Although cancer may be present even when the PSA level is < 1 ng/mL, experts do not recommend a biopsy unless the PSA is higher (unless there is a suspicion on digital rectal examination or other modality). Some clinicians use 2.5 ng/mL as the cutoff, whereas others wait until it is 3 ng/mL or greater.
The percentage of free PSA is generally used as an additional factor in making an informed recommendation for or against biopsy in patients with a PSA level of 4-10 ng/mL. Free PSA percentage is most useful in men with very large glands and in patients in whom one biopsy result has already been negative. In healthy men with a PSA level of 4-10 ng/mL, many experts recommend biopsy without the additional free PSA test. Typically, a free PSA > 25% is considered normal. Some experts recommend a biopsy when the free PSA is < 18%; others advise a cutoff of 12%.
Learn more about PSA testing.
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Cite this: Bradley Schwartz. Fast Five Quiz: Prostate Cancer Practice Essentials - Medscape - Apr 19, 2023.