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Is the Free PSA Test Actually a Good Indicator of Prostate Cancer?

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The total and free PSA tests are important procedures for men to have performed as they age. These tests are fairly simple and routine, but invaluable in that they can be used to identify the likelihood of prostate cancer, which is often treatable when detected early.

Since there are usually no symptoms related to the early stages of prostate cancer, these tests are the best first line of defense against the disease.

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The Total PSA Test vs. the Free PSA Test

Prostate-specific antigen (PSA) is a protein produced in the prostate. Upon ejaculation, a small amount of PSA is released into the bloodstream, and aids in the semen’s ability to carry sperm to the fallopian tubes and achieve conception.

PSA exists in two basic states — bound to another protein and floating freely in the blood. It is the free-floating PSA that is measured by the free PSA test, while the total PSA test measures all of the present PSA in the bloodstream, including those that are bound and floating freely.

Since both tests measure the respective levels of PSA in the blood, test results help doctors to identify issues related to the prostate, such as prostate inflammation and/or prostate cancer.

Typically, the free PSA test is only performed after a total PSA test and is primarily used to help doctors rule out cancer. However, the free PSA test may also be used to indicate the degree to which cancer has progressed following treatment.

The free PSA test is therefore often used as only one part of a complete diagnosis and generally does not rule out the possibility of prostate cancer. Depending on the results of the total and free PSA test, a tissue biopsy may be necessary to provide a more reliable diagnosis.

The Value of the Free PSA Test

In and of itself, the free PSA test does not lead to a diagnosis, as it does not reveal enough information to conclude that a person has cancer. However, the free PSA test offers much value regardless, as it may reduce the number of necessary biopsies, and help to provide context for a total PSA test and lend strength to the results of a biopsy.

The former benefit is particularly important, as even biopsies may miss cancer, but when paired with a free PSA test, a much higher degree of confidence can be achieved. In many cases, both the total and free PSA tests are used as initial evaluations, with a biopsy only being required if there is sufficient cause to perform further testing for cancer.

In conjunction with the results of PSA tests, doctors consider other factors when evaluating an individual’s risk of prostate cancer. The person’s age, ethnicity, and prostate volume are all important factors to contemplate, along with a number of more in-depth considerations.

Moreover, there are many other factors that may affect PSA levels, so it is important to communicate with your physician about physical activity and habits.

Final Thoughts on Prostate Cancer Evaluation

As prostate cancer is the most frequently diagnosed form of cancer in the United States, the American Cancer Society has updated its recommendation, and now suggests that men start being evaluated at age 40, as opposed to the previous benchmark of 50.

Take the time to understand the purposes and indications of the free and total PSA tests and talk to your doctor about these procedures. Early detection is the key to successful treatment and positive outcomes, so it is imperative to take this basic preventive measure sooner than later.


Derek is a researcher, presenter and community liaison at the Behavioral Health & Wellness Program at the University of Colorado, specializing in promoting health systems change and combating health disparities. With his background as a technical writer and editor, he has over 15 years of experience working in the health care field. His experience includes serving as a contributing author on several textbooks in the medical field, running a nuclear cardiology licensing course, and writing a variety of other pieces ranging from online training courses to medical software manuals. Derek pursues his personal passion for health and wellness by playing multiple sports, hiking and running marathons, and travels extensively, having visited or lived in over 60 countries.


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