A PSA test with the counselling that should always come first — the result is far less clear-cut than people expect.
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A standard PSA test is a blunt instrument. Around three in four men with a raised PSA turn out not to have cancer, and some men with prostate cancer have a normal PSA — yet a raised result routinely leads to MRI and biopsy, with all the anxiety and risk that involves.
We use an enhanced prostate profile rather than PSA alone. Alongside total and free PSA it measures three additional markers and produces a calculated risk score, designed specifically to separate men at genuinely higher risk from those who can safely be reassured.
It is not a perfect test — no prostate test is — but it is a meaningfully better one, and the consultation still covers what the result can and cannot tell you before you decide to proceed.
Total PSA and free PSA, plus interleukin-8, monocyte chemotactic protein-1 and epidermal growth factor — markers of the inflammatory environment around the prostate. These are combined into a calculated prostate cancer risk score.
PSA alone rises with cancer but equally with benign enlargement, infection, recent ejaculation, cycling and simple ageing, which is why the additional markers matter.
Urinary symptoms, a family history of prostate cancer, being of Black ethnicity, which carries higher risk, or being over 50 and wanting to consider screening.
Included: total prostate specific antigen · free prostate specific antigen · interleukin-8 · monocyte chemotactic protein-1 · epidermal growth factor · calculated prostate cancer risk score.
A plain total PSA test is available on its own if you would prefer, or if a specialist has asked specifically for that.
Counselling consultation first, then a referral to a Randox Health clinic if you decide to proceed, then a results review with a clear plan.
Avoid ejaculation for 48 hours and vigorous exercise or cycling for 48 hours beforehand — both raise PSA. Postpone the test for at least six weeks after a urinary infection or prostate procedure.
It measures a protein made by the prostate, and it rises for several reasons — most of them not cancer. Benign enlargement, infection, prostatitis, recent ejaculation, cycling and a recent catheter all raise it.
A raised PSA means "this needs looking into", not "you have cancer". Most men with a raised PSA turn out not to have it.
Thresholds rise with age, because the prostate enlarges naturally. What matters as much as the absolute figure is:
Not straight to biopsy. Current UK practice is multiparametric MRI first, which frequently avoids a biopsy altogether and, where one is still needed, targets it far better than the older approach.
That change matters, and it is worth knowing before deciding whether to test — the pathway is considerably less unpleasant than its reputation.
If you take finasteride or dutasteride — for hair loss or prostate enlargement — your PSA is roughly halved. The result must be doubled to be interpreted.
Tell any doctor checking your PSA that you take it. This is missed regularly, and it produces falsely reassuring results.
There is no national prostate screening programme in the UK, and that is a deliberate decision rather than an oversight. The evidence is finely balanced, and it is worth understanding why before testing.
Whether a cancer, if present, is the aggressive kind. That needs MRI and biopsy. PSA cannot distinguish an indolent cancer from a dangerous one, which is precisely the problem.
A family history of prostate cancer, and Black African or Caribbean heritage, both raise risk substantially — and in those groups the argument for testing, and for testing earlier, is considerably stronger.
Any man over 50 can request a PSA test free from his NHS GP, after a discussion about the pros and cons. Men at higher risk — family history, or Black African or Caribbean heritage — should be having that conversation earlier, from around 45.
That entitlement is under-known, and it is worth stating plainly: you do not have to pay for this.
Twenty minutes to have the decision properly, rather than a yes or no. What a raised result would lead to, what overdiagnosis means, and where your own risk sits.
It is a decision that deserves more time than it usually gets, and that is the honest case for paying.
It is a decision worth twenty minutes rather than a yes or no, and reasonable men reach opposite conclusions on the same evidence.
There is no national screening programme precisely because the balance is close. What shifts it: a family history of prostate cancer, and Black African or Caribbean heritage, both of which raise risk substantially.
No — and most men with a raised PSA do not have it.
Benign enlargement, infection, prostatitis, recent ejaculation and cycling all raise it. A raised result means further assessment, not a diagnosis.
No. A proportion of significant prostate cancers occur with entirely normal PSA levels.
Symptoms still matter — a normal result is not a reason to ignore a change in urinary pattern, bone pain or weight loss.
Ejaculation for 48 hours, and vigorous exercise or cycling for 48 hours — both genuinely raise PSA and produce results that need repeating.
And postpone for at least six weeks after a urinary infection or any prostate procedure.
Yes, considerably — and it is missed regularly. Finasteride and dutasteride roughly halve PSA, whether taken for hair loss or for prostate enlargement.
The result must be doubled to be interpreted, so tell any doctor checking it that you take it.
Not an immediate biopsy. Current UK practice is multiparametric MRI first, which frequently avoids biopsy altogether and targets it better where one is needed.
That is a meaningful improvement on the older pathway, and worth knowing when weighing whether to test.
Finding a cancer that would never have caused you harm. Some prostate cancers grow so slowly that they would never produce symptoms or shorten life.
The difficulty is that once found, they are hard to leave alone — and treatment carries real risks of incontinence and erectile dysfunction. That is the central argument against routine screening, and it deserves stating plainly.
No — that requires an in-person examination, which we cannot do. We can arrange the blood test, interpret it, and refer.
Saw palmetto and similar products have not shown convincing benefit in good trials for either symptoms or prevention.
Some may also affect PSA readings, which is an unhelpful side effect for a product bought by men worried about their prostate.
Usually benign prostate enlargement, which is common and treatable. Prostate cancer typically causes no urinary symptoms at all until it is advanced.
Worth mentioning: sleep apnoea is a frequently missed cause of getting up at night, and it is not a prostate problem at all.
Clinically reviewed by Dr Mohammad Zubair Khan, GMC 7563469
Last reviewed
August 23, 2026
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Yes. Care is led personally by Dr Mohammad Khan, so you are not passed between clinicians. Continuity is the point of a small practice: someone who knows your history and is listening attentively rather than working through a checklist.
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It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
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If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
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