A raised or rising PSA does not necessarily mean cancer, but it should be assessed carefully. We use a structured, evidence-based work-up to decide who needs further tests.
CONDITIONS
Abnormal PSA
Understanding PSA
PSA is an enzyme produced by the prostate. It is not specific for prostate cancer, and can be influenced by infection, sexual activity, physical activity, medications and recent hospitalisation. However, PSA can be useful to help identify individuals needing further testing for possible prostate cancer. Multiple large studies have shown that PSA testing reduces deaths from prostate cancer, and the updated 2026 Australian PSA Guidelines have helped provide guidance in this tricky area.
PSA testing can be done every 2 years for men aged 50–69, with testing considered for older men if their life expectancy is more than 7 years. Repeat testing and referral is suggested for men aged 50–69 with a PSA ≥3.0 µg/L, and for men aged 70 and over with a PSA ≥5.5 µg/L.
Higher risk includes men with a brother diagnosed with prostate cancer, a father diagnosed before turning 65, or two or more second-degree relatives who died from prostate cancer, as well as men with a BRCA2 mutation or of sub-Saharan African ancestry.
For men at higher risk, testing can start earlier at 45, with lower PSA thresholds for further testing (≥1.0 µg/L for men aged 45–49, and ≥2.0 µg/L for men aged 50–69).
What Happens Next
• Repeat the PSA in 1–3 months to confirm, and include the free-to-total PSA ratio
• PSA density and velocity as additional risk tools
• Urine test to exclude infection
• Referral to a urologist for review and MRI of the prostate
Please see our Prostate Cancer page for more information.
