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Prostate cancer is the second most common type of cancer, after breast cancer. The Centers for Disease Control and Prevention (CDC) states that, for every 100 Americans with penises, 13 will develop prostate cancer in their lifetime.

Genetics and age can play critical roles in determining the likelihood of prostate cancer. If you have relatives on your maternal or paternal sides with prostate cancer, you’re at an increased risk. According to the CDC, African American men are at an increased risk for developing prostate cancer.

Prostate cancer typically has a relative 5-year survival rate of 90 percent, but it can still be deadly, depending on the stage it’s detected at. Prostate cancer can be aggressive, which is why early detection is so important.

One beginning step in testing for prostate cancer is a prostate-specific antigen (PSA) test. PSA is a protein made by the prostate, the small gland underneath the bladder.

In some cases, an elevated PSA level can be a sign of prostate cancer. However, not all elevated PSA is a sign of prostate cancer. PSA is also found in enlargement of the prostate (benign prostatic hyperplasia), and infections and inflammation of the prostate (prostatitis).

Since PSA is found in the blood, a PSA test is usually taken with a finger prick.

A PSA test won’t provide enough information for a diagnosis, but it may help your doctor decide if cancer is likely and what to do next. While PSA tests once required you to be present in a lab or at your doctor’s office, you can now administer a test from your own home.

PSA occurs in two forms within the blood. The first form, complexed PSA, is attached to proteins. The other form, percent-free PSA, floats freely within the bloodstream.

A standard PSA test typically measures total PSA — a combination of attached and unattached PSA. If your PSA test result isn’t normal, some doctors might consider testing different types of PSA to decide if you need a biopsy.

Percent-free PSA test

If your total PSA falls in the borderline range (between 4 and 10), your doctor may take a percent-free PSA test. A lower percent-free PSA means that your chance of having prostate cancer is higher.

According to the American Cancer Society, doctors generally advise those with a percent-free PSA of 10 percent or less to get a biopsy.

Complexed PSA test

Unlike the roaming PSA in your blood, complexed PSA are directly attached to proteins. This test can be done in lieu of total PSA, but it isn’t often used.

Other types of tests

Science and testing methodologies are always evolving. Several newer tests combine different types of PSA levels to offer an overall score to predict if a person has cancer.

  • Prostate Health Index (PHI). This combines total PSA, percent-free PSA, and proPSA (a premature form of PSA).
  • 4kscore Test. This combines total PSA, percent-free PSA, complexed PSA, human kallikrein 2 (hK2), and other factors.

Most people with penises will get a PSA test in their lifetime. Depending on the person’s age and risk factors, your doctor may encourage one.

Organizations, like the U.S. Preventive Services Task Force (USPSTF), have laid out recommendations for those considering a screening.

The USPSTF recommends the following for those who have an average or increased risk of prostate cancer, do not have symptoms of prostate cancer, and have never been diagnosed:

  • If you’re 55 to 69 years old, you should make an individual decision whether you want to take a PSA test.
  • Before making a decision, you should talk with your doctor about the benefits and harms of screening for prostate cancer, including the benefits and harm of other tests and treatment.
  • If you’re 70 and older, you shouldn’t be screened for prostate cancer routinely.

The CDC suggests people also consider the following with their doctor prior to screening:

  • if you have a family history of prostate cancer
  • if you’re African American
  • if you have other medical conditions that may make it difficult for you to be treated for prostate cancer if it’s found
  • how you value the potential benefits and harms of screening, diagnosis, and treatment

When researching at-home PSA tests, we read online reviews to determine the best tests on the market. We also ensured each test is studied in a CLIA approved lab.

Best overall

LetsGetChecked

  • Price: $99
  • Type: self-collection
  • Insurance coverage: FSA and HSA accepted

LetsGetChecked has an average 4.4-star rating, with over 9,000 reviews on TrustPilot.

The company offers 38 testing kits and will soon be offering a PSA test. Customers praise the clear instructions, customer care, and quick results.

The LetsGetChecked at-home PSA test will check total and free PSA, as well as, calculated PSA ratio.

After activating the kit, customers collect a blood sample via finger prick and ship the sample in the mail. LetsGetChecked gives you confidential results within 2 to 5 days and provides 24/7 access to nurses who can explain the results.

Best for fast results

Health Testing Centers

  • Price: $49–$59
  • Type: in-person collection
  • Insurance coverage: FSA and HSA accepted

If you’re looking for quick results, Health Testing Centers offers one of the quickest solutions available. The online database of testing options provides customers with the ability to purchase lab-certified tests from LabCorp or Quest Diagnostics, and results are provided within 1 to 2 days.

Unlike at-home tests, Health Testing Centers requires customers to visit a lab in person.

Customer reviews say the affordable prices, reliability, and quick results are benefits to the service. The ability to schedule and pay for testing online provides convenience to customers looking to bypass an initial doctor’s visit.

The LabCorp PSA test is $59, and the Quest Diagnostics PSA test is $49 — and both labs have locations around the country.

Best report

imaware

  • Price: $69
  • Type: self-collection
  • Insurance coverage: FSA and HSA accepted

Founded in 2017, imaware has garnered more than 172 reviews on TrustPilot with an average of 4.5 stars. The testing company offers a $69 at-home testing kit that measures total PSA.

Customers praise the convenience of the testing, helpful customer service, and low cost. One reviewer on the imaware website shares that the company’s PSA test was a “perfect match” with a PSA test they took in the hospital.

Customers activate their kit and collect blood samples using imaware’s lancets. After mailing the collection samples, customers can expect to find out their results within 7 days on imaware’s secure online portal.

The results share how likely you are to have the condition, how to discuss the results with your physician, and how to track your health progress over time.

The company’s medical leadership and advisory boards are compiled with professionals from top institutions, like Stanford Medicine, Harvard Medical School, UC San Diego Health, Mount Sinai, University of Chicago, and the Knight Cancer Institute.

Best in-person testing option

QuestDirect

  • Price: $69 (plus a $6 physician fee)
  • Type: in-person collection
  • Insurance coverage: FSA and HSA accepted

You may be familiar with Quest Diagnostics clinical laboratory and testing sites, but did you know the company also offers an on-demand option?

Rather than meet with a physician, customers can order a test through the QuestDirect website. Quest Diagnostic partnered with PWN, a national clinician network, to provide physician oversight and evaluation for all kits purchased online. The online e-commerce site allows those seeking answers to bypass the first step of visiting a doctor.

While QuestDirect offers many at-home testing kits, and you can purchase the PSA online, the company currently requires customers to set up an appointment and come into a testing center for an in-person PSA test.

After the PSA screening, results are posted to the MyQuest online portal within a week. In-person tests can be purchased in all states, except Arizona, Alaska, and Hawaii, as well as Puerto Rico.

Your results will share the nanograms per milliliter of PSA in your blood. This biomarker has stirred controversy over the years, since there is no number considered normal. Typically, a PSA of 4 or higher would show an increased risk of prostate cancer.

According to the organization Zero Cancer, general PSA guidelines are:

  • 0 to 2.5 ng/mL is considered safe.
  • 2.6 to 4 ng/mL is safe for most, but you should talk with your doctor about other risk factors.
  • 4.0 to 10.0 ng/mL is suspicious and might suggest the possibility of prostate cancer. It’s associated with a 25 percent chance of having prostate cancer.
  • 10.0 ng/mL and above is dangerous and should be discussed with your doctor immediately. It’s associated with a 50 percent chance of having prostate cancer.

It’s important to understand that this is not always the case. Some people with lower levels of PSA may have prostate cancer, and some people with higher levels of PSA might not have cancer. The PSA test is simply the first marker of prostate enlargement and cell activity.

How can I prepare for an at-home PSA test?

One important step for an accurate test is to abstain from sexual activity — either masturbation or with a partner — for 48 hours. People with penises cannot ejaculate prior to the test, since the semen released can elevate PSA levels and skew the results.

Most at-home PSA kits recommend that you collect blood samples first thing in the morning, but no fasting is required.

While no food or drinks are proven to skew results, imaware notes that some supplements and medications may raise or lower PSA levels.

You should consult with your doctor if you’re undergoing chemotherapy or taking any of the following medications or supplements:

  • nonsteroidal anti-inflammatory drugs (NSAIDs)
  • statins
  • urinary health medications
  • carninte
  • fenugreek
  • pomegranate
  • saw palmetto
  • PC-SPES
  • lycopene
  • phytoestrogens

Heavy exercise can also temporarily increase PSA levels, leading to inaccurate results. According to imaware, even seemingly simple activities, like riding a bike, may increase your PSA level. It’s best to refrain from exercise for a few days prior to testing.

Urinary tract infections (UTIs) or recent pelvic injuries can also impact your PSA, so it’s best to consult with your doctor if you’re experiencing an infection or taking antibiotics for a UTI.

Are at-home PSA tests reliable?

At-home PSA tests are sent to CLIA approved labs, which may be the same ones used by doctors and government agencies. That being said, it’s important to know that the PSA test isn’t a perfect method of detecting prostate cancer, but it can be a helpful first step.

Having elevated PSA levels doesn’t always mean cancer. Noncancerous conditions, like benign prostatic hyperplasia or an enlarged prostate, can also raise PSA levels.

After a PSA test, your doctor will usually recommend an ultrasound and a biopsy as your next step if your levels are elevated.

On the contrary, PSA tests can also provide a false sense of safety to some. According to Harvard Health, the PSA test doesn’t detect all types of cancers, and 20 percent of people who have cancer also have normal PSA.

PSA tests are a good starting point for those in higher-risk groups, but they aren’t a definitive answer. As with any at-home test kit, at-home PSA test results aren’t comparable to ones from a clinic, hospital, or in-person lab.

What is a normal PSA by age range?

There’s no specific level that classifies as abnormal, but levels can be helpful in determining if a biopsy is needed. According to the National Cancer Institute, most doctors used to consider PSA levels of 4.0 ng/mL and lower as normal.

Various factors, like medication and physical activity, can cause PSA levels to rise, so your doctor may look at a variety of factors before deciding to perform additional tests.

What is a dangerous PSA level?

The higher a person’s PSA level, the higher the risk for prostate cancer. While PSA levels may fluctuate in a person’s life, a consistent rise in PSA over time can indicate prostate cancer.

If you have a PSA level between 4 and 10, you’re considered to be in the “borderline range,” according to the American Cancer Society. You have a 1 in 4 chance of having prostate cancer.

If the PSA level reaches above 10, there’s a 50 percent chance you have prostate cancer.

Do false negatives and false positives happen?

The PSA test isn’t a fool-proof method to test for prostate cancer.

When prostate cancer develops, the PSA level often rises about 4.0 ng/mL but there are exceptions to the rule.

A 2004 study showed that some people with PSA levels below 4.0 ng/mL had prostate cancer, while some with higher levels did not.

The American Cancer Society states that about 15 percent of people with a PSA below 4 will have prostate cancer.

What can skew a PSA test?

There are many factors that can elevate PSA levels prior to a test, such as:

  • physical activity
  • ejaculation
  • certain medical conditions, like prostatitis and an enlarged prostate
  • older age

Some factors that can lower PSA levels include supplements and medicines, like:

  • 5-alpha reductase inhibitors
  • herbal mixtures
  • thiazide diuretics
  • aspirin
  • cholesterol-lowering drugs

What are the benefits and risks of a PSA test?

Finding prostate cancer before it spreads is a benefit to PSA testing.

However, PSA testing is no longer routinely recommended, because the detection of all prostate cancers doesn’t always lead to improved survival.

The CDC states that a false positive can lead to unnecessary worry and tests, like a biopsy, causing potential harm.

There are some cases where the amount of prostate cancer is so minimal that it would never be life-threatening. Overdiagnosis of people who would have not had symptoms or died from their amount of prostate cancer may lead to more medical complications from the treatment.

Some treatment side effects include:

  • urinary incontinence
  • erectile dysfunction
  • bowel problems

If you’re concerned about your treatment plan, it’s a good idea to get a second opinion and weigh the pros and cons of treatment.

How long should you wait between taking PSA tests?

Depending on your age and family history, your doctor will likely recommend how often your PSA levels should be tested. Your PSA results can also factor into how often you need testing.

John Hopkins Medicine states that every 2 to 3 years is common frequency if you’re 55 to 69 years old. It’s best to consult with your doctor when considering your next test.

PSA tests can be a valuable tool to help you get preliminary answers regarding your prostate health. While PSA tests can have flaws, the information can still be beneficial for doctors when combined with your medical history and other criteria.

A PSA test can provide comfort while also potentially removing the need for a more invasive biopsy. While the results can help you feel a sense of ease, it’s best to talk with your doctor. False positives and negatives can occur.


Jillian Goltzman is a freelance journalist covering culture, social impact, wellness, and lifestyle. She’s been published in various outlets, including Cosmopolitan, Glamour, and Fodor’s Travel Guide. Outside of writing, Jillian is a public speaker who loves discussing the power of social media — something she spends too much time on. She enjoys reading, her houseplants, and cuddling with her corgi. Find her work on her website, blog, Twitter, and Instagram.