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Prostate Health · Imphal

PSA testing,
an informed choice.

PSA is a simple blood test that can help find prostate cancer early. It has real benefits and real limits — here is what to know before and after the test.

● Simple blood test ● Men 50+, or 45+ with family history ● A raised PSA is not always cancer ● Free PSA ratio explained

💬 Say "Hi" to book If my PSA is high ↓

Dr. Nameirakpam ShantajitMBBS (SPMC Bikaner) · MS Surgery & M.Ch Urology (RIMS Imphal) · MMC Reg. No. MNP 150

Who should talk to us about PSA?

Testing is a personal choice — made after discussing benefits and downsides.

Men aged 50 and above
From 45 if a father or brother had prostate cancer
Any age with urinary symptoms, blood in urine or semen, or bone pain
Men already on prostate medicines, before starting some of them

About PSA

What PSA can and can't tell you

PSA (prostate-specific antigen) is a protein made by the prostate. Higher levels can be a sign of prostate cancer — but several other things raise it too.

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Enlarged prostate (BPH)

The commonest reason for a mildly raised PSA.

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Infection or inflammation

Prostatitis or a urine infection can raise PSA for weeks.

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Recent activity

Ejaculation or long cycling in the previous 48 hours.

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Recent procedures

A catheter, cystoscopy or prostate examination shortly before the test.

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Some medicines lower it

Finasteride and dutasteride roughly halve PSA — tell us if you take them.

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Prostate cancer

One possible cause — which is why a raised PSA is checked carefully.

Free PSA

Free PSA and the free-to-total ratio

PSA circulates in the blood in two forms — attached to proteins ("bound") or unattached ("free"). Men with prostate cancer tend to have a lower proportion of free PSA. When total PSA is in the borderline range of 4–10 ng/mL, the free-to-total ratio (% free PSA) helps estimate the chance of cancer and decide who needs further tests.

Chance of cancer on biopsy, by % free PSA

Catalona et al., JAMA 1998 — 773 men aged 50–75, total PSA 4–10 ng/mL, normal-feeling prostate on examination.

0 – 10%

56%

10 – 15%

28%

15 – 20%

20%

20 – 25%

16%

Above 25%

In this study, using 25% or less as the cut-off for further testing detected about 95% of cancers while avoiding about 20% of unnecessary biopsies. Laboratories use slightly different cut-offs (often between 18% and 27%) depending on the test kit — your report's reference range applies to your result.

Work out your % free PSA

Enter the two values from your report.

Total PSA (ng/mL) Free PSA (ng/mL)

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Enter both values to see the ratio.

For general information only — not a diagnosis. The study figures apply to men aged 50–75 with total PSA 4–10 ng/mL and a normal prostate examination. Results are interpreted together with your age, prostate size, examination, medicines and MRI findings.

When the ratio is less reliable

Total PSA outside 4–10 ng/mL
Recent urine or prostate infection, catheter or procedure
Taking finasteride or dutasteride
A very large prostate, or a different test kit from the study

How it fits with today's practice% free PSA is one piece of the picture. Today an MRI of the prostate is often done before deciding on a biopsy, and the decision is made together with you after looking at all the findings.

Before Testing

Benefits and downsides

Possible benefits

Can find prostate cancer early, before symptoms, when treatment options are wider
A normal result can be reassuring
Helps in planning care for men with urinary symptoms

Possible downsides

A raised PSA is often not cancer, which can mean worry and more tests
It can find slow-growing cancers that may never have caused harm
It can miss some cancers
A biopsy, if needed, carries small risks such as bleeding and infection

Preparing for the test

48 hours beforeAvoid ejaculation and long cycling

If you had a UTIWait about 6 weeks after treatment

Tell usAbout prostate medicines and recent procedures

ResultsDiscussed with your age, prostate size and history

If PSA Is Raised

What happens next

Repeat & review

Often the test is repeated, after treating any infection, and looked at alongside prostate size and % free PSA.

Examination

A gentle prostate examination and urine tests.

MRI of the prostate

A multiparametric MRI helps decide whether a biopsy is needed and where to target it.

Biopsy if needed

Small samples are taken for testing — only when the MRI and other findings suggest it.

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If cancer is found

Many early, low-risk prostate cancers are simply monitored closely (active surveillance). Others may need surgery, radiotherapy or hormone treatment. Options are explained in detail, and specialist cancer care is arranged where needed.

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Go to the nearest hospital emergency if you have

Unable to pass urine, with a painful swollen lower belly
Heavy bleeding in urine with clots
Sudden weakness or numbness in the legs, or loss of bladder or bowel control

WhatsApp numbers and the chatbot are not emergency services.

Questions

Frequently asked questions

At what age should I think about a PSA test?

Usually from 50, or from 45 if your father or brother had prostate cancer. Men with urinary symptoms or other warning signs may need it at any age. It is a choice best made after a discussion.

Do I need to fast before a PSA test?

No. Avoid ejaculation and long cycling for 48 hours before the test, and tell us about any recent urine infection or procedures.

My PSA is high. Does that mean I have cancer?

Not necessarily. Enlargement of the prostate, infection and recent activity can all raise PSA. The test is usually repeated and looked at with other findings, and an MRI may be advised.

Myth: “After TURP, I can't get prostate cancer.” Is that true?

No — this is a common myth. TURP removes only the inner part of the prostate that blocks urine flow. The outer part of the prostate, where most prostate cancers start, is left behind, so cancer can still develop later. Continue PSA checks as advised. Because PSA falls after TURP, a new baseline PSA is usually checked about 3 months after surgery, and any later rise is taken seriously. The tissue removed during TURP is also tested, and occasionally finds an early cancer.

What is free PSA, and what does a ratio below 25% mean?

Free PSA is the part of PSA not attached to proteins. When total PSA is between 4 and 10 ng/mL, a lower percentage of free PSA means a higher chance of cancer. In a large 1998 study, men with 10% free PSA or less had about a 56% chance of cancer on biopsy, while men above 25% had about 8%. A ratio of 25% or less usually means further evaluation is advised. Labs may use slightly different cut-offs depending on the test kit.

Is a prostate biopsy always needed?

No. An MRI often helps decide whether a biopsy is needed at all, and where to target it if it is.

I take finasteride or dutasteride. Does that matter?

Yes. These medicines lower PSA by about half, so results are interpreted differently. Always mention them.

How often should PSA be repeated?

It depends on your age, your PSA level and your risk. This is decided individually at your review.

Book a consultation

NAM Consultants, Singjamei: mornings daily 6:00–9:30 AM (Mar–Oct) / 6:30–9:30 AM (Nov–Feb), evenings 4–6 PM Mon–Sat · Raj Medicity Hospital: Mon–Sat 11 AM–1 PM

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Medically reviewed by Dr. Nameirakpam Shantajit, M.Ch Urology (MMC Reg. No. MNP 150) · Last reviewed: 10 October 2026

PSA testing,an informed choice.