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Prostate Specific Antigen (Free) PSA

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Test Preparation
  1. Do not give sample within 7 days of Digital Rectal Examination (DRE) or Rectal Prostatic Ultrasonography.
  2. It is advisable to avoid sexual intercourse, ejaculation, and vigorous exercise for up to 48 hours before sample collection.
  3. Prostate biopsy causes a substantial elevation of the PSA levels. Talk to your doctor about the appropriate timing of the test.

Understanding Prostate Specific Antigen (Free) PSA

What is Prostate Specific Antigen (Free) PSA?

The Prostate Specific Antigen (Free) PSA test measures the levels of unbound or free prostate-specific antigen (PSA) in blood. It helps in differentiating between prostate cancer and other prostate-related conditions, such as prostate inflammation and an enlarged prostate. This test is often used in conjunction with the total PSA (free and bound PSA) test and other diagnostic tools to assess prostate health.

The prostate is a small walnut-shaped gland located just below the bladder and in front of the rectum in males. It produces a protein called prostate-specific antigen (PSA) that is mainly found in semen (also produced by the prostate gland) and is present in small amounts in the bloodstream of all men. It helps liquify the semen and facilitates sperm motility during ejaculation in males.

The Prostate Specific Antigen (Free) PSA test helps determine the level of free PSA in men. Unlike total PSA, which measures the total amount of PSA in the bloodstream (both free and bound to proteins), this test specifically measures the proportion of PSA that is not bound to proteins. Your doctor may recommend the Prostate Specific Antigen (Free) PSA test if you experience symptoms such as difficulty passing urine, straining or taking a long time while urinating, terminal dribbling, passing urine more frequently than usual, especially during the night, or blood in the urine. This test is also especially recommended in men over the age of 50 or at an earlier age (>40 years) for those at higher risk due to family history or other risk factors such as a high-fat diet.

Fasting is not required for this test; you may eat and drink as per your daily routine. However, talk to your doctor if you take any prescription or over-the-counter medications, as some may interfere with your test results. It is advised to avoid sexual intercourse for at least 48 hours before the test, as semen release (ejaculation) can increase your PSA levels, leading to inaccurate results. The Prostate Specific Antigen (Free) PSA test should also not be done immediately after cystoscopy, digital rectal examination (DRE), prostatic massage, indwelling catheterization, ultrasonography, and prostate needle biopsy as they too may falsely elevate PSA levels

Free PSA levels alone do not have much role in diagnosis and management. However, the ratio of free PSA to total PSA (percent free PSA) is an important indicator in the detection of prostate cancer. In individuals with elevated total PSA levels  (4- 10 ng/ml), a high percent free PSA suggests a benign cause, while low percent free PSA values are more indicative of prostate cancer. Furthermore, while total PSA is used as a sensitive marker for prostate cancer recurrence after treatment, the Prostate Specific Antigen (Free) PSA test may not have much role in post-treatment monitoring.

Talk to your doctor about your specific test results. Regardless of levels, PSA values are not absolute evidence of the presence or absence of disease. Further diagnostic tests, such as digital rectal examination (DRE) and biopsy, may be needed to confirm or rule out the possibility of cancer. Values obtained with different assay methodologies should not be used interchangeably. It is recommended that only one assay method be used consistently to monitor the course of therapy.

What is Prostate Specific Antigen (Free) PSA used for?

The Prostate Specific Antigen (Free) PSA test is done: 

  • To screen for prostate cancer.
  • To assess overall prostate health and detect benign diseases of the prostate gland like benign prostatic hyperplasia (BPH) or prostatitis.
  • If you have symptoms of any prostate condition, such as painful or frequent urination, interrupted urine, blood in urine or semen, pelvic and/or back pain, or painful ejaculation.


What does Prostate Specific Antigen (Free) PSA measure?

The Prostate Specific Antigen (Free) PSA test measures the level of free prostate-specific antigen in the blood. PSA, a protein produced by prostate gland cells, circulates through the body in two ways: bound to other proteins or on its own. PSA circulating unbound in the blood is called free PSA. The total PSA test measures the total of both bound and free PSA, while the free PSA measures the level of unbound PSA alone.

Free PSA levels in the blood get affected in conditions affecting prostate health, such as prostate enlargement (benign prostatic enlargement or BPH) and prostate cancer. Prostate cancer does not show any symptoms in its early stages but may be fatal as it progresses to its advanced stages. Therefore, a free PSA test, along with other tests like total PSA, can be used as an early diagnosis and primary screening test for prostate health.

Interpreting Prostate Specific Antigen (Free) PSA results


The normal value of PSA (total) in blood is below 4.0 ng/ml

Total PSA levels roughly between 4.0 and 10.0 ng/ml are considered in “grey zone” and the probability of finding prostate cancer based on % free PSA in such cases is given below:


% free PSA

   Probability of prostate cancer









Greater than 25%



Some patients with a “normal” total PSA may have cancer. So, some doctors order both tests at the same time as a low total PSA and a low percentage of free PSA would probably indicates biopsy in these cases.

Answers to Patient Concerns & Frequently Asked Questions (FAQs) about Prostate Specific Antigen (Free) PSA

Frequently Asked Questions about Prostate Specific Antigen (Free) PSA

Q. Why do I need the Prostate Specific Antigen (Free) PSA test?

You may need the Prostate Specific Antigen (Free) PSA test to screen for prostate cancer, especially if you fall in a group that is at high risk, including those aged over 40 or individuals with a family history of prostate cancer.

Q. How is the Prostate Specific Antigen (Free) PSA test performed?

A phlebotomist will take a blood sample from a vein in your arm using a small sterile needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial will then be transported to a lab for testing and analysis.

Q. How often should I get the Prostate Specific Antigen (Free) PSA test?

The frequency of the Prostate Specific Antigen (Free) PSA testing depends on your age, health, and risk factors for prostate cancer. Discuss with your healthcare provider for personalized recommendations.

Q. How is the Prostate Specific Antigen (Free) PSA test different from the Total PSA test?

The total PSA test measures all forms of PSA in the blood. The Prostate Specific Antigen (Free) PSA test measures only the unbound form of PSA. These two tests are often used together to diagnose and monitor prostate conditions.

Q. What additional tests can be prescribed if my Prostate Specific Antigen (Free) PSA test reports are abnormal?

If your reports suggest abnormal Prostate Specific Antigen (Free) PSA levels, your doctor may prescribe additional tests before considering a prostate biopsy. These tests include digital rectal examination (DRE), Total PSA test, PSA velocity (indicating the rate at which PSA increases over time), PSA density (indicating the PSA per volume of the prostate), PSA-based markers (like Prostate Health Index, 4K score), urinary markers, and magnetic resonance imaging (MRI) of the prostate.

Q. What are the symptoms associated with high total PSA levels?

High total PSA levels occur with disorders affecting the prostate gland. The patient may have difficulty in urination, painful or frequent urination (particularly at night), blood in urine or semen, weak or interrupted flow of urine, difficulty holding urine, painful ejaculation, and persistent pain in the lower back, pelvis, or thighs.

Q. Does a high PSA level always mean I have prostate cancer?

Not necessarily. While higher levels of total PSA can be a sign of prostate cancer, other conditions, such as an enlarged prostate (BPH) or a prostate infection, can also raise PSA levels.

Q. How can I reduce my PSA levels naturally?

Always consult your doctor if your test results show elevated PSA levels. However, you can make lifestyle changes to reduce your PSA levels naturally. These changes include eating more proteins, tomatoes, and cruciferous vegetables; maintaining adequate vitamin D levels in your body; exercising regularly to maintain a healthy weight; and managing your stress, as high stress may be associated with high PSA levels.

Q. What is BPH?

Benign prostatic hyperplasia, or BPH, is a condition characterized by the enlargement of the prostate gland. Enlargement due to BPH is usually caused due to aging. However, the enlarged prostate puts pressure on the urethra and leads to blockage, causing urinary retention, weak or no urine flow, urinary bladder stones, infections, or kidney damage.
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Prostate Specific Antigen (Free) PSA test price for other cities

Price inMumbaiRs. 799
Price inKolkataRs. 799
Price inBangaloreRs. 799
Price inGurgaonRs. 799
Price inNoidaRs. 810
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  1. The Prostate-Specific Antigen (PSA) Test. [Internet]. Prostate Cancer Foundation; [Accessed 05 Mar. 2024]. Available from: https://www.pcf.org/about-prostate-cancer/what-is-prostate-cancer/the-psa-test/External Link
  2. Prostate cancer. Should I have a PSA test? [Internet] NHS; [Accessed 05 Mar. 2024]. Available from: https://www.nhs.uk/conditions/prostate-cancer/should-i-have-psa-test/External Link
  3. What is prostate cancer? [Internet]. CDC; [Accessed 05 Mar. 2024]. Available from: https://www.cdc.gov/cancer/prostate/basic_info/what-is-prostate-cancer.htm#:~:text=The%20prostate%20is%20located%20just,tends%20to%20increase%20in%20size.External Link
  4. PSA test [Internet]. Prostate Cancer UK; [Accessed 05 Mar. 2024]. Available from: https://prostatecanceruk.org/prostate-information-and-support/prostate-tests/psa-blood-testExternal Link
  5. David MK, Leslie SW. Prostate Specific Antigen. [Updated 2022 Nov 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557495/ External Link
  6. Morote J, Raventós CX, Lorente JA, Lopez-Pacios MA, Encabo G, de Torres I, Andreu J. Measurement of free PSA in the diagnosis and staging of prostate cancer. Int J Cancer. 1997 May 29;71(5):756-9. [Accessed 05 Mar. 2024]. Available from: https://pubmed.ncbi.nlm.nih.gov/9180142/ External Link
  7. Yazdani M, Saberi N, Baradaran A, Mohajeri Z. Diagnostic value of total serum/free prostate specific antigen and prostate cancer antigen-3 levels in prostate cancer. Am J Clin Exp Urol. 2023 Oct 15;11(5):414-419. PMID: 37941653; PMCID: PMC10628628. [Accessed 05 Mar. 2024]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10628628/#:~:text=Serum%20free%20PSA%2C%20which%20is,higher%20risk%20of%20prostate%20cancer. External Link
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