Raised PSA

The Scottish Cancer Referral Guidelines have been updated and went live on Wednesday, 6th August 2025. We are working hard to update all relevant information on the RefHelp website. If you would like to see the guidelines please click here Scottish Referral Guidelines for Suspected Cancer 2025 – gov.scot

R.C. & H.S 16-12-24

Who to refer:

Men with raised PSA according to the following age-adjusted limits:

Under 60 years ˃3

Aged 60-69 years ˃4

Aged 70 years and over ˃5

The principles of Realistic Medicine should be applied when considering referral and, in older men, routine or no referral may be appropriate for PSA levels of:

Aged 80-85 years > 10

Aged 86 years and over > 20

Before having a PSA test men should NOT have:

an active urinary infection or prostatitis
had a proven UTI within last 6 weeks
ejaculated in the previous 72 hours
exercised vigorously in the previous 48 hours
had a prostate biopsy in the previous 6 weeks

Men with an abnormal DRE

Who not to refer:

Men who have a raised PSA as a result of a suspected benign cause (see above). Where the PSA is raised in these situations, it should be repeated 4 weeks later. Referral is indicated if it remains elevated. If there is a downward trend, it can be monitored until it returns to normal.
Men with significant co-morbidities, especially those aged 75 or over, should not undergo investigations for prostate cancer without careful consideration of whether a diagnosis of prostate cancer is in their interests. Please indicate any such co-morbidities on the referral.
PSA testing in elderly men is not recommended unless a diagnosis of prostate cancer is relevant to that particular patient’s situation and will affect their management.