Free PSA

Cancer

Report in 4Hrs

At Home

No Fasting Required

Details

This ratio helps distinguish between benign prostate conditions like Benign Prostatic Hyperplasia (BPH) and prostate cancer, especially when total PSA is in the intermediate range (4–10 ng/mL)

₹449₹935

52% OFF

Free PSA Test Information Guide

Why is it done?
- Measures the unbound prostate-specific antigen (PSA) in the blood; specifically evaluates the ratio of free PSA to total PSA
- Helps differentiate benign prostate hyperplasia (BPH) from prostate cancer when total PSA is elevated (4.0-10.0 ng/mL)
- Improves specificity of PSA screening to reduce unnecessary biopsies in men with borderline PSA levels
- Typically performed in men with elevated total PSA levels to assess cancer risk
- Used as part of prostate cancer screening protocols in asymptomatic men over age 50, or age 40-45 in high-risk populations
Normal Range
- Units of Measurement: ng/mL (nanograms per milliliter)
- Free PSA Ratio (Percentage): ≥25% (free PSA/total PSA × 100)
- Normal (Lower Risk): Free PSA ratio >25% suggests low cancer probability; results indicate benign cause of elevated total PSA
- Borderline: Free PSA ratio 18-25% indicates intermediate risk; requires clinical judgment and possible repeat testing
- Abnormal (Higher Risk): Free PSA ratio <18-25% suggests increased prostate cancer probability; often warrants further evaluation or biopsy
- Interpretation Context: Normal results do not exclude cancer but indicate lower probability; results are most useful when total PSA is between 4.0-10.0 ng/mL
Interpretation
- Free PSA Ratio >25%: Approximately 8% prostate cancer risk; suggests benign etiology; repeat PSA testing may be recommended at intervals
- Free PSA Ratio 18-25%: Approximately 16-25% prostate cancer risk; clinical judgment required; consider repeat PSA, imaging, or urology referral
- Free PSA Ratio <18%: Approximately 25% prostate cancer risk; strong recommendation for urology consultation and possible prostate biopsy
- Factors Affecting Results: Age (PSA increases with age), recent ejaculation (within 48 hours), prostate trauma, digital rectal exam (within 48 hours), recent urinary tract infection, urinary retention, prostate biopsy (affects PSA for 4-6 weeks), and medications such as finasteride
- Clinical Significance: Higher percentages of free PSA are reassuring and suggest benign disease; lower percentages suggest possible malignancy. The test is most useful in men with total PSA 4.0-10.0 ng/mL range where clinical decision-making is most challenging
- Important Limitation: Normal or high free PSA ratio does not completely exclude prostate cancer; clinical correlation with total PSA, digital rectal examination findings, and patient risk factors is essential
Associated Organs
- Primary Organ: Prostate gland (male organ producing seminal fluid)
- Associated Conditions - Benign: Benign prostatic hyperplasia (BPH), prostatitis (bacterial and non-bacterial), urinary tract infections
- Associated Conditions - Malignant: Prostate cancer (adenocarcinoma), metastatic prostate cancer
- System Involvement: Reproductive system; lower urinary tract; endocrine system (hormone-dependent)
- Potential Complications from Abnormal Results: If malignancy confirmed: progressive urinary obstruction, urinary retention, hematuria, erectile dysfunction, urinary incontinence, bone metastases, systemic cancer spread
- Risk from Diagnostic Procedures: Prostate biopsy (if recommended) carries small risks of infection, bleeding, hematuria, hematospermia, and rectal bleeding
Follow-up Tests
- High Free PSA Ratio (>25%): Repeat total PSA in 1-2 years; continue routine screening per guidelines; clinical reassurance
- Borderline Free PSA Ratio (18-25%): Repeat free PSA and total PSA at 3-6 months; may perform transrectal ultrasound (TRUS); urology referral optional; discuss risk factors with physician
- Low Free PSA Ratio (<18%): Urology referral strongly recommended; transrectal ultrasound (TRUS); prostate biopsy consideration; magnetic resonance imaging (MRI) of pelvis; additional PSA density assessment
- Related/Complementary Tests: Total PSA (benchmark test), PSA velocity (rate of change), PSA density (PSA adjusted for gland volume), digital rectal examination (DRE), prostate cancer antigen 3 (PCA3), 4Kscore, PHI (Prostate Health Index), Phi score
- Monitoring Frequency: Men with normal results: annual or biennial screening based on age and risk; men with borderline results: 3-6 month intervals; men with suspicious results: urgent urology consultation within 2-4 weeks
- Imaging Tests if Indicated: Transrectal ultrasound (TRUS) for gland volume and lesion characterization; multiparametric MRI (mp-MRI) for cancer detection and localization; bone scan if elevated PSA with symptoms
Fasting Required?
- Fasting: No - fasting is not required for Free PSA testing
- Patient Preparation Instructions: Avoid ejaculation for 48 hours prior to test (impacts PSA levels)
- Avoid Recent Procedures: No digital rectal examination (DRE) within 48 hours; no vigorous rectal procedures within 7 days; no prostate biopsy for at least 4-6 weeks prior to testing
- Avoid Recent Infections: Defer testing if active urinary tract infection (UTI) or prostatitis present; test at least 1-2 weeks after infection resolution
- Medications: Finasteride (Proscar) and dutasteride (Avodart) reduce PSA levels by approximately 50%; report current use to physician as this affects result interpretation
- Timing Consideration: No specific time of day restriction; may take blood sample anytime during business hours
- Specimen Requirements: Venipuncture (blood draw); serum sample usually required; tube type typically serum separator (SST) or similar
- Additional Considerations: Hydration status is not restricted; normal daily activities acceptable prior to test; inform phlebotomist of recent medical procedures or infections

How our test process works!