Prostate-Specific Antigen (PSA) Testing and Other Tests for Prostate Cancer
Overview of prostate cancer screening tests
What is prostate cancer screening?
Prostate cancer screening means getting routine tests to find prostate cancer, even before you have any signs or symptoms. The goal of regular screening is to prevent or find cancer early, when it’s easier to treat.
The most common prostate cancer screening test is a prostate-specific antigen (PSA) test.
A PSA test is a simple blood test for PSA, a protein made by cells in your prostate. The prostate cancer screening test measures how much PSA is in your blood. It’s normal to have a low level of PSA.
There are many reasons to have a rising or high PSA level. One of them is prostate cancer. Your PSA level will go up if there’s a problem with your prostate.
Some doctors may also do a digital rectal exam (DRE) to screen for prostate cancer. If you have prostate cancer, you’ll have other tests to guide your treatment plan.
You may have questions about tests for prostate cancer. This guide is a good place to start.
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Types of prostate cancer screening
The prostate-specific antigen (PSA) test
Most people assigned male at birth should get their first PSA test starting at age 45 to 49.
Anyone with a prostate can get prostate cancer. People of all genders can get prostate cancer, including a transgender woman or a nonbinary person.
Most often you’ll have a PSA test as part of your routine check-up. Your healthcare provider can draw the blood for a PSA test and send the sample to a lab.
If you have an abnormal (not normal) PSA test result, your doctor may recommend getting another PSA test. They may also talk with you about getting other tests to rule out prostate cancer.
Based on the test results, your care team will give you a follow-up care plan. It will say when you should get your next prostate cancer screening.
This schedule is based on:
- Your past PSA test results
- Your age
- Whether other family members had prostate cancer
- Changes in your PSA level
- Your general health
If your PSA level is rising, your doctor will recommend other tests, such as:
- A repeat test, so they can spot any sudden, big change since your last PSA test
- A digital rectal exam (DRE)
- A biomarker test
- Computed tomography (CT) scan
- Magnetic resonance imaging (MRI) test
- A prostate biopsy
If prostate cancer is causing your high PSA level, we’ll talk with you about treatment options.
The PSA test tells you how much PSA protein is in your blood, measured in nanograms per milliliter (ng/ml).
In the past, results between 0 and 3 ng/ml were normal. But recent research shows a risk for prostate cancer even at these low levels of PSA.
You should have a repeat test to confirm the result if the PSA is 3 ng/ml or higher. If the PSA still is above 3 ng/mL, you should consider a secondary test, imaging, or a biomarker. This can tell us if you need a prostate biopsy.
Most people with a high PSA level do not have prostate cancer. The higher PSA level may be caused by things other than prostate cancer, such as:
- Your age, because PSA levels rise as you get older.
- An enlarged (bigger) prostate or benign (not cancer) prostatic hyperplasia.
- Prostatitis (PROS-tuh-TY-tis), an infection or inflammation of the prostate.
Digital rectal exam to screen for prostate cancer
A digital rectal exam (DRE) is another prostate cancer screening test. Your healthcare provider will put a gloved finger into your rectum to feel your prostate. They’re checking for swelling, hardness, bumps, or other changes that are not normal.
A DRE test can be uncomfortable. You’ll feel a lot of pressure but not pain. The exam takes a few minutes.
Biomarker tests for prostate cancer
MSK has a team of experts that use biomarker testing to find and treat prostate cancer. We developed many of the biomarker tests we use.
A biomarker is a biological molecule (substance) in your body. A biomarker test is a simple blood test that looks for prostate cancer biomarkers in your blood under a microscope. You may have this test even if you have a normal biopsy result.
Biomarker testing can help us learn if you have prostate cancer, as well as the type. Prostate cancer biomarkers give us information that guides treatment. They can tell us:
- If there’s a known genetic change (mutation or variant) in the prostate tumor.
- Which treatments will work best.
- Where cancer cells are, and how fast they may grow.
Your doctor will tell you if biomarker testing is right for you and which one you need.
- Prostate-specific membrane antigen (PSMA) imaging test
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Prostate-specific membrane antigen (PSMA) is a type of biomarker for prostate cancer. It’s a protein that’s not on normal cells.
A radiologist will insert (put in) a liquid into your arm through an IV. The liquid has a tracer that looks for the PSMA biomarker on the surface of a cell. It lets us see any cells that have the PSMA biomarker on a positron emission tomography (PET) scan.
The results can show us early signs of prostate cancer, how advanced it is, and if it’s spreading.
MSK experts played a major role in developing the PSMA test.
- 4Kscore® test
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The 4Kscore test is a blood test developed by prostate cancer experts at MSK.
Your 4Kscore results tell us if you need a prostate biopsy and the timing to have one.
This test measures 4 different biomarkers. Your doctor may ask for a 4Kscore test for you if you have an abnormal (not normal) PSA or DRE result.
The 4Kscore measures 4 protein biomarkers in the blood:
- PSA
- Free PSA
- Intact PSA
- Human kallikrein 2
The 4Kscore tells us the chances you have a Gleason 7 or higher prostate cancer. Your doctor also considers your age and any DRE or biopsy results.
- Prostate Health Index
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The Prostate Health Index (PHI) measures your risk of getting prostate cancer. PHI is a blood test that measures 3 levels of prostate-specific antigen (PSA):
- Total PSA
- Free PSA
- p2PSA, which at higher levels may mean you have cancer
Your PHI score results can tell your risk for prostate cancer and if you need a prostate biopsy.
- Prostate cancer gene 3 (PCA3) test
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The PCA3 test is a urine test. PCA3 is a gene that’s only in prostate cancer cells.
If you have prostate cancer, your urine test may show very high levels of PCA3. Your care team may use this test to learn if you should have another prostate biopsy.
- ConfirmMDx
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ConfirmMDx is a test done on prostate biopsy samples that did not show cancer. It can help us decide whether to repeat a biopsy.
This test checks for prostate cancer biomarkers. Your doctor may recommend doing a ConfirmMDx test if you had other test results that were not normal.
Many MSK surgeons focus only on prostate cancer. Our prostate surgeons are among the most experienced in the U.S. They’re part of a team ranked #1 in the nation for Urology Cancer Care, 2023 to 2025, by U.S. News & World Report. MSK also ranks among the nation’s top 2 cancer hospitals.
Common questions about PSA tests and other lab tests
Some screenings are covered by health insurance. There also are programs that provide low-cost or free screenings.
Most health insurance must cover prostate cancer screening with no out-of-pocket costs. A PSA test is covered by most insurers and Medicare. It’s a type of prevention health screening. Contact your health insurer to get more information.
MSK offers low-cost or free prostate cancer screenings at our Ralph Lauren Center and Memorial Medical Care, PC, in New York City.
MSK recommends people at average risk for prostate cancer get their first PSA test at age 45. This is called your baseline reading.
MSK recommends people at higher risk for prostate cancer talk with their healthcare provider about when to start screening. Your healthcare provider may recommend you start screening at age 40 if:
- You’re a Black man.
- A blood relative (such as your father or brother) has had prostate cancer.
MSK’s prostate cancer screening guidelines help you know when and how often to get regular screenings.
PSA tests save lives, but also find prostate cancers that have a low chance of spreading. Some people feel getting a PSA test can lead to treatments you don’t need, such as surgery or radiation therapy. This can be very stressful.
MSK prostate cancer experts believe the PSA test should be used as a tool for finding cancer. The PSA test also can provide more information and guide treatment decisions.
It’s important to choose cancer care from experts who understand how PSA test results affect prostate cancer treatment options. For example, the best treatment may be active surveillance, not surgery.
If your PSA level is higher than normal, your doctor may recommend getting a repeat PSA. A high PSA level is not always prostate cancer.
Other tests can help confirm if your PSA is high for a reason other than prostate cancer. This includes:
- Your age. PSA levels rise as you get older.
- An enlarged (bigger) prostate or benign (not cancer) prostatic hyperplasia.
- Prostatitis, an infection or inflammation of the prostate.
If your PSA level is normal for your age, your healthcare provider will tell you when to come back for your next screening. Most often, it’s 2 to 4 years later.
