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Doctor's Assessment Included

Every result includes a professional assessment from a BIG-registered doctor. For treatment decisions, discuss your results with your GP.

Tumor Markers

PSA levels: what do they tell you about your prostate health?

PSA is particularly important for older men, as the prostate naturally enlarges with age. BPH is a very common cause of elevated PSA in older men. Regular PSA monitoring supports early awareness of changes in prostate health.

Reference Ranges

Male
ug/l
Low 0 Normal 4 High

Reference ranges may vary between laboratories. When you order a test, a BIG-registered doctor assesses your personal results in context. For treatment decisions, discuss your results with your GP.

What It Measures

This test measures the concentration of prostate-specific antigen in your blood, expressed in micrograms per litre (µg/L). PSA is produced by both healthy and abnormal prostate tissue. The protein plays a role in keeping seminal fluid liquid.

The most commonly used threshold is 4.0 µg/L, but interpretation depends heavily on your age. In men under 50, a value above 2.5 µg/L is already considered noteworthy, while in men over 70, a value up to 6.5 µg/L can be normal. In addition to total PSA, the ratio between free and bound PSA can be determined, which provides additional information about the nature of any elevation.

Why It Matters

PSA is currently the most widely used blood marker for early detection of prostate cancer. Prostate cancer is the most common cancer in men in the Netherlands, and early detection significantly improves treatment options.

However, an elevated PSA does not automatically mean cancer. Benign prostatic hyperplasia (BPH), which is common in men over 50, is the most frequent cause of mildly elevated PSA. Prostate inflammation (prostatitis) can also raise the value considerably. Even temporary factors such as cycling, ejaculation shortly before the test, or a digital rectal exam can influence PSA.

The value of PSA lies particularly in its trend over time. A gradually rising PSA across multiple measurements (PSA velocity) can be more clinically relevant than a single elevated value. If a result is notable, a doctor will usually recommend further investigation, such as an MRI or biopsy.

When to Test

The question of when to test PSA is a topic of debate in the medical community, as screening can also lead to unnecessary anxiety and follow-up investigations. There is no national population screening programme for prostate cancer in the Netherlands.

It is sensible to have your PSA level measured if you have symptoms related to the prostate, such as difficulty urinating, frequent urination (especially at night), or a weak urinary stream. Men over 50 with a family history of prostate cancer (father, brother) also benefit from periodic monitoring. For men with a first-degree relative with prostate cancer, a baseline measurement is sometimes recommended from age 40.

Fasting is not required, but avoid cycling and ejaculation in the 48 hours before the test for the most reliable result.

Symptoms

Low Levels

A low PSA level is normal and indicates no signs of prostate problems based on this marker. There are no symptoms associated with low PSA. It is a favourable result, but it does not completely rule out prostate issues — PSA is an indication, not a definitive answer.

High Levels

An elevated PSA in itself does not cause symptoms — it is the underlying cause that may produce them. With benign prostatic hyperplasia (the most common cause), you may experience a weak urinary stream, frequent urination, nighttime urination, or the feeling that your bladder does not empty completely.

With prostatitis (prostate inflammation), pain in the pelvic area, pain during urination, and sometimes fever often occur. Prostate cancer in its early stages usually causes no symptoms — which is precisely why PSA screening is considered for at-risk groups.

A PSA above 10 µg/L is considered significantly elevated and is more frequently associated with prostate cancer, but even here the diagnosis is never based on PSA alone.

Lifestyle Tips

The influence of lifestyle on PSA is more limited than for many other blood values, but there are some relevant factors. Being overweight, particularly abdominal fat, has been linked to slightly elevated PSA and a higher risk of aggressive forms of prostate cancer. Maintaining a healthy weight can therefore contribute to a more favourable PSA profile.

Regular exercise appears to have a protective effect on prostate health. A diet rich in vegetables (especially tomatoes for lycopene), fish, and limited red meat is linked by some researchers to a lower prostate cancer risk, although the evidence is not conclusive.

Avoid cycling and sexual activity in the 48 hours before a PSA test, as both can temporarily elevate the value. Also report medication use to your doctor: 5-alpha reductase inhibitors (such as finasteride) artificially halve the PSA value.

Frequently Asked Questions

What is a normal PSA level?
The general threshold is 4.0 µg/L, but normal values are age-dependent. In men under 50, a value above 2.5 µg/L already warrants attention. In men between 60 and 70, a value up to 4.5 µg/L can be normal, and above 70 up to 6.5 µg/L. PSA is not applicable to women.
Does an elevated PSA mean I have prostate cancer?
No, not necessarily. The most common cause of elevated PSA is benign prostatic hyperplasia (BPH). Prostate inflammation, cycling, ejaculation, and certain medications can also affect the value. If a result is notable, a doctor will suggest further investigation to determine the cause.
Do I need to fast before a PSA test?
No, fasting is not required. However, avoid cycling and ejaculation in the 48 hours before the blood draw, as both can temporarily raise PSA.
From what age is PSA screening useful?
There is no single recommendation. Men with a first-degree relative with prostate cancer are sometimes advised to have a baseline measurement from age 40. For men without risk factors, it is sensible to discuss this with your GP from age 50.
How often should I have my PSA checked?
This depends on your baseline value and risk profile. With a normal value and no risk factors, a check every two to four years is sufficient. With borderline values or known risk factors, annual monitoring may be sensible. Discuss this with your doctor.
What is free PSA and what does the ratio indicate?
PSA circulates in the blood in two forms: free and bound to proteins. In prostate cancer, the proportion of free PSA is often lower. A free PSA ratio above 25% makes cancer less likely; a ratio below 10% increases suspicion. The ratio is mainly determined when total PSA is between 4 and 10 µg/L.

Test Products

This marker is included in the following test panels.