancer. PSA alone is not a reliable screening test: it may be elevated without cancer or normal with cancer. Testing men without symptoms is therefore a shared decision with their doctor. The stated early detection ages follow the European Association of Urology (EAU), which advises offering PSA testing to informed men. Signs to watch for are described in the article Early signs of prostate cancer.

Save with a panel

Test PSA is also included in these panels.

Prostate health panelPSA, fPSA, Urine: dipstick and sedimentPrice of individual tests: 50.00€45.00€ Original price was: 45.00€.31.50€Current price is: 31.50€.Details ›Tumour marker panel – menCEA, CA19-9, PSA, AFPPrice of individual tests: 80.00€72.00€ Original price was: 72.00€.50.40€Current price is: 50.40€.Details ›

All panels including PSA (3) ›

Preparation and sample

PSA is measured in blood from a vein and fasting is unnecessary. Results are affected by what has happened to the prostate in preceding days, so the following applies:

• avoid ejaculation and strenuous exercise, particularly cycling, for 48 hours before blood collection;
• have blood collected before a digital rectal prostate examination or at least a week afterwards;
• wait at least 6 weeks after prostate biopsy or surgery unless the urologist instructs otherwise;
• if you have prostatitis or a urinary tract infection, postpone testing until it is treated, because PSA may remain elevated for weeks or sometimes months;
• tell your doctor if you take finasteride or dutasteride (medicines for enlarged prostate or hair loss), because they lower PSA by approximately half.

How PSA results are interpreted

PSA is expressed in µg/L, equivalent to ng/mL. The reference interval depends on the method and is printed on the report. A value of 4 µg/L was long used as a threshold, but it does not suit every age group: lower values may require checking in younger men, while PSA is naturally slightly higher in older men. British NICE guidelines give these age thresholds for men with possible prostate cancer symptoms:

Age	PSA requiring further assessment
40–49 years	above 2,5 µg/L
50–59 years	above 3,5 µg/L
60–69 years	above 4,5 µg/L
70–79 years	above 6,5 µg/L

These thresholds do not apply to men taking finasteride or dutasteride or those being treated for prostate cancer. Your doctor interprets results alongside age, symptoms, examination and previous results.

Elevated PSA

One elevated value does not mean cancer. The doctor usually repeats testing after several weeks with correct preparation and rules out infection through urine testing. If PSA remains elevated, particularly around 4 to 10 µg/L, the free-to-total PSA ratio helps. Further investigation is led by a urologist: prostate examination, prostate magnetic resonance imaging (MRI) and biopsy if needed.

Normal PSA

Normal PSA reduces the likelihood of prostate cancer but does not rule it out completely. If you have symptoms or the doctor feels an abnormality during examination, a normal result is no reason to abandon further investigation. Changes in PSA over time also matter, so keep previous results.

How to arrange testing

You can come for blood collection without an appointment or referral at one of our branches throughout Croatia (listed on the Contactpage). Prices for all tests and panels are listed in the service price list. PSA, free PSA and urinalysis are performed together in the Prostate health.

Frequently asked questions

What is a normal PSA value?

There is no single threshold for everyone. Many laboratories print an upper limit around 4 µg/L, but the doctor interprets results according to age, prostate size, medicines and previous values.

Can cycling or sexual intercourse raise PSA?

Yes, temporarily. Avoiding ejaculation and strenuous exercise, particularly cycling, is therefore recommended for 48 hours before blood collection.

How often should PSA testing be repeated?

This depends on age, family history and the first result. With low PSA, intervals may be several years, while borderline results prompt the doctor to recommend more frequent checks. Agree the interval with your doctor.

Is PSA a tumour marker?

Yes, but unlike most tumour markers, it is also used for early prostate cancer detection, always after discussion with a doctor. The purposes of other markers are explained in the article Tumour markers.