Medically reviewed by Dr. Farhana Mukhtar, M.B.B.S., M.Phil (Pb.), Consultant Chemical Pathologist, Al-Nasar Lab & Diagnostic Centre. Updated September 2026.
Quick answer: PSA is a protein produced by the prostate gland and measured with a simple blood test. A level below 4 ng/mL is traditionally considered normal, though the threshold is lower in younger men. A raised PSA does not mean cancer. Enlarged prostate, infection, recent catheterisation and even cycling can all raise it.
Book a PSA test: call 0300 0341944, or arrange home sample collection across Lahore on 0309 1166944.
What is PSA?
PSA stands for Prostate Specific Antigen. The prostate produces it naturally as part of semen, and a small amount leaks into the blood. When the prostate is enlarged, inflamed or diseased, more escapes into the bloodstream and the blood level rises.
The key word is specific to the prostate, not specific to cancer. PSA tells you something is going on in the prostate. It does not tell you what.
What is a normal PSA level?
| Age | Commonly used upper limit |
|---|---|
| 40 to 49 | up to about 2.5 ng/mL |
| 50 to 59 | up to about 3.5 ng/mL |
| 60 to 69 | up to about 4.5 ng/mL |
| 70 and above | up to about 6.5 ng/mL |
The prostate enlarges naturally with age, so age adjusted ranges are more useful than a single cutoff of 4. Ranges vary between laboratories, so read the range on your own report.
What raises PSA apart from cancer?
This list matters, because acting on a single raised PSA without considering it leads to unnecessary anxiety and unnecessary biopsies.
- Benign prostatic hyperplasia, the age related enlargement that affects most older men. By far the most common cause of a mildly raised PSA
- Prostatitis, infection or inflammation of the prostate, which can push PSA very high indeed
- Urinary tract infection
- Recent ejaculation, within 48 hours
- Cycling or long motorcycle rides, from pressure on the perineum
- A recent digital rectal examination, catheter, cystoscopy or prostate biopsy
- Simply getting older
Conversely, some medicines used for an enlarged prostate lower PSA by roughly half. If you take one, your doctor must know, because an apparently normal result may in fact be a raised one.
What is free PSA and why does it help?
PSA circulates in two forms: bound to proteins, and free. The useful measure is the free to total PSA ratio.
The pattern is consistent. Benign enlargement tends to produce a higher proportion of free PSA. Cancer tends to produce a lower proportion. So when total PSA sits in the grey zone of roughly 4 to 10, the free PSA ratio helps separate the men who genuinely need further investigation from those who do not.
A ratio above about 25 percent suggests benign enlargement is the likely explanation. Below about 10 percent raises more concern. Your urologist interprets this alongside your examination, symptoms and often an MRI.
What happens if PSA is high?
Not a biopsy, at least not immediately. The usual sequence is:
- Repeat the test after 4 to 6 weeks, avoiding the things that falsely raise it. A meaningful number of raised results normalise on repeat
- Treat infection if prostatitis or a urinary infection is present, then retest
- Check free PSA ratio and the trend over time. How fast PSA is rising is often more informative than the single value
- Examination by a urologist, including a digital rectal examination
- Multiparametric MRI of the prostate, which now commonly precedes biopsy and helps avoid unnecessary ones
- Biopsy only if the combined picture warrants it
Who should consider PSA testing?
PSA screening is a decision to discuss with your doctor rather than an automatic test, because it can detect slow growing cancers that would never have caused harm. That said, testing is generally worth discussing for:
- Men from age 50, as part of a considered conversation
- Men from age 45 with a father or brother who had prostate cancer
- Any man with urinary symptoms: weak stream, difficulty starting, dribbling, getting up repeatedly at night, or a sense of incomplete emptying
- Blood in the urine or semen
- Persistent pelvic, lower back or hip pain without another explanation
- Men already diagnosed with prostate cancer, for monitoring
Urinary symptoms in older men are usually caused by benign enlargement rather than cancer, but they are a reason to be assessed rather than to wait.
How to prepare
- Avoid ejaculation for 48 hours before the test
- Avoid cycling or long motorcycle rides for 48 hours
- Wait at least 6 weeks after a prostate biopsy, and several days after a catheter or rectal examination
- Postpone if you currently have a urinary infection, and test after it has been treated
- Tell the laboratory about prostate medicines, as some halve the reading
- Fasting is not required
PSA testing at Al-Nasar Lab
Al-Nasar Lab & Diagnostic Centre has provided laboratory and imaging services in Lahore since 1996 and holds ISO 15189:2022 accreditation from the Pakistan National Accreditation Council. Total PSA and free PSA are both available, with home sample collection across Lahore and same day digital reports. Where imaging is needed, prostate ultrasound and MRI are available at our Johar Town campus.
PSA is often ordered alongside a kidney function test and a urine examination when urinary symptoms are the reason for testing, and all three can be taken from one visit.
Find your nearest collection centre, see our full test list, or contact us to book.
Frequently Asked Questions
What is a normal PSA level?
Below 4 ng/mL is the traditional cutoff, but age adjusted limits are more useful: roughly 2.5 in the forties rising to about 6.5 after 70. Read the range on your own report.
Does a high PSA mean I have prostate cancer?
No. Most raised PSA results are caused by benign enlargement or inflammation. Further assessment, not panic, is the appropriate next step.
Do I need to fast for a PSA test?
No. Fasting is not required. Avoiding ejaculation and cycling for 48 hours matters much more.
What is a good free PSA ratio?
A ratio above about 25 percent points towards benign enlargement, while below about 10 percent raises more concern. It is most useful when total PSA is between 4 and 10.
How often should PSA be repeated?
That depends on your baseline and risk. Many men with a low result test every two years, while those with a raised or rising level are monitored more closely. Your doctor sets the interval.
This article is for general information and is not a substitute for medical advice. Please discuss your results with a qualified doctor.
One Response