reference range (PSA)

Last edited 01/2022 and last reviewed 09/2023

There has been recent guidance as to the level of PSA test that indicates further investigation is required (1). This reference range takes into account the patients age.

NICE state (1):

• Consider a prostate-specific antigen (PSA) test and digital rectal examination to assess for prostate cancer in people with:
  • any lower urinary tract symptoms, such as nocturia, urinary frequency, hesitancy, urgency or retention or
  • erectile dysfunction or
  • visible haematuria
    
    
• consider referring people with possible symptoms of prostate cancer, using a suspected cancer pathway referral (for an appointment within 2 weeks) for prostate cancer if their PSA levels are above the threshold for their age in table below. Take into account the person's preferences and any comorbidities when making the decision.

Age-specific PSA thresholds for people with possible symptoms of prostate cancer

Age (years)	Prostate-specific antigen threshold (micrograms/litre)
Below 40	Use clinical judgement
40 to 49	More than 2.5
50 to 59	More than 3.5
60 to 69	More than 4.5
70 to 79	More than 6.5
Above 79	Use clinical judgement

PSA is also used as a means of monitoring disease:

Its main use is to monitor disease:

• if PSA > 40, there is a high chance that there is nodal or metastatic spread
• if PSA > 100, there is almost certainly metastatic spread

Note that reference ranges may vary between laboratories.

Reference:

1. NICE (December 2021). Suspected cancer: recognition and referral
2. NHS Cancer screening programmes - Prostate Cancer Risk Management Programme (2002).