Prostate-Specific Antigen (PSA), (Total + % Free)

PSA is a protein made by the prostate gland that can be measured in the blood. Higher-than-normal PSA levels can be caused by several conditions, including prostate cancer, an enlarged prostate, or prostate inflammation — so an elevated result does not automatically mean cancer is present. The 'percent free PSA' test helps doctors better understand whether an elevated PSA is more likely due to cancer or a non-cancerous cause. Your doctor will consider your PSA result alongside your age, symptoms, medical history, and other tests before making any decisions. Regular PSA monitoring over time is often more informative than a single measurement.

When elevated: Elevated total PSA may indicate prostate cancer, BPH, prostatitis, or other prostate pathology; markedly elevated levels or rising PSA velocity increase concern for malignancy or disease progression. A low %fPSA in the context of elevated total PSA increases the likelihood of prostate cancer and may prompt further evaluation such as biopsy or advanced imaging. When low: Low total PSA is generally reassuring and associated with a lower probability of significant prostate pathology. A high %fPSA (>25%) in the gray zone is associated with a lower probability of prostate cancer, though it does not exclude it entirely. Notably, 5-alpha reductase inhibitors (e.g., finasteride, dutasteride) can suppress PSA levels by approximately 50%, potentially masking underlying malignancy if not accounted for.

PSA is not specifically athlete-relevant for performance or training monitoring. However, athletes undergoing routine health screening should be aware that PSA testing is a standard prostate health assessment, particularly for men over 50 or those with risk factors, regardless of activity level.