PSA Free:Total Ratio, Prostate Markers


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Quest Diagnostics Test Code: 31348

PSA lab test helps to establish a timely diagnosis of prostate cancer and save a patient. Higher total PSA levels and lower percentages of free PSA in the body increase risks of prostate cancer. Men with a PSA level between 4 and 10 have about a 1 in 4 chance of having prostate cancer.

The prostate is a small gland in males which help produce fluid that make up part of semen. It is a common site to get enlargement of the gland or develop cancer. The cells of the prostate produce a protein called prostate specific antigen (PSA) which is usually in such small amounts in a normal male. In the event of disease to the prostate gland, like prostatitis or benign prostatic hyperplasia, the level of PSA in the blood increases. This test measures total PSA and unbound or free PSA in the blood. When the free PSA is very low, there is a greater chance of prostate cancer.

PSA is one of the most important parameters of health among 45 -year-old males. It helps doctors to establish a timely diagnosis of prostate cancer and save a patient. The importance of prostate cancer timely diagnosis is immense! Men with a PSA level between 4 and 10 have about a 1 in 4 chance of having prostate cancer. If the PSA is more than 10, the chance of having prostate cancer is over 50%.

Prostate cancer patients whose cancer has not yet spread to the other parts of the body have the 5-year survival rate of almost 100%. Roughly 96% of those patients are still alive after 15 years. The 5-year survival rate of the patients diagnosed with prostate cancer with metastases is 29%. The only difference between those two groups of patients is the time of diagnosis. The early stage of cancer development is usually asymptomatic, so the only way to detect is through screening testing. PSA and free-PSA are the screening tests for prostate cancer.

Increased levels of PSA and free-PSA does not automatically mean that a person is a cancer patient. For accurate interpretation of results (this apply to those patients with increased levels of markers), a health professional needs to be consulted. Depending on the risk of the prostate cancer, the testing should start at the age of:

• 40 for “very high risk” males (several first degree relatives with prostate cancer),
• 45 for “high risk” population (if there is a family history of prostate cancer, father for example),
• 50 for “average risk” population (all other).

What does this test reveal about your health?
Increased PSA and free-PSA levels suggest that a prostate is metabolically more active than usual. It is a signal that there is some kind of growth happening. It could be an inflammation, benign hyperplasia or carcinoma. Depending on the level of increase a rough estimation can be made whether or not the reason is prostate carcinoma. Medical examination will reveal a definitive diagnosis if the PSA and free-PSA are increased.

This test is performed in following conditions such as:

• Screening for prostate cancer after age 50
• For those at high risk, such as American men of African descent
• Difficult, painful, and/or frequent urination
• Back pain
• Pelvic pain
• Difficulty ejaculating
• Suspicious mass on DRE

Also Known As: Prostate Specific Antigen


It is recommended that someone taking Biotin (also known as vitamin B7 or B8, vitamin H, or coenzyme R) stop consumption at least 72 hours prior to the collection of a sample. It is also recommended to avoid ejaculation 24 hours prior to giving sample as it may cause higher PSA levels. Also, sample should be collected before a digital rectal exam (DRE) and prostate biopsy are performed.


Specimen Collected
  • Blood
Estimated Time Taken

The turnaround for this test is typically 1-3 business days.